dee27
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Post by dee27 on Jul 18, 2017 11:34:39 GMT -5
DH's former insurance company rejected his claim for hearing aids because he was too old! Hearing aid coverage was part of the contract, and he did get the bill paid, but the explanation was funny.
I was billed for an MRI I did not have, and it still took months for the claim to drop off my insurance. The doctor's office made the mistake, but ironically the insurance company initially paid the bill.
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TheOtherMe
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Post by TheOtherMe on Jul 18, 2017 11:57:28 GMT -5
During my winter of hospital stays and surgery, I think one bill got messed up. Hospital failed to send it to Medicare to BCBS denied it. I called hospital and it was submitted to Medicare and then to BCBS. A couple of weeks ago I got the EOB showing it was paid in full.
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Post by The Walk of the Penguin Mich on Jul 18, 2017 13:30:06 GMT -5
I was thinking about this last night. Between 1995 and 2012, I have had surgery 9 times (8 orthopedic, one gall bladder emergency surgery). I have been hospitalized as few as 2 days, as long as 6 weeks at a time. There was not a single surgery where billing questions did not occur - from minor, to me being sent to collections.
In 1995, the anesthesiologist sent me to collections because I did not pay the bill. I only found out when collections called me. I called my insurance company, insurance copy sent me a copy of the canceled check. Anesthesiologist's bookkeeper was skimming off the top, and my insurance payment was one she had skimmed. This mess took almost a year to resolve.
In 2005, I got billed for $180 despite the fact that I had paid my surgical deductible up front. I didn't realize that the handful of surgical dressings I was given when I left the hospital, I'd be billed for. I paid it. Same year, I got billed for a surgery that had been previously preauthorized by my insurance company.
In 2011, my anesthesiologist billed me because my insurance denied my anesthesia. They billed Medicare, assuming my Humana insurance was Humana Medicare. This was easy.
In 2011 was my emergency gall bladder surgery. My insurance would not pay despite the fact that the hospital had a preauthorization number. It took me getting my employer's insurance advocate to get this resolved.
In 2011-2012 (4 surgeries) was my medical nightmare. I wrote no less than 8 letters of appeal about seeing physicians in the facility OON when the facility was in network. All were covered in network, according to my insurance. I won all these. However, the lab the hospital used was OON and that nightmare caused me to get sent to collections when my final bill really wasn't my final bill and I didn't find out about it until collections called. The rehab facility billed me for a wheelchair that they claimed I stole (yes, I got a call from the facility director asking me to return their wheelchair). They later found it, and fell all over themselves apologizing to TD about this. I never heard a word myself. The lab the local home health used for my weekly blood work was OON as well. I had no choice of them using this lab, but still had to pay the OON charges myself.
In Jan 2013, I started PT. I had a $50 copay and knew my insurance would pay for 30 sessions and I'd need every single one of them to get back on my feet. In my first visit, right before Jan 2013, I paid $1500 up front because 2012 I had enough medical expenses to declare on my taxes. I had to keep track of every single visit and copay, because their record system was so screwed up they couldn't keep track of a credit on my account. I must have given them 10 copies of my canceled check.
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Deleted
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Post by Deleted on Jul 18, 2017 19:56:42 GMT -5
I talked with the provider's office manager today. She then called the hospital's billing department who told her to send an email to the person that does the coding. The provider, hospital, and outpatient therapy are all part of one group.
She called me back twice to keep me in the loop. On one of the calls, she said she had mentioned this to her boss. They are trying to help me. I believe that.
I keep rereading the process for appeals, and I believe the insurance company has 60 days to respond. I'd like the hospital to stop the clock until I hear from the appeal process and/or the refiling.
If I have to pay it, I want the total that the insurance company would have paid. It is always such a small fraction.
Any idea how you negotiate that? I'm not good at stuff like that.
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Sharon
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Post by Sharon on Jul 18, 2017 20:40:03 GMT -5
It took me 6 months to get the insurance to pay for the anesthesia when I had DD via C-section. They kept denying it as unnecessary. I made multiple phone calls to the insurance company and finally got this one woman on the line who said this is stupid what man thinks that you don't need anesthesia when you have a c-section. The anesthesiologist received the payment within a week. Not sure how long it would have taken if I hadn't just randomly gotten her on the phone.
