Insurance woes....****UPDATE****
Back in January I had an MRI (I had to go to a hospital out of town because the local imaging center wasn't in the network)...the scan was denied by the insurance company as an "unneccesary procedure".....I went through the Oncologist's office and got that straightened out, and in February I received a letter from the Insurance Co. that said they decided it WAS medically necessary. Never heard a word from anybody.....until yesterday when I received a bill from the Hospital for $2000.00. The insurane paid $200.....that's it. I already paid $500 up front.....then another $235.00 because the scan was read by the "local" imaging center, which as we know....isn't in the network.
Here's another strange thing.....that $500 I paid up front has never been added into my deductable for in-network.....My ENT isn't in the network, so that's all been out of my pocket.....but that HAS been put towards my deductable (it's the only thing, tho that has)......I'm going to go to the HR department where I worked and see if they can help me get some of this paid by the insurance company.....
I guess I'm just venting.....but dammit. I've been forking out $600.00 a month for insurance, and basically been paying all my bills out of my own pocket.....WTF? I'm scheduled for another MRI in August, but won't be getting it unless this gets straightened out.....
My insurance is supposed to be: $500 deductable in network......$1000 deductable out of network (with the in-network deductable counting towards the out of network deductable)......there is a $2000 out of pocket max.....What they are showing on my EOB's is:
$500 in network (met)
$772 out of network.........(That's from paying the ENT and that leaves $228 left for out of network).
Out of pocket - $26.00
If I pay the $2000, then I'm WAY over the out of pocket for in-network.....I keep thinking this isn't a denial, it's a total screw up....that the insurance company's book-keeping is way off.
p
Comments
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Madness
Phrannie, I just find it bizarre that somebody like yourself who has bravely recovered from a serious illness should have to be doing these calculations. There appears to be a lot of vultures and incompetence in the system. That's why I have never grumbled about paying my taxes for the NHS. Not just for me but for others. Hope you resolve this. What would happen if a citizen just didn't have the money? Regards, G
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Phrannie try not to panic
I have a feeling based on what you posted in the past that the ball got dropped or punted incorrectly. Please back track and see if the oncologists office person who I think you said was new did get the authorization (from the right ins. co.) and she should have the auth. number and a persons name from the insurance co that she spoke to on record. Once you have that I think you were in between insurance companies and that could have been the problem with a communication glitch on the new ins. co.'s part or the hospital's part so get with them and see if they have it straight. I believe you will untangle this mess. It happens to me all the time. Always amazing to me how many people do not know how to do their job.
Hang in there and I agree WTF!
PJ
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Patti...PJ47 said:Phrannie try not to panic
I have a feeling based on what you posted in the past that the ball got dropped or punted incorrectly. Please back track and see if the oncologists office person who I think you said was new did get the authorization (from the right ins. co.) and she should have the auth. number and a persons name from the insurance co that she spoke to on record. Once you have that I think you were in between insurance companies and that could have been the problem with a communication glitch on the new ins. co.'s part or the hospital's part so get with them and see if they have it straight. I believe you will untangle this mess. It happens to me all the time. Always amazing to me how many people do not know how to do their job.
Hang in there and I agree WTF!
PJ
I did get names (no numbers tho) when this mess started in February, just like you told me to do
. I've got that piece of paper in the same file with the rest of this and will be taking it all to the HR person in my company. You're right, I got this scan at the beginning of the year when we got a new insurer....so it may be a glitch that happened with the change.....it's just so hard to see it from here. I'm sure the girl in HR will be able to help me out.....gawd I HOPE she can.p
PS....who is your insurer? I want to make sure I never go to them if you have to do this all the time!!
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Cigna primary, Medicare secondaryphrannie51 said:Patti...
I did get names (no numbers tho) when this mess started in February, just like you told me to do
. I've got that piece of paper in the same file with the rest of this and will be taking it all to the HR person in my company. You're right, I got this scan at the beginning of the year when we got a new insurer....so it may be a glitch that happened with the change.....it's just so hard to see it from here. I'm sure the girl in HR will be able to help me out.....gawd I HOPE she can.p
PS....who is your insurer? I want to make sure I never go to them if you have to do this all the time!!
Medicare has yet to process my Vandy hospital surgery bill from last Sept! It is so much fun calling Medicare and Vandy billing dept. A weekly ritual now.
