I hate my health insurance

[LD1]

Actually my wife's. United healthcare plan with a $3k deductible, and a 70/30 plan.

We are expecting a second child. So all of this that I am going to speak about is pregnancy related.

According to her plan, they pay 100% of everything prenatal and done in office. Everything delivery related and postnatal is 70/30 after the $3k deductible.

Our first visit a month ago, for the ultrasound and whatnot(first visit), I expected to be paid in full by the ins. Not so. Some of the lab work done that was sent to an outside lab wasn't covered cause it wasnt billed from the office, and thus isn't an "office setting".

So I called and boy do you need a 8 year degree to understand coding. So in my quest (lots of calls to ins and her doctor) for knowledge, I was trying to get an idea of what costs I may expect.

In this quest I have now found out that her office only bills for the first appointment. And that all appts between now and delivery are billed globally, one time, under the delivery charge. Kinda a package deal. That's great, except now the ins isn't going to be paying for the dozen or so prenatal visits at 100% cause they are being billed as one charge. $3100 is what her doc. Said they charge for delivery AND all appts. Plus I will be billed for whatever the hospital charges are.

And now the real kick in the teeth...her doctor requires $600 of coinsurance to be paid by the 7th month. Do bog deal except she said (which don't make any sense) the 600 cannot be applied toward the deductible??? Well with a $3k deductible, if they get their bill in first, I have to pay them the 3k, then the $600 will go toward my 30%. But wait, they only charge $3100. So now they will have over $500 of mine tied up that I could use to pay the hospital bills with. Not to mention I am not thrilled about paying for services until services are rendered.

Our health care system is definitely broken .

 

[Western]

We have UHC too, the 60/40 through my wife's work. They dont pay jack until our $3500 deductible is met, then they only pay the 60%. It seems the best way to get decent health care may be to be one of the "great ones" indigents.

 

[TripleR]

You certainly have my sympathy, we now have Blue Cross Blue Shield, but have had some bad ones, I about went broke with Humana and another the name of which I forgot.

 

[powerpace]

We have UHC too, the 60/40 through my wife's work. They dont pay jack until our $3500 deductible is met, then they only pay the 60%. It seems the best way to get decent health care may be to be one of the "great ones" indigents.

As of this week the insurance companys are posting their rates. Required by the new "rules of the so-called great one". The same coverage by different companies is now out in the open for comparison. Look up the rates. Obamacare "if you care to call it that" is leveling the ground so people are not gouged by the insurance companys. Individuals do not get different medical care they just get reasonable rates with the care. Massachusets (Romneyland) is what Obama care is based on and is very successful.

High medical costs are the result of people not having insurance, not because they have insurance. When I was working for a hospital 30% of all patient bills were not collected. My wife with 25 years of Emergency Nursing and Nursing instructor says that is still true. No insurance! The Government has required Hospitals to treat emergency cases for years. That is for initial treatment not definitative care afterward. The initial treatment is covered partially by the Government. Take a look at the Medical Insurance companys stock. Look at the increased value. Pre ObamaCare till now. Each year over 450,000 households go bankrupt because of medical bills.

An example is my care at the hospital where my wife works. I had kidney problems for three years eventually losing the left one. The hospital billed my insurance Blue Cross. The policy at the hospital is if you or you family works at the hospital all costs are written off after insurance pays. I was billed for over $200,000 for the three years. The actual hospital and doctors costs billed were less than $120,000. Eighty thousand was written off. If I had been a private citizen that would have helped cover the cost of a non-insured patient.

Recently I had a CAT Scan. Total cost $3440. All of it was written off exept for $750 from the insurance. A nearby hospital does not have that same write off policy and has some of the highest rates around. So high thast people are traveling 60 miles away for treatment.

http://www.forbes.com/sites/rickung...e-insurance-exchange-announces-premium-rates/

 

[Pirate]

....snip......

Our health care system is definitely broken .

Yep. And until they get the greedy bloodsucking insurance industry out of healthcare, it will remain broke. The biggest failing of the Affordable Health Care Act was not including a government option.

 

[Western]

Go into almost any hospital and ask for the "insurance" price and the "non-insurance" price, you will find the difference as mush as 50% cheaper if you DONT have insurance. If medical establishments are going to "raze" the insurance company's, that may have something to do with "insurance paying" persons paying more.

 

[LD1]

Lets try to keep the politics out of this thread please. As I did not post it in the political section.

Go into almost any hospital and ask for the "insurance" price and the "non-insurance" price, you will find the difference as mush as 50% cheaper if you DONT have insurance. If medical establishments are going to "raze" the insurance company's, that may have something to do with "insurance paying" persons paying more.

That that also ticks me off. They jack the prices sky high, and then make you think you are getting a "great" discount on the portions you actually have to pay Or gouge the crap out of you if you go out of network.

But one of my biggest frustrations seems to be everytime I call, I get a different answer from United.

My first call, was to question the charges in the first place, since according to her plan, it pays 100% prenatal. The lady said your right and I dont see why it wasnt covered and transfered me to a specialist.

The call was dropped, and it was after 8PM when they close so I called the following evening on my way home from work. This time they said it wasnt covered because they were labs that were billed from the lab and not an "office setting".