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justme
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Post by justme on Jul 18, 2017 23:15:11 GMT -5
I don't know what insurance you have, but if I go online my insurance now has a calculator that let's you estimate cost. Down to the provider now (it's gotten more robust over time). If your insurance has that you could use that.
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dee27
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Post by dee27 on Jul 18, 2017 23:40:35 GMT -5
Patients have little knowledge of all of the medical professionals, other than the surgeon and anesthesiologist, who may also render a bill to the insurance company. Patients talk with the anesthesiologist and their surgeon prior to surgery, but rarely do they know who else will be in the surgical suite. They are sedated and often asleep before entering the surgical theater. During my last surgery, I found out when I received the EOB from the insurance company.
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dee27
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Post by dee27 on Jul 25, 2017 13:25:52 GMT -5
This is why patients need more transparency. Doctors (and hospitals) should not be allowed to hide behind the veil of out-of-network pricing without disclosing to the patient that they do not have a contract with his/her insurance. Do we have to wear signs that say, please don't look at me, touch me, or speak to me unless you are in my insurance network?
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saveinla
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Post by saveinla on Jul 25, 2017 13:28:45 GMT -5
I read this yesterday and was amazed at the difference in rate between this company and the other one that they compared with.
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NomoreDramaQ1015
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Post by NomoreDramaQ1015 on Jul 25, 2017 13:30:07 GMT -5
Patients have little knowledge of all of the medical professionals, other than the surgeon and anesthesiologist, who may also render a bill to the insurance company. Patients talk with the anesthesiologist and their surgeon prior to surgery, but rarely do they know who else will be in the surgical suite. They are sedated and often asleep before entering the surgical theater. During my last surgery, I found out when I received the EOB from the insurance company. My parents ended up having to pay 100% of the anesthesiologist costs after my dad's hernia surgery because they switched people in the operating room. They had already verified the guy that was supposed to do it, my dad met with the guy during pre-op but apparently something happened right as my dad was wheeled in and they used a different anesthesiologist. Insurance refused to pay because this guy was not in network or pre-verified. What the heck was my dad supposed to do have everyone take off their masks and make sure they were the same people he talked to in pre-op? Then what, hop off the table and refuse to do the surgery? I got so many bills after Gwen was born it was crazy. I told DH I would not be surprised if we got a bill for the janitor and oh by the way, he's out of network.
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dee27
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Post by dee27 on Jul 25, 2017 13:40:17 GMT -5
That sucks, Drama. Patients literally have no control even when they are proactive.
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OldCoyote
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Post by OldCoyote on Jul 27, 2017 22:25:56 GMT -5
Why do we have to go thru this, It is not like this is a isolated incident, This happens all the time!
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saveinla
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Post by saveinla on Jul 27, 2017 22:33:24 GMT -5
Why do we have to go thru this, It is not like this is a isolated incident, This happens all the time! Just skip the thread if you are not interested like we do all your threads on your employees.
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OldCoyote
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Post by OldCoyote on Jul 27, 2017 22:53:36 GMT -5
Why do we have to go thru this, It is not like this is a isolated incident, This happens all the time! Just skip the thread if you are not interested like we do all your threads on your employees. I know it is confusing, I was point out that we all have issues with getting our medical bills paid by the insurance Cos. Payment was rejected for ?
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Deleted
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Post by Deleted on Jul 28, 2017 8:09:43 GMT -5
Just skip the thread if you are not interested like we do all your threads on your employees. I know it is confusing, I was point out that we all have issues with getting our medical bills paid by the insurance Cos. Payment was rejected for ?The payment was rejected for diagnosis as coded does not allow for this treatment. The rejection was complicated by the insurer's representative's insistence that the claim could not be resubmitted with the correct diagnosis. Happy now?
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hoops902
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Post by hoops902 on Jul 28, 2017 8:38:13 GMT -5
Why do we have to go thru this, It is not like this is a isolated incident, This happens all the time! Just skip the thread if you are not interested like we do all your threads on your employees. I don't think he's saying "Why do we have to go through this thread because this is such a common problem that everyone deals with it" but rather "this system is so ridiculous, why do they put us through this...if everyone has the same problems with the system then why won't they just change the system?!?!".