I know you will prevail,
PJ
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p. it sounds like some
p. it sounds like some figured wrong. i just called a doc (ent) on a $1300 bill, turns out they figured wrong, it should have been $168. hoping this is the case for you.
dj
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Pdebbiejeanne said:p. it sounds like some
p. it sounds like some figured wrong. i just called a doc (ent) on a $1300 bill, turns out they figured wrong, it should have been $168. hoping this is the case for you.
dj
It has gotten so I hate going to the mailbox. They got me to understand that my $1500 max out of pocket does not include co-pays, deductibles and co-insurance. I am with you...why do they call it out-of-pocket max when they continue to hit you in the pocketbook. My recent frustration is incorrect billings from Barnes to my prior BCBS policy# and not getting preauth when I specifically asked if they had. Going thru so much, we don't need to deal with this cr**!
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I do understand that my maxhwt said:P
It has gotten so I hate going to the mailbox. They got me to understand that my $1500 max out of pocket does not include co-pays, deductibles and co-insurance. I am with you...why do they call it out-of-pocket max when they continue to hit you in the pocketbook. My recent frustration is incorrect billings from Barnes to my prior BCBS policy# and not getting preauth when I specifically asked if they had. Going thru so much, we don't need to deal with this cr**!
out of pocket is $1000, separate from the deductables......however, the insurance should be covering 80% and I should be 20% until that out of pocket is reached......so far tho, I seem to be paying 100% out of pocket, because they never applied my $500 to the deductable in network.....it's frustrating, and spooky because the insurance company is so huge.
We shouldn't have to fight every damn thing.....if we're corking out a big lump sum every month....so far they haven't had a problem with that part of their bookkeeping.
p
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question?phrannie51 said:I do understand that my max
out of pocket is $1000, separate from the deductables......however, the insurance should be covering 80% and I should be 20% until that out of pocket is reached......so far tho, I seem to be paying 100% out of pocket, because they never applied my $500 to the deductable in network.....it's frustrating, and spooky because the insurance company is so huge.
We shouldn't have to fight every damn thing.....if we're corking out a big lump sum every month....so far they haven't had a problem with that part of their bookkeeping.
p
P.sorry you're dealing with this s**t. My question that makes me curious is what would happen to somebody who just didn't have the money , perhaps because they couldn't work because of their illness. I hope you find somebody with a bit if humanity at yhis company. Regards, G.
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Insurancephrannie51 said:I do understand that my max
out of pocket is $1000, separate from the deductables......however, the insurance should be covering 80% and I should be 20% until that out of pocket is reached......so far tho, I seem to be paying 100% out of pocket, because they never applied my $500 to the deductable in network.....it's frustrating, and spooky because the insurance company is so huge.
We shouldn't have to fight every damn thing.....if we're corking out a big lump sum every month....so far they haven't had a problem with that part of their bookkeeping.
p
Hi Phrannie, sorry you are going through this bull. First off, you are not on Medicare or Medicaid right? When was/is the renewal date of the plan through your employer. I am a retired HR Director and dealt with this all of the time. Some of this could be attributed to the new regulations of Obamacare or simply insurance company screw up or holding back in anticipation of Obamacare. Don't be surprised if the girl in HR can't help much. The person with the hammer here is the broker tha sold your plan to the company. Find out who it is and go directly to them. They have a financial stake in customer service and will not want to lose the account because of screw ups. HR people, unless it's the top dog, do not understand the finite details of the plan. Broker, Broker, Broker. Denis
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Denis....my insurance is throughdenistd said:Insurance
Hi Phrannie, sorry you are going through this bull. First off, you are not on Medicare or Medicaid right? When was/is the renewal date of the plan through your employer. I am a retired HR Director and dealt with this all of the time. Some of this could be attributed to the new regulations of Obamacare or simply insurance company screw up or holding back in anticipation of Obamacare. Don't be surprised if the girl in HR can't help much. The person with the hammer here is the broker tha sold your plan to the company. Find out who it is and go directly to them. They have a financial stake in customer service and will not want to lose the account because of screw ups. HR people, unless it's the top dog, do not understand the finite details of the plan. Broker, Broker, Broker. Denis
my old employer.....they have a HSA benifit, so when I retired with over 1000 hours in my personal leave account, I was able to switch those into the HSA account, and my insurance is being paind out of that.....until it runs out (which won't be until probably January of 2015).
I do think this is a screw up from change of insurers at the beginning of the year, tho.....My scan was on 1/14/14....and the change took place 2 weeks before that.....(tho they didn't miss the Oncology appointment I had on the 2nd of January. They switched from NRECA to United Health Care, tho it's still managed by CBA (who also managed our NRECA healthcare).
