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General Discussion => Essentially Flyertalk => Topic started by: 420seriouscat69 on July 30, 2013, 01:35:18 PM
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Says I have to hit $1500 for my deductible before they start helping pay for my prescriptions. I go to the doctor like once a year and today I went to the doctor because of an inflamed eye. Turns out I need to get a steroid to heal it and it costs $84 :curse: Would you get a different insurance? This is blue cross blue shield. Good grief, I miss uop insurance.
THANKS, OBAMA! :shakesfist:
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You probably have a higher rate because of pre-existing conditions.
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what kind of steroids we talking here? i might know a guy.
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Would you rather pay a higher premium but only have a copay when you go to fill your RX? Get the generic.
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Sounds like you have a high deductible plan if it doesn't cover prescriptions. Odds are you are saving money in premiums over a plan that has a prescription co-pay if you only see the doctor once a year.
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Would you rather pay a higher premium but only have a copay when you go to fill your RX? Get the generic.
I guess. I didn't realize how good UOP's insurance was. I never paid for a thing and it took about $85 per check out. Now I'm getting $85 per check out and having to hit a deductible. This doesn't make sense for a guy who barely goes to the doctor right? :knockonwood:
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Are you on the PPO buy up plan or the HSA? Probs the HSA. They are designed exactly for that to keep your premium low for ppl that don't go to the doc much. The idea is that even with an $84 script, you save money in the long run on lower premiums.
if you hate it, buy up to the PPO next yr(assuming that is an option as someone who has had BCBS often throughout the last many yrs).
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You probably have a higher rate because of pre-existing conditions.
One broken nose in my life. I have really bad allergies in the fall (Usually the K-State opener) and after that the only sickness I have is my daily hangover. :dunno:
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Are you on the PPO buy up plan or the HSA? Probs the HSA. They are designed exactly for that to keep your premium low for ppl that don't go to the doc much. The idea is that even with an $84 script, you save money in the long run on lower premiums.
if you hate it, buy up to the PPO next yr(assuming that is an option as someone who has had BCBS often throughout the last many yrs).
Hmmm. That makes sense. I guess that means I should plan on paying for my visit today.
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Thanks, guys. I really needed to just talk this one out. You're the best!
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Going to the doctor once a year seems like a lot.
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Going to the doctor once a year seems like a lot.
Preventative measures are dumb. :don'tcare:
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I assumed he meant non-checkups since he went because he was sick.
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Did you have choices when you chose your insurance? You may want to look at that stuff a little more closely when open enrollment comes around.
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Are you on the PPO buy up plan or the HSA? Probs the HSA. They are designed exactly for that to keep your premium low for ppl that don't go to the doc much. The idea is that even with an $84 script, you save money in the long run on lower premiums.
if you hate it, buy up to the PPO next yr(assuming that is an option as someone who has had BCBS often throughout the last many yrs).
Hmmm. That makes sense. I guess that means I should plan on paying for my visit today.
:lol:
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Get some FLEX money. Pre-tax 300 dollars for a year and you should be good.
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$85 per check is a lot for health insurance, how often are you paid?
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$85 per check is a lot for health insurance, how often are you paid?
:dubious:
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$85 per check is a lot for health insurance, how often are you paid?
:dubious:
Not my fault my company's benefits are so much better than yours :dunno:
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Jesus... sound like a bunch of Poors. $84? LOL
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Going to the doctor once a year seems like a lot.
I disagree. Mayhaps though you do the thing where the person at Walgreens can write your a Rx? I need to try that sometime.
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Going to the doctor once a year seems like a lot.
I disagree. Mayhaps though you do the thing where the person at Walgreens can write your a Rx? I need to try that sometime.
Never heard of this.
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Nurse practitioner? I might be screwing it up because I'm pretty ignorant about the concept.
Anyway I usually go at least once a year, usually for like sinus infection or spider bite or some random thing.