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trippypea
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Post by trippypea on Jul 28, 2017 8:43:48 GMT -5
When my daughter was a toddler, she had to have a cardiology workup as prescreening for a surgery. This was done in a large children's hospital where all the groups are different entities. However, the billing system is all the same, so once they have your insurance number, it's in the computer. The group that did the cardio, submitted the claim with the wrong ID number. Instead of QVF... they put WVF, so someone just input a letter wrong.
So when I saw the claim had been rejected, I called BCBS and they told me what the problem was and that the provider needed to resubmit the claim. I called them and they said no problem. Six months later, I get another rejection EOB. Go through the whole thing again, giving them the right info (even though they had it, they just weren't fixing the problem). Same thing. Disregard any bills, yada yada. Several months later, again. Then I started taking the EOB, the cards, etc to their office when I'd be in the hospital for other appointments, and hand delivering it to their accounting department.
Same thing kept happening. For 3 years! Finally, it got to the point where BCBS denied the claim for being too old. The provider continually told me to disregard any bills, etc, they would fix it (the bill was almost $4000).
Then I got a letter from a collection agency. The provider had turned it over for non-payment! I was so ticked! I called the collection agency and told them the whole story, that we had insurance who would have paid the bill (we also had secondary insurance, which would have paid 100% after the primary, yet they couldn't be billed until the primary paid. So they paid nothing too). They ended up writing it off since we had done everything we could to pay the bill; the provider was the one who screwed up...
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OldCoyote
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Post by OldCoyote on Jul 29, 2017 8:41:34 GMT -5
I know it is confusing, I was point out that we all have issues with getting our medical bills paid by the insurance Cos. Payment was rejected for ?The payment was rejected for diagnosis as coded does not allow for this treatment. The rejection was complicated by the insurer's representative's insistence that the claim could not be resubmitted with the correct diagnosis. Happy now? This was no reflection on you, My comment is on why there seems to be constant mistake on coding or the insurance co's trying to get out of paying a bill!
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Ava
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Post by Ava on Jul 29, 2017 17:12:27 GMT -5
This thread clearly shows the craziness of health insurance in this country.
All the calls, the letters, the different employees involved in reviewing the claim, the comings and goings, etc. add an enormous cost to our already gloated system.
For-profit healthcare doesn't work. The demand is inelastic, we NEED healthcare, and there is no substitute product for it. So that alone puts the consumer at a huge disadvantage and at the mercy of the for-profit system.
Susana; I hope your billing issue gets fixed soon.
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milee
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Post by milee on Jul 29, 2017 17:53:05 GMT -5
Demand for healthcare services is not inelastic and that's part of the problem with making it "free."
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Deleted
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Post by Deleted on Jul 29, 2017 19:33:10 GMT -5
Demand for healthcare services is not inelastic and that's part of the problem with making it "free." I agree about it not being inelastic. I don't want it for free. We pay for it. We actually pay for it twice with DH with mine being primary (about $300 extra a month) and then paying for Medicare. It is worth it because his health procedures are expensive. They are all covered this way. What it needs to be is TRANSPARENT. I actually worried about this issue BEFORE I had therapy. I called my insurer. I read my benefits policy (which was what I was basically told to do). I asked when I started therapy if it was covered. You need to be able to see beforehand that this procedure will/will not be covered at Whatever Percent. Let me decide, then, if I want therapy. While I feel it was medically necessary, I have been known to refuse to go get something done. The most notable example was when I had appendicitis. I had it the year before, but it was diagnosed as a kidney infection after they pumped me full of antibiotics and made me pay for a non-emergency visit to the ER. So maybe I almost died (exaggeration, but I did spend 7 days in the hospital). It was my choice. I actually rejected the second set of therapy sessions--not for cost but really because I was better and didn't want to take off from work. If I hadn't, I guess I would be looking at a $9,000 bill. What are patients to DO?
