The Vent Part Quatre

[Colleens 40]

My experience with the stupid system and insurance has been a crappy one and Ive only been here 6 months. First there was my blood work where they processed it without my insurance sending me a lovely 500 dollar bill (of course I called and straighten it out), then my son had a Speech therapy assessment which I got billed 240 dollars for and yet I signed a sheet of paper that said it was 120 a session. After a few phone calls and 3 weeks I finally got it reprocessed. They cover the initial appointment to find out if there is a problem then your on your own lol. Now I have a lovely 700 dollar bill for my ultrasound as well as a bill for the radiologist, which I am stuck with due to our annual deductible. The great thing is my baby is due October so I will not have to do the deductible again till Jan, however They only pay 80%, thats a few thousand dollars in hospital bills I will see in October.

My insurance paid 80% of my delivery and I ended up with an almost $2500 bill plus $200 for the anestiesologist(sp). I did have to be induced, but my delivery was uncomplicated other than that. I only stayed in the hospital for 1 day but they usually want you to be in there for a min 2 days, so that would have added to the bill a bit if I had stayed.

[Gypsyangel 11]

Health insurance companies here are so bad. If we all didn't have to call them and spend hours on the phone getting the coverage that we paid for in the first place, they would be a lot more cost efficient. The whole "in network" thing is so confusing that not even the insurance companies can figure it out.

We had to bring my husband's daughter to an appointment at a Children's Hospital. Well, the hospital was in network (but in a different state), but the doctor wasn't. The insurance company kept saying they were in network and the doctor kept saying they weren't.

My husband spent about 5 hours on the phone going back and forth between the hospital and the insurance company, finally got an out-of-network authorization, but we couldn't get an appointment before the authorization ran out. So, he had to go through the whole thing again to get the authorization extended.

A total of about 8 hours on hold or calling either the insurance company or the hospital. Part of it was that the doctor had to fax something, so they faxed it but the fax wasn't clear so the insurance company couldn't read it so they just closed the file, but they didn't tell us. My husband had to start the whole thing over 3 times, and then the doctor doesn't want to fax it again. So friggan stupid.

The good news is that every medical professional I've come across since I've been here is excellent. It's just the insurance that's stupid. They do everything in their power to make it difficult for you. And even when you think you have the problem fixed, they still mess it up.

[Krikit 1,164]

^^ :angry:

I remember my husband trying to explain that I had to get an in-network doctor who was also authorized at an in-network hospital in proximity to our house. Luckily, my first doctor in the US (that I had to do a search for online using the authorized doctors list by our health insurance with a disclaimer that the list wasn't necessarily correct :blink: ) was a Canadian. He totally understood my confusion with the American system and did his best to explain. He also explained why he was or wasn't doing things so I wouldn't get unncessarily charged. I.E. he told me to go give blood so I could get free bloodtests. If he had ordered them I'd be charged. We didn't account for the fact that they refused my blood for spending too much time in the UK, though.

[Gypsyangel 11]

Oooh. That's lucky to find a Canadian who understands your confusion. It's not that hard but I get confused too. One of the things that messed me up is going for an annual physical, which I always did in Canada. First my GP was a little confused as to why I was asking for an annual physical. When I got out of my appointment I realized they hadn't done a pap or breast exam. I think I've figured it out that women go to their gyno's once a year for an annual check up and then you just go to your doctor if you have a problem. Anyway, that's how it seems to work in this neck of the woods. Though, it's possible that I still may be confused.

[Canadiandggal 49]

Oooh. That's lucky to find a Canadian who understands your confusion. It's not that hard but I get confused too. One of the things that messed me up is going for an annual physical, which I always did in Canada. First my GP was a little confused as to why I was asking for an annual physical. When I got out of my appointment I realized they hadn't done a pap or breast exam. I think I've figured it out that women go to their gyno's once a year for an annual check up and then you just go to your doctor if you have a problem. Anyway, that's how it seems to work in this neck of the woods. Though, it's possible that I still may be confused.

That is the same in my area. When i got here I couldnt find a doctor due to living in a small town , all the doctors were full so it took a few months of waiting to see a GP/family doctor. In Canada I did have a GYN but only because I was having some problems but My GP usually did all my annual physicals including the girl bits. Here I got blood work and some questions NO physical and when I found out I was pregnant (same visit) I was automatically told to find an OB.. Can you not use a GP for pregnancy here? Not that I would but I thought I could see him till I got into the OB...I was wrong lol.