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if you only go to the doctor 0-2 times a year an HDHP is the way to go. my HDHP has a huge deductible but I think it costs me like $25 a month for my premium. I have a deductible of $2800 and an OOP max of $5600 and more than enough in my HSA to cover that in case I have a legit medical emergency. I also invest my HSA in index funds!
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Keep your current insurance. Insurance is for big things you can't afford not for piddly $80 payments the one time of year you go to the doctor. A lower deductable plan is going to cost you more then an extra $80 per year.
The main thing to look for with insurance is what big things it covers or doesn't cover and also what the different maximum payouts are on an annual and lifetime basis. The insurance you think is great when you pay nothing out of pocket for a piddly exam may turn out to be total crap when when you get cancer and it maxes out at $100K in benefits per year. Vice versa the policy with a $1,500 deductable may turn out to be money for you when the crap really hits the fan. I believe Obama care is set to address some of this stuff with the maximums but I'm not sure when that all takes effect.
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Going to the doctor once a year seems like a lot.
I disagree. Mayhaps though you do the thing where the person at Walgreens can write your a Rx? I need to try that sometime.
Never heard of this.
Did this with the flu and my son last winter. In and out in like 20 min and my insurance covered flu shots for the rest of the fam for free through the wallgreens/cvs/whatevs clinic thingy.
wouldn't go there for anything serious, but it is great and cheap for the things that the doctor doesn't actually need to see you for. Also, they are there in the evening and stuff.
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Going to the doctor once a year seems like a lot.
I disagree. Mayhaps though you do the thing where the person at Walgreens can write your a Rx? I need to try that sometime.
Never heard of this.
Did this with the flu and my son last winter. In and out in like 20 min and my insurance covered flu shots for the rest of the fam for free through the wallgreens/cvs/whatevs clinic thingy.
wouldn't go there for anything serious, but it is great and cheap for the things that the doctor doesn't actually need to see you for. Also, they are there in the evening and stuff.
sinus infection = decongestant + anti-biotic would be slam dunk for this?
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Jesus... sound like a bunch of Poors. $84? LOL
Poor and cheap/smart are two separate things. Especially after having rocking benefits previously.
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$85 per check is a lot for health insurance, how often are you paid?
:dubious:
Not my fault my company's benefits are so much better than yours :dunno:
he didnt say it was $85 per check, he said the steroids are going to cost him $85
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$85 per check is a lot for health insurance, how often are you paid?
:dubious:
Not my fault my company's benefits are so much better than yours :dunno:
he didnt say it was $85 per check, he said the steroids are going to cost him $85
Mmmmm..........
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LOL at people who pay for their insurance. And for people with shitty health insurance.
(https://goemaw.com/forum/proxy.php?request=http%3A%2F%2Fwww.seiuhcwi.org%2Ffiles%2F2011%2F11%2Funion_yes.jpg&hash=70f104f6973087292e856478eda03c96e7b6d443)
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i can't bring myself to even tongue-in-cheek lol at anything healthcare related
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.
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Just be happy you have insurance. We have a 5k family ded which we have hit due to my pneumonia. Here is just one of the claims from my hospital stay. A $1500 deductible is nothing if you get really sick. You'll be loving your insurance then.
RW
Dr. Richa Arya 07/13/2013
to 07/17/2013
$51,354.75
View Claim $0.00
In Process
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Just become an illegal immigrant, I heard us taxpayers have to pay for every single healthcare cost to make sure they have the best coverage possible
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I think I pay $8 per check in health. Another $12 in dental.
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I think I pay $8 per check in health. Another $12 in dental.
That sounds great. Where do you work?
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My health care is 100% free for me and my entire family, no premiums, pretty good plan in my estimation. For vision/dental for me and my wife I think I pay $12/month. Benefit of working for a Scandinavian country with socialist values.
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My health care is 100% free for me and my entire family, no premiums, pretty good plan in my estimation. For vision/dental for me and my wife I think I pay $12/month. Benefit of working for a Scandinavian country with socialist values.