So I got home, and looked at al the charges. There are a total of 6 "labs" and 1 pap test. They actually paid for 4 of the labs in full, (that werent billed from her doctors office), but wouldnt pay for the other two and pap test.

So now even more confused (especially since she is supposed to get one pap per year free), I call a third time. This time they said that the doctors office coded things wrong on the "visit itself" and didnt put a primary diagnosis of pregnancy on there, and once that is corrected, they will cover the labs and pap.

So That was the first call to the doctors office, which confirmed things were billed right and had no idea what they were talking about.

So now I call the ins a fourth time. This time they say the 2 labs weren't covered because they weren't in the office. And that the pap test is only covered if coded as preventative and not as pregnancy related.

So I call her doctors office back, they will correct a few issues and re-submit, and thats when I asked them about all the future visits before delivery, and thats when she told me about the "global" billing and not actually "charging" for all the rest of the visits as it is all balled in with delivery. So that was another few calls between the ins and docs office.

This is WAY more complicated than it needs to be. It seems United dont even understand.

The fact that our insurance covers all office prenatal stuff is a bit deceiving, since I have now found out in the "Real-world", only the first appointment is billed as such. And obviously, my preference would be to get as much as possible billed as prenatal:mur:

 

[TnWV]

Actually my wife's. United healthcare plan with a $3k deductible, and a 70/30 plan.

We are expecting a second child. So all of this that I am going to speak about is pregnancy related.

According to her plan, they pay 100% of everything prenatal and done in office. Everything delivery related and postnatal is 70/30 after the $3k deductible.

Our first visit a month ago, for the ultrasound and whatnot(first visit), I expected to be paid in full by the ins. Not so. Some of the lab work done that was sent to an outside lab wasn't covered cause it wasnt billed from the office, and thus isn't an "office setting".

So I called and boy do you need a 8 year degree to understand coding. So in my quest (lots of calls to ins and her doctor) for knowledge, I was trying to get an idea of what costs I may expect.

In this quest I have now found out that her office only bills for the first appointment. And that all appts between now and delivery are billed globally, one time, under the delivery charge. Kinda a package deal. That's great, except now the ins isn't going to be paying for the dozen or so prenatal visits at 100% cause they are being billed as one charge. $3100 is what her doc. Said they charge for delivery AND all appts. Plus I will be billed for whatever the hospital charges are.

And now the real kick in the teeth...her doctor requires $600 of coinsurance to be paid by the 7th month. Do bog deal except she said (which don't make any sense) the 600 cannot be applied toward the deductible??? Well with a $3k deductible, if they get their bill in first, I have to pay them the 3k, then the $600 will go toward my 30%. But wait, they only charge $3100. So now they will have over $500 of mine tied up that I could use to pay the hospital bills with. Not to mention I am not thrilled about paying for services until services are rendered.

Our health care system is definitely broken .

First off, congrats in the new addition! My wife and I are also expecting and I have gone through the exact same scenario except fortunately my insurance is 80/20 and a 1500 deductible, but prenatal is 100%.

When my wife's OB/GYN told us they wanted a $1000 up front to cover her personal deductible, I laughed and said I don't think so. Like you said, they could end up owing you if they are last to bill. Luckily my wife didn't care much for her anyway, so she changed doctors, and the new one said he never heard of a doctor asking for that. Anyways, good luck with the insurance and pregnancy! I know from experience that you need it!

 

[Bird]

We have Medicare and the AARP Medicare Supplement, which is United Healthcare. Our primary physicians are 2 doctors in the same office and they always bill Medicare for exactly what Medicare will approve. Everyone else, doctors, hospitals, labs, etc. send in huge bills and Medicare approves about a third of the amount billed. Of course, it doesn't cost us anything because these places accept Medicare. But of course we're paying more in premiums that I ever paid before we were on Medicare. The UHC Medicare Supplement is OK, but their dental insurance and Medicare Part D (prescription drugs) are another matter. Those two things will drive you nuts.

You certainly have my sympathy, we now have Blue Cross Blue Shield, but have had some bad ones, I about went broke with Humana and another the name of which I forgot.

Yesterday, in a doctor's office, I saw that they had posted a notice that they no longer accept Humana at all. A Walmart greeter that I've known the last 7 years died Monday at the age of 87, but he told me a few years ago that the main reason he kept that job was that Walmart provided him and his wife excellent health coverage at a very low cost with Blue Cross Blue Shield.

 

[/pine]

Let me tell you about a health/hospitalization ins. experience I had last year...you will think I am making this up but I'm not...

I've had basically the same policy since the early '80's'...back then the premiums were about $65/month...since then they have risen to close to $500/month...(with only two ER claims filed within said the time frame)

Since I was spending more time in GA than I was in FL I changed my mailing address from FL to GA to eliminate forwarding issues...(legal resident and business address is in FL)...I got a premium notice from the ins. co. saying my premiums were now over $1600.00/month...!...I called them and asked what was going on and why the premium had over quadrupled and they told me that the state of GA allowed them to charge more...(same policy)...I changed my mailing address back to FL and the premiums dropped back to what they were previously...