[Ontarkie 14,221]

I noticed that here too about the GP's sending you off to the GYN's. I think my GP was going to take care of me if I couldn't find an OB right away, since he did order an ultra sound for me right away. We needed to know asap if I had an ectopic pregnancy or not. Then the nurses gave me a OB's name and when I called his office explained my history he got me in the next day of an ultrasound. So my GP really never had to do anything other then the pregnancy test.

[Udella&Wiz 325]

Well we reviewed the new rates with my husband's benefits and you guessed it,the rates have sky rocketed! And by skyrocketed I mean Family coverage health rates alone have increased by $2000.00+ per year, over $80 per pay. basically my husband's raise went down the crapper.

I am astounded, mind you last year was about the same...we didn't think they would go up that much again.

So now we're considering the plan below that which worries me - the coverage is relatively the same, our usual doctors are all 'in network' thankfully. Did someone say they have experience with a plan that has an annual out of pocket(OOP) maximum? Do I understand that after you've met the yearly family deductible and the OOP max...you don't pay anything more? So if something like a surprise cancer diagnosis occurred for 1 of us - we would only pay the OOP max per year and not more? What freaks me out is that paying for 90% of something like that would do us in obviously. Just trying to understand the yearly max and how it applies.

It's a significant savings to us and we know that we'd easily meet the max deductible because I have a fair number of dr's appts but there's still another $2k of savings if we take the 'middle of the road' plan.

Help!

[CanadaLove 16]

Oooh. That's lucky to find a Canadian who understands your confusion. It's not that hard but I get confused too. One of the things that messed me up is going for an annual physical, which I always did in Canada. First my GP was a little confused as to why I was asking for an annual physical. When I got out of my appointment I realized they hadn't done a pap or breast exam. I think I've figured it out that women go to their gyno's once a year for an annual check up and then you just go to your doctor if you have a problem. Anyway, that's how it seems to work in this neck of the woods. Though, it's possible that I still may be confused.

Yup, that's the general way of things. Girly bit checkup is for the GYN, any other medical stuff, go to the GP.

[Udella&Wiz 325]

I HATE INSURANCE COMPANIES!

Last Fall, my stepson went for drug counselling, we very carefully made sure we had a pre-approval from the insurance company. Good to go!

Yesterday we receive a bill from the counselling place indicating we owe them $$$ - turns out the insurance company denied all the claims for the visits despite having given us a pre-approval.

Someone's a$$ will pay and hopefully it will not be ours....either the Ins co. for mistakenly pre-approving or the facility for perhaps not providing the proper info when getting the pre-approval.

Either way - if I cannot resolve it with the carrier, I will take it to the state insurance claims review board who handle these tyoes of complaints.

%$#@

[Ontarkie 14,221]

I HATE INSURANCE COMPANIES!

Last Fall, my stepson went for drug counselling, we very carefully made sure we had a pre-approval from the insurance company. Good to go!

Yesterday we receive a bill from the counselling place indicating we owe them $$$ - turns out the insurance company denied all the claims for the visits despite having given us a pre-approval.

Someone's a$$ will pay and hopefully it will not be ours....either the Ins co. for mistakenly pre-approving or the facility for perhaps not providing the proper info when getting the pre-approval.

Either way - if I cannot resolve it with the carrier, I will take it to the state insurance claims review board who handle these tyoes of complaints.

%$#@

That's total bull. They make you jump through hoops and then pull that #######. Did they give you a confirmation letter saying he was pre-approved? We had to go through that too for my oldest when he was having panic attacks. Hopefully it can be resolved easy enough.

[Udella&Wiz 325]

We're in the process of getting a copy from the counselling center of the pre-approval so we'll see where that leads.

According to my husband, the CSR at the insurance company said that a 'pre-approval does not guarantee that they will pay it' and they include a dislcaimer to that effect on the pre approval...well than why the "F" do we have to get one if it doesn't mean anything?

That's total bull. They make you jump through hoops and then pull that #######. Did they give you a confirmation letter saying he was pre-approved? We had to go through that too for my oldest when he was having panic attacks. Hopefully it can be resolved easy enough.

[The Dude 206]

We're in the process of getting a copy from the counselling center of the pre-approval so we'll see where that leads.