:emawkid:
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nothing is free
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My health care is 100% free for me and my entire family, no premiums, pretty good plan in my estimation. For vision/dental for me and my wife I think I pay $12/month. Benefit of working for a Scandinavian country with socialist values.
as is ours....fully paid family plan, dental, optical, $425 deductible for family per year, no copay. I pay $13/pay period for a long term disability plan that is optional.
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LOL at people who pay for their insurance. And for people with shitty health insurance.
you pay for your insurance
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LOL at people who pay for their insurance. And for people with shitty health insurance.
you pay for your insurance
like I said
nothing is free
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I think those arguments have some merit, but the Mormon guy in an entry level job with 6 kids and a wife on the plan isn't "paying" crap for his health care.
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I think those arguments have some merit, but the Mormon guy in an entry level job with 6 kids and a wife on the plan isn't "paying" crap for his health care.
It's subsidized by you in that case.
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tax free tho
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LOL at people who pay for their insurance. And for people with shitty health insurance.
you pay for your insurance
only in the sense that without benefits, I could potentially take a higher salary. however, that is not an option here, and our insurance plan is a private self-insurance plan that is roughly half the cost of products on the open market.
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My health care is 100% free for me and my entire family, no premiums, pretty good plan in my estimation. For vision/dental for me and my wife I think I pay $12/month. Benefit of working for a Scandinavian country with socialist values.
Hopefully the United States will evolve to this point in a decade or so. National healthcare, baby!
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My health care is 100% free for me and my entire family, no premiums, pretty good plan in my estimation. For vision/dental for me and my wife I think I pay $12/month. Benefit of working for a Scandinavian country with socialist values.
Hopefully the United States will evolve to this point in a decade or so. National healthcare, baby!
The system is mumped now. Thanks, Obama! Now we can get taxed to make sure illegal immigrants have healthcare. :cheers: and party the eff on!
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My health care is 100% free for me and my entire family, no premiums, pretty good plan in my estimation. For vision/dental for me and my wife I think I pay $12/month. Benefit of working for a Scandinavian country with socialist values.
Hopefully the United States will evolve to this point in a decade or so. National healthcare, baby!
Well they do pay a 180% tax on new cars, so like, looking forward to it bro! :cheers:
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My health care is 100% free for me and my entire family, no premiums, pretty good plan in my estimation. For vision/dental for me and my wife I think I pay $12/month. Benefit of working for a Scandinavian country with socialist values.
Hopefully the United States will evolve to this point in a decade or so. National healthcare, baby!
Norway pays for everything through oil production.
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You guys ever see an insurance plan with no out-of-pocket limit for out of network? I’ve never seen this before. Are there supplemental plans you can get for health insurance costs like an umbrella plan that only kicks in in case of a catastrophe?
This plan is a great plan as long as you don’t have an incident that requires surgery in rural Kansas and the only close hospital is out of network.
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You guys ever see an insurance plan with no out-of-pocket limit for out of network? I’ve never seen this before. Are there supplemental plans you can get for health insurance costs like an umbrella plan that only kicks in in case of a catastrophe?
This plan is a great plan as long as you don’t have an incident that requires surgery in rural Kansas and the only close hospital is out of network.
Yes. My wife works for a hospital and can't get a plan through work that covers ANY out of network costs. I think they have a deal where they'll let some emergencies slide but that's it. Health insurance is terrible.
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Wow I just assumed that was the law or something. My plan has the same out of pocket max for in or out of network so if you hit it you can basically just get whatevs from wherever
/Insurance brag
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I have to fly to my home office in Detroit to get my dental fix because we have no offices around me.
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My insurance covers emergency as in network but once stabilized you have to go to an in network place.
So you can go to an er to “stop the bleeding” but then you have to go somewhere in network.
I’m in a high deductible hsa plan
I also mostly go to Walgreens for stuff because you pick the time and get in and out with a script.
Would have to wait at my dr forever
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My coverage rules
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I've never used insurance for anything, I just don't get sick or hurt. Superior genes I suppose
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My daughter just had surgery and ended up staying the night in the hospital. The hospital billed my insurance $36k. The insurance company paid $11k, said I owed $3k and told the hospital to get bent on the other $22k.