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milee
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Post by milee on Jul 29, 2017 19:40:02 GMT -5
Demand for healthcare services is not inelastic and that's part of the problem with making it "free." I agree about it not being inelastic. I don't want it for free. We pay for it. We actually pay for it twice with DH with mine being primary (about $300 extra a month) and then paying for Medicare. It is worth it because his health procedures are expensive. They are all covered this way. What it needs to be is TRANSPARENT. I actually worried about this issue BEFORE I had therapy. I called my insurer. I read my benefits policy (which was what I was basically told to do). I asked when I started therapy if it was covered. You need to be able to see beforehand that this procedure will/will not be covered at Whatever Percent. Let me decide, then, if I want therapy. While I feel it was medically necessary, I have been known to refuse to go get something done. The most notable example was when I had appendicitis. I had it the year before, but it was diagnosed as a kidney infection after they pumped me full of antibiotics and made me pay for a non-emergency visit to the ER. So maybe I almost died (exaggeration, but I did spend 7 days in the hospital). It was my choice. I actually rejected the second set of therapy sessions--not for cost but really because I was better and didn't want to take off from work. If I hadn't, I guess I would be looking at a $9,000 bill. What are patients to DO? Completely agree that cost transparency is a huge issue and one that has to be addressed. People can't be reasonable consumers of a service if there's no information about what that service will cost. And that's a critical issue that has not attracted the political attention it should.
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Ava
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Post by Ava on Jul 29, 2017 19:49:19 GMT -5
Nobody expects healthcare for free.
Reasonable costs and taking out the for-profit motive of it is what we need. Healthcare is a need. It's not a luxury or a want.
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milee
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Post by milee on Jul 29, 2017 21:03:02 GMT -5
Many people want healthcare for free.
My experience with both government and not-for-profit organizations - especially healthcare providers - is that they provide the lowest quality services for the money spent. The idea that there would be no alternative to that care is truly frightening.
Some healthcare is a need, some is a want. Some healthcare is necessary because of luck and things beyond an individual's control, some is due to poor personal choices. I'm fine with paying for what my family and I need and I'm getting tired of people wanting me to pay for what they want, especially when they don't make good personal choices. The idea that my family and I would get lower quality care while paying large amounts more for other people to get free care - people who don't always take care of their own health - is not at all appealing to me.
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siralynn
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Post by siralynn on Jul 30, 2017 7:08:55 GMT -5
I am frequently thankful that I live in CA and therefore have access to Kaiser Permanente, but this thread really reinforces that. It's not perfect (you can definitely tell when you're in the middle of their scripts/checklists sometimes), but in general it's fantastic.
As long as the building you're in says Kaiser on it, you're good. The systems all talk to each other. You pay your copay upfront and never see another piece of paper. ER? $100. My c-sections? $150 each.
1 year old gets a fever after older sister is confirmed to have Flu A? Tamiflu prescribed via email, no office visit required.
And our premiums are totally reasonable. Healthcare reform in this country would do well to look at the Kaiser model. I can't help but think a lot of our cost/difficulties is just because the system is too goddamn complicated with way too many middlemen taking their cut (and far too many incompetent people in charge of paperwork).
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Deleted
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Post by Deleted on Aug 4, 2017 16:37:55 GMT -5
I started back school today. Didn't someone tell me teachers have 3 months off for summer? Anyway, DH greeted me with the news that the insurance company called. The representative said that they agreed with me that it should be covered and the payment would be processed Monday. She wanted us to know as soon as possible. I will owe about $350. I always knew it was only covered at 80%. That means the negotiated price reflects a huge difference from the $4500 I would have had to pay without insurance. Saying that they "agreed" with me and wanting me to know "as soon as possible" sounds as if they were responding to the appeal and not the later refiling. It doesn't really matter, though, as long as they pay. Anyway, happy ending!
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TheOtherMe
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Post by TheOtherMe on Aug 4, 2017 18:38:58 GMT -5
Happy it worked out for you. The negotiated price is so much lower than the original bill.
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dee27
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Post by dee27 on Aug 4, 2017 20:30:20 GMT -5
SS, I'm glad you received a resolution.
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Ava
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Post by Ava on Aug 5, 2017 9:39:39 GMT -5
I'm very happy for you, Susana. I hope you don't have to deal with that sort of situation again.
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bean29
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Post by bean29 on Aug 5, 2017 12:43:43 GMT -5
I'm really happy it worked out for your but re: the huge difference between negotiated prices for the insured and the prices the un-insured are expected to pay in this country. There is something hugely wrong with our system. People with little to no $$/resources should not logically be expected to pay more.
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