Insurance problems!!!

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EZLiving66
EZLiving66 Member Posts: 1,483 Member

A new year; a new insurance deductible!  We changed plans this year and bought a plan with a fairly low out-of-pocket expense since I knew I would be hitting it.  I called them today to make sure I didn't need a referral from my primary care physician before I go to my wound care appointment.  The customer service rep didn't seem to know much and said to call my primary care doctor, which I did.  They said that's up to your insurance company.  It's bad enough having to deal with cancer but this insurance is NUTS!!!!

Love, 

Eldri

Comments

  • Gardena
    Gardena Member Posts: 102
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    Sorry to hear

    You're getting the run around. I hope you can resolve it quickly so your wound gets the attention it requires.

  • Abbycat2
    Abbycat2 Member Posts: 644 Member
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    Eldri, what a run around

    you are getting. It may help if you can review the policies governing your health insurance policy. This info may be on-line. I can access info about my BCBS coverage on-line. I hope this is resolved quickly and painlessly!

    Warm Wishes,

    Cathy

  • MoeKay
    MoeKay Member Posts: 479 Member
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    Hi Eldri,Unfortunately,

    Hi Eldri,

    Unfortunately, based on my experience, the primary care doctor's office often has a difficult time keeping up with all of the requirements for all of the ever-changing insurance plans.  My doctor's support people, for example, rely on me to tell them what my current copay is for a primary-care visit.  I think the best source of information would be the plan's benefits brochure, which is the contract between you and your insurance company.  If you did not receive a hard copy of the new benefits brochure yet, I would think it should be available online.  The online version may actually be more useful, because you can enter a search term such as "referral" and locate the section that discusses when and if referrals are required.  For example, the contract for my Blue Cross Blue Shield plan is well over 100 pages, but I've searched it on a number of occasions to get answers to a variety of questions I had concerning my plan's coverage. 

    I find that the insurer's customer service reps are hit or miss.  Sometimes they are very knowledgeable, and other times they are virtually useless.  When I do call about questions such as you are asking, however, I would not just rely on their word, but ask them to point me to the page in the benefits brochure that provides the information they are giving you.  Hopefully, the rep can tell you where you can find an electronic copy of the entire benefits brochure online, or can either email you an electronic copy or mail you a hard copy for your future use.  When you call your insurer, if you don't get the answers you want from the customer service rep, I wouldn't hesitate to ask to speak to a supervisor. 

    Good luck and good health!

     

    Maureen

     

  • EZLiving66
    EZLiving66 Member Posts: 1,483 Member
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    MoeKay said:

    Hi Eldri,Unfortunately,

    Hi Eldri,

    Unfortunately, based on my experience, the primary care doctor's office often has a difficult time keeping up with all of the requirements for all of the ever-changing insurance plans.  My doctor's support people, for example, rely on me to tell them what my current copay is for a primary-care visit.  I think the best source of information would be the plan's benefits brochure, which is the contract between you and your insurance company.  If you did not receive a hard copy of the new benefits brochure yet, I would think it should be available online.  The online version may actually be more useful, because you can enter a search term such as "referral" and locate the section that discusses when and if referrals are required.  For example, the contract for my Blue Cross Blue Shield plan is well over 100 pages, but I've searched it on a number of occasions to get answers to a variety of questions I had concerning my plan's coverage. 

    I find that the insurer's customer service reps are hit or miss.  Sometimes they are very knowledgeable, and other times they are virtually useless.  When I do call about questions such as you are asking, however, I would not just rely on their word, but ask them to point me to the page in the benefits brochure that provides the information they are giving you.  Hopefully, the rep can tell you where you can find an electronic copy of the entire benefits brochure online, or can either email you an electronic copy or mail you a hard copy for your future use.  When you call your insurer, if you don't get the answers you want from the customer service rep, I wouldn't hesitate to ask to speak to a supervisor. 

    Good luck and good health!

     

    Maureen

     

    My policy was vague about

    My policy was vague about referrals.  It said something like "you may need a referral....." but didn't give specifics at all.  That's why I called them, to get specifics!!!  I'm going to keep my wound care appointment since its in the same medical group as my GP and oncologist.

    This is how weird things are with insurance....my levothyroxine (generic synthroid) is not covered but SYNTHROID is Tier 1 and will cost me $5.00.  Since when is a name brand covered and the generic is not??

    Love,

    Eldri