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told the hospital to get bent on the other $22k.
Not exactly. This is the amount that was excluded from the contracted amount previously negotiated between the insurance company and the hospital.
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Sounds like they told them to get mumped in advance
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told the hospital to get bent on the other $22k.
Not exactly. This is the amount that was excluded from the contracted amount previously negotiated between the insurance company and the hospital.
My mom recently had quite the ordeal from a "routine" surgery that didn't go well. Her tab from this is over $400k and still growing. The $400k is the bullshit billed amount and of course the insurance company has only paid about $220k of that. That's why healthcare costs are so mumped, the providers are throwing made up numbers out there just to see what they can get. Thankfully her out of pocket maximum is $3k.
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Yeah, I mean, I think everything is totally messed up all the way around, and I don't place blame anywhere, but you do see things like hospitals charging $15 for a single aspirin tablet.
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A lot of that is shipping and handling
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Yeah, it costs more for the hospitals to buy their aspirin individually, but they have to because most of their patients only need one or two.
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Fifty cents for the aspirin, $14.50 for knowing where to put the aspirin :th_twocents:
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Both my daughters were born naturally. not even an advil. second daughter we were in the hospital for about 30 hours total, got there at 3 PM, baby born at 9, left the next day at 930. The total bill to insurance was over $8000.
healthcare here is completely mumped beyond belief.
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I mean, doctors make a lot of money for a reason. Not only because you want them to know wtf they are doing but because malpractice insurance costs much more than what most people make in a year. You’re paying for that, nurses, facilities, licensing, single use everything, etc. I’m not saying it’s not too expensive but I understand why it costs a lot.
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Doesn’t really explain why some medical equipment costs 100x more if you get it through insurance vs. on Amazon but yeah many of those things are true.
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Yeah, it costs more for the hospitals to buy their aspirin individually, but they have to because most of their patients only need one or two.
They never charge pills on a single basis. They charge by the package, so when you only took one you are paying for one hundred or whatever the size of the package is. My wife works at an hospital pharmacy. BTY, you can request the total of the medicine payed for, but hardly anyone asks for it.
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I mean, doctors make a lot of money for a reason. Not only because you want them to know wtf they are doing but because malpractice insurance costs much more than what most people make in a year. You’re paying for that, nurses, facilities, licensing, single use everything, etc. I’m not saying it’s not too expensive but I understand why it costs a lot.
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When I was in hospital in '11 for surgery, they gave me check out notice at around 8:00 pm. They didn't get approval of discharge paper work until 00:15 that morning. When I received the billing they charged $1,200 for a full day from the 15 minutes they held me over.
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Hospitals and dr offices gouge the crap out of you for every penny they can get.
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My wife had an emergency c-section where the hit the oh crap button, an alarm went off in the hallway and people started sprinting to the OR. This was an in-network hospital. When that button was pressed an extra pediatric surgeon was paged and ran in. He was out-of-network. We got multiple denials to have that charge re-coded as in network. Each denial had a statement that next time we should ask each doctor present if they are in-network to avoid this issue in the future. After the final denial they told me if I wanted to appeal further it would have to be with legal action.
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My daughter just had surgery and ended up staying the night in the hospital. The hospital billed my insurance $36k. The insurance company paid $11k, said I owed $3k and told the hospital to get bent on the other $22k.
Nobody is paying that 22K, the EOB is complete horse crap.
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My wife had an emergency c-section where the hit the oh crap button, an alarm went off in the hallway and people started sprinting to the OR. This was an in-network hospital. When that button was pressed an extra pediatric surgeon was paged and ran in. He was out-of-network. We got multiple denials to have that charge re-coded as in network. Each denial had a statement that next time we should ask each doctor present if they are in-network to avoid this issue in the future. After the final denial they told me if I wanted to appeal further it would have to be with legal action.
