Health insurance help please

[kthompson]

deere755, I am glad to hear your health insurance is through your employer. That means there is an agent to meet with and help you. Unless you have a large employer who has a Human Resource (NR) Manager.

My only concern with it being group is you made a choice of going to a NON Network or Contracted provider and it was not classed as an emergency.

 

[deere755]

deere755, I am glad to hear your health insurance is through your employer. That means there is an agent to meet with and help you. Unless you have a large employer who has a Human Resource (NR) Manager.

My only concern with it being group is you made a choice of going to a NON Network or Contracted provider and it was not classed as an emergency.

The hospital is part of our PPO and all the Doctors are except for my Heart surgeon. He has only been with the hospital since July. He explained to my wife and family that he was not part of our PPO yet but he has signed up to be. He told her that he had been approved from the insurance company as long as he had another heart surgeon assist him that was part of the PPO so another surgeon from a neighboring city assisted him with the operation. If that makes any since, pay two surgeons to do the job of one. Now that it is all said and done the insurance company says he is not part of my PPO and it is my responsibility to pay the difference on his bill. His office is trying to work this out with them. As for classing it as an emergency I don't know if it would be or not. All I know is as soon as they figured out stints would not work they were trying to get me in to surgery that day while I was still on the table. They were unable to so they had me on the table 6 am the next morning.

 

[dave1949]

I received a bill after taking my wife to an emergency room and everything was double billed, 2 charges for x-rays, 2 charges for antibiotics. etc.

I went to the billing department to try to get it corrected. They said they would have an accountant sit down and go over the bill with me for $50 an hour.

Well, there you go, a decently designed billing system would at least flag that bill for review before you ever see it.

Dave.

 

[ToadHill]

I'd check with the state insurance regulator, many states have minimum requirements for health insurance policies sold within their state. If your state has them, they can require your insurance company to pay at least to the state limit.

 

[kthompson]

deere755, it really is not sounding as drastic as it first did. If your surgeon has been contracted with the network or insurance company which ever in this case to me it would seem they will be able to come to agreement. It might be what you need to do is relax and give those parties time to talk. But I still suggest you get the agent to meet with you and see if they are able to help grease the issue. All in the billing and payment process make mistakes and sometimes all it takes is to question the way a bill was paid and you hear, oh let us reprocess it.

As to the billing system that docheb is talking about, I do know the medical providers in some cases it seems are set up by the regulators on how they must bill. Especially with Medicare and Medicaid cases. You have heard the President tell about all the fraud in Medicare he (not sure he meant himself) was going to be able to save. Much of that fraud is not real fraud but paperwork does not suit their desire. If any of you have ever had an issue with any government agency it seems all have more than one way they read their own rules. Our health care needs less Government rules to get cost down, not more.