If nothing else, the HR gal can help me with contacts......I can't seem to find the right web site for United to find out what's going on, nor am I able to get into "Employee Benefits" any longer......so if nothing else she will be able to give me some direction.
p
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INSURANCE BLUES
Hey Phrannie,
I'm sorry to hear about all of the greif and aggrivation that the insurance company is putting you through, it's the last thing in the world that you need. It is a tragedy that they are so eager to collect the premiums, but so reluctant to readily provide the benefits that you are entitled to. I hope that your HR representative will be able to intercede for you, or maybe someone higher up in your company that may have more clout. I send you the best of all good thoughts, wishes, energy, and mojo that you are able to resolve this in your favor a whole lot sooner than later. Hang in there.
PATRICK
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Ppatricke said:INSURANCE BLUES
Hey Phrannie,
I'm sorry to hear about all of the greif and aggrivation that the insurance company is putting you through, it's the last thing in the world that you need. It is a tragedy that they are so eager to collect the premiums, but so reluctant to readily provide the benefits that you are entitled to. I hope that your HR representative will be able to intercede for you, or maybe someone higher up in your company that may have more clout. I send you the best of all good thoughts, wishes, energy, and mojo that you are able to resolve this in your favor a whole lot sooner than later. Hang in there.
PATRICK
If it is any consulation, UHC did right by me. Unfortunately, my husband's employer made a change so we no longer have UHC.
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Hi P
I had the same thing last year happen when I pulled a tooth. The only dentist in the USA who dared to try and pull my tooth was not in network and the place where he was going to pull it was not. The only thing that helped me was my ENT was going to clean out my sinus at the same time I was under for the tooth problem. After that I needed to do 10 HBO dives. After it was all said and done to my dismay I ended owing over 4,000 bucks. I was able to get some of it cut down and got the insurance to pay a little more not much, but the Hospital where I did the HOB would not budge I owe them 2,000 and they wanted their money So I am still paying on that. It is amazing that all these people and doctors think we are made of money for them to just grab when they want too and the insurance companies are no better.
I hope you get it straight and don’t end up paying a lot
Tim Hondo
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WoesHondo said:Hi P
I had the same thing last year happen when I pulled a tooth. The only dentist in the USA who dared to try and pull my tooth was not in network and the place where he was going to pull it was not. The only thing that helped me was my ENT was going to clean out my sinus at the same time I was under for the tooth problem. After that I needed to do 10 HBO dives. After it was all said and done to my dismay I ended owing over 4,000 bucks. I was able to get some of it cut down and got the insurance to pay a little more not much, but the Hospital where I did the HOB would not budge I owe them 2,000 and they wanted their money So I am still paying on that. It is amazing that all these people and doctors think we are made of money for them to just grab when they want too and the insurance companies are no better.
I hope you get it straight and don’t end up paying a lot
Tim Hondo
Phrannie, a few years ago when I was still working my broker brought in a proposal from United Health Care, we were self insured at the time, which, in my opinion is the best way for a small to midsize company to go, the plan they came with was less overall than what we had but was very bureacratic and network dry, it would have cost our employees 20% more in the long run. I rejected it and we went with Blue Cross. Since then I have heard many horror stories about United. They are the official recommendation from the AARP so that says enough there. Don't go thinking that this is definitely a screw up, it may be, but the new regulations are nightmarish. The fact that your hospital was out of network is a start. Ask the HR girl for the brokers name and number and call them and raise hell. Denis
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Hi Phran
I'd say threaten a few people but now days that only puts your butt in a bind unless you know for sure they aren't recording it or your face to face and there are no witnesses. Second thought, better just keep your cool and try to reason . But if that doesn't work........................... feel free to go the other way.
Hoping you can work it out.
Jeff
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Through the crack....
Went the HR office today where I used to work....and lo....who should also be in the office? The Rep for the insurance company....is that good luck or what? So we called the main office, and it appears that my stuff "fell through the cracks". It should have been processed a long time ago. The supervisor at the main office handed it to a lead person, and things (hopefully) will be taken care of.
While I was there, I also found out my ENT is now in the network.....that means all the money I've been paying out of pocket for him will now be refunded back to me....this turned out to be a good day!!
p
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Yay!phrannie51 said:Through the crack....
Went the HR office today where I used to work....and lo....who should also be in the office? The Rep for the insurance company....is that good luck or what? So we called the main office, and it appears that my stuff "fell through the cracks". It should have been processed a long time ago. The supervisor at the main office handed it to a lead person, and things (hopefully) will be taken care of.
While I was there, I also found out my ENT is now in the network.....that means all the money I've been paying out of pocket for him will now be refunded back to me....this turned out to be a good day!!
p
Lorna (We need a likeYay!
Lorna (We need a like button!)
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