I would legal action them so hard
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Yeah, it costs more for the hospitals to buy their aspirin individually, but they have to because most of their patients only need one or two.
They never charge pills on a single basis. They charge by the package, so when you only took one you are paying for one hundred or whatever the size of the package is. My wife works at an hospital pharmacy. BTY, you can request the total of the medicine payed for, but hardly anyone asks for it.
What does the hospital do with the rest of the package?
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we are getting off topic but entering the world of health care billing and insurance is extremely intimidating and stressful. Starting with MiR's easy step one of going to the website of your provider. OK, I'll find a doctor listed on their site. Are they REALLY in my network? do I even need an in-network provider? Are they in my network for my level of plan? are they actually taking patients?
And then you start to get bills (maybe). I actually upgraded to a plan that covered out-of-network treatment this year. When I went to the website to figure out how to file an out-of-network claim, I learned you could do it VIA MAIL ONLY. WHAT THE eff. Of course I haven't done it yet, and that's 100% the intended result by requiring you to mail in claims.
so this inspired me to spend my Saturday morning trying to file an out of network claim. First step: log into my account. I look around for instructions on how to file a claim. Maybe there's a link when I'm logged in? Nope, nothing. I google "how to file out of network claim with my insurance" and am able to find a link to a pdf form to fill out and an address to send it to. Then there's a field for "Account Number (front of ID card)" that I'm supposed to fill. I look at my ID card and there is NO ACCOUNT NUMBER there, just Group, Issuer, and ID. So now I'm worried that I have the wrong form. Let's see what happens next.
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OK, so this is for an out-of-network service I've already paid for out of pocket. I want to make sure it counts toward my out of pocket deductible. Well I get down and there's a section for authorizing payment directly to the health care professional. Which is what I don't want! So once again I do a little googling, then go back to the 12 step instructions at the bottom of the claim form. It says that if you want payment sent directly to you, you need to leave the payment instructions section blank. Great!
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Glad to see that private sector efficiency working for you.
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onto the next section!
FAMILY/OTHER COVERAGE INFORMATION: Complete only if claim is for a dependent and/or other coverage is in effect
Since it's for a dependent, I have to fill this out, right? But one of the fields is name and address of spouse's employer???? Why should I fill this out if there is no coverage from the spouse? I will anyway because I don't want to get denied. I guess I look up last year's taxes for the official address?
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You only need to fill that out if there’s other insurance.
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Oh well this is a fun one. I completed the form and printed it out along with my invoices. And I'm looking at the page where I downloaded the form to make sure I was going to send it to the correct address. Then I notice that there is a separate form for "behavioral health" which I think is what I need and goes to a different address. Is it a different plan than what I have? NO IDEA. I'm going to call now.
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You only need to fill that out if there’s other insurance.
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You would think but that's not how the instructions are worded - why mention dependents if it's only if other coverage in effect? And within that section there is a box for "IS THE PATIENT COVERED UNDER ANOTHER HEALTH INSURANCE PLAN"?
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Depending on what the service is and your insurance company, you may be able to get it covered as an in network service. Insurance companies work with healthcare providers on claims even when they don't have a contract together.
Also, you can get your healthcare provider to file a claim to your insurance company even when out of network.
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Depending on what the service is and your insurance company, you may be able to get it covered as an in network service. Insurance companies work with healthcare providers on claims even when they don't have a contract together.
How? The provider currently doesn't currently accept insurance.
Also, you can get your healthcare provider to file a claim to your insurance company even when out of network.
It looks like the provider does do this. Goddammit.
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on the plus side, I spoke with a human about which form I needed and got an answer within 10 minutes.
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Depending on what the service is and your insurance company, you may be able to get it covered as an in network service. Insurance companies work with healthcare providers on claims even when they don't have a contract together.
How? The provider currently doesn't currently accept insurance.
The first step would be to call the insurance company, tell them why you couldn't get the service from a network provider, and ask if they can process at your in network benefit level. If not, and you're really determined, you could file an appeal with them on the same basis, which may or may not work depending on their policies.