According to my husband, the CSR at the insurance company said that a 'pre-approval does not guarantee that they will pay it' and they include a dislcaimer to that effect on the pre approval...well than why the "F" do we have to get one if it doesn't mean anything?

Did you ask them what language's definition of "approval" they were using? [/snide]

That is absurd that they are essentially changing the definition of the term approval. You might want to call the counseling center and talk to their billing department. You need to find out how they report non-payment situations like this. I have heard of some outpatient facilities submitting invoice after invoice simply as a formality so they can file with a collection agency. Most of them will be up front with you and tell you their policy. I had a friend several years ago who ran into a similar scenario. Her insurance company had told her that she was approved for a procedure, then after decided that it was not covered. Neither the surgeon's office, nor her insurance company would really help her, and why would they? They only care about money. She ended up calling the local media who did a story about it, and followed up with the story 3 times on-air. It's sad that they only reversed their decision after thousands of calls and letters shamed them into doing the right thing.

[Udella&Wiz 325]

Did you ask them what language's definition of "approval" they were using? [/snide]

That is absurd that they are essentially changing the definition of the term approval. You might want to call the counseling center and talk to their billing department. You need to find out how they report non-payment situations like this. I have heard of some outpatient facilities submitting invoice after invoice simply as a formality so they can file with a collection agency. Most of them will be up front with you and tell you their policy. I had a friend several years ago who ran into a similar scenario. Her insurance company had told her that she was approved for a procedure, then after decided that it was not covered. Neither the surgeon's office, nor her insurance company would really help her, and why would they? They only care about money. She ended up calling the local media who did a story about it, and followed up with the story 3 times on-air. It's sad that they only reversed their decision after thousands of calls and letters shamed them into doing the right thing.

Do you mean when the non payments are by the insurance company? I'll have to inquire. After the insurance company denied their submission the counselling center is simply billing us. Luckily (I suppose) - this isnt an outrageous amount of money($650) which is not the point of course, its the principle. I find it hard to believe that they send us 1 notice and than promptly send it to a collection agency...does that sound right to anyone either? The note was dated 5/9 and it said if a check was not received by 5/20 it would go to a collection agency. It's outrageous because this is the first time they've tried to contact us or sent a letter concerning this bill - since last November

[Krikit 1,164]

Do you mean when the non payments are by the insurance company? I'll have to inquire. After the insurance company denied their submission the counselling center is simply billing us. Luckily (I suppose) - this isnt an outrageous amount of money($650) which is not the point of course, its the principle. I find it hard to believe that they send us 1 notice and than promptly send it to a collection agency...does that sound right to anyone either? The note was dated 5/9 and it said if a check was not received by 5/20 it would go to a collection agency. It's outrageous because this is the first time they've tried to contact us or sent a letter concerning this bill - since last November

OMG. :angry:

Re the bolded bit. I think it's a scare tactic. A couple of years ago we received a threat like that.... saying they would put a lien on our property if it wasn't paid within x amount of days. Funny thing is.... the bill had been paid..... on time. It was THEM that had credited the payment to another account. MAN, was I mad. They got very strongly worded letters, let me tell you.

I'm sorry you have to go through this on top of the issues you are already having to deal with. I did read, somewhere, that some insurance companies automatically deny the claim, and only pay out after a fight with the insured. Apparently they save money this way because a lot of people will give up and just pay it. This is outrageous, usurious, and more than despicable. Definitely go after them, Udella. I'd google their company name for reviews from other people, too, to see how they've handled the issues and what results they got. Grrrrr.

Funnily enough, my husband and I had this exact same conversation last night. I had received an invoice from the physical therapy place I'm going to..... even though our insurer is supposed to have covered it. I have a follow-up appointment with the specialist on Monday, so I will speak with them at that time. (They're in the same office.) Stupid American healthcare system. :angry:

[Kimbear 53]

wow this must be the theme of the month or something.

we just got a bill from the doctors office that David went to back in January. he was having sever back pain and spasm and had to have xrays and see the physical therapist. the place was covered by his insurance but lo and behold we just got a bill in the mail saying the therapist was not covered.

they even asked him for his insurance when he went in for the appointment, and of course this was 4 months ago!!! I mean..#######.

And now they are saying we are 30 plus days past due!!!!

Edited May 12, 2011 by Kimbear