Regardless of that outcome, there is a billed amount that is over and above the "usual and customary" amount that insurance companies normally pay. You can try to get your healthcare provider to agree not to charge you this amount by asking nicely.
Sounds like you are the middle man on the payment, but that's okay. Getting a refund from either party is NBD if they determine you're owed one.
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Obviously, this is a great example of how complicated things are.
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I had no idea this was possible. Honestly we probably could find in network services but it would be a lot of work. Would I need to verify like a long waiting list of in network folks or something?
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I mean, if I could get this in network I'd go back to my cheaper plan
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The most significant part for a favorable determination is that going out of network was out of your control in some real sense.
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I mean, if I could get this in network I'd go back to my cheaper plan
What I'm describing is more of an exceptional case kind of thing, but I think aarrangements for ongoing exceptions are also possible.
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Eh we mostly chose to go out of network
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also, when I was researching the value of switching to a plan that had out-of-network coverage, I learned that no one I talked to had any idea what the reimbursement rates would be. When I had the attention of the honestly very nice customer service agent today, she mentioned a medicare rate but said she had no way to get a firm number.
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UPDATE: So I mailed these in May 6. After mailing them, my HCP said they often needed to show that it was paid before I could get reimbursed, which I didn't have. So that was great.
I've been logging in every day this week to see if the claims had been processed. Of course they hadn't. So I called, and the guy said that I could actually send them electronically by logging in and sending it via the insurance's messaging system. He said he sent it while he was on the phone but it usually takes about 30 minutes to go through. This call had already taken over 15 minutes to get to that point so I let him go. I waited. And waited. No message in the little shitty messaging system. So I call this morning. "oh, you can't send them electronically, but you can send them via fax!" so let's see if I can send a fax online.
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UPDATE: So I mailed these in May 6. After mailing them, my HCP said they often needed to show that it was paid before I could get reimbursed, which I didn't have. So that was great.
I've been logging in every day this week to see if the claims had been processed. Of course they hadn't. So I called, and the guy said that I could actually send them electronically by logging in and sending it via the insurance's messaging system. He said he sent it while he was on the phone but it usually takes about 30 minutes to go through. This call had already taken over 15 minutes to get to that point so I let him go. I waited. And waited. No message in the little shitty messaging system. So I call this morning. "oh, you can't send them electronically, but you can send them via fax!" so let's see if I can send a fax online.
I forgot to mention that when I called the first thing that they say is "I'm going to tell you right now that our system is being upgraded and we can't access anything until Monday after 7am Eastern".
American's love their insurance!
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UPDATE: So I mailed these in May 6. After mailing them, my HCP said they often needed to show that it was paid before I could get reimbursed, which I didn't have. So that was great.
I've been logging in every day this week to see if the claims had been processed. Of course they hadn't. So I called, and the guy said that I could actually send them electronically by logging in and sending it via the insurance's messaging system. He said he sent it while he was on the phone but it usually takes about 30 minutes to go through. This call had already taken over 15 minutes to get to that point so I let him go. I waited. And waited. No message in the little shitty messaging system. So I call this morning. "oh, you can't send them electronically, but you can send them via fax!" so let's see if I can send a fax online.
We have a response! I got a letter in the mail from them yesterday! The letter was dated May 14 and postmarked May 18. There were 12 pages in the envelope - an actual letter, 7 pages of information in different languages, followed by the invoices I submitted. It said we needed a diagnostic code on the invoices and to send them in again and that I could call the number on the back of my card if I needed help (they did not print the number on the letter). The day after I sent it I got an email from the HCP saying we might need a diagnostic code but they usually don't include them by default for privacy reasons. I love my health insurance and can't wait to see how the reimbursement process goes.
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UPDATE: So I mailed these in May 6. After mailing them, my HCP said they often needed to show that it was paid before I could get reimbursed, which I didn't have. So that was great.
I've been logging in every day this week to see if the claims had been processed. Of course they hadn't. So I called, and the guy said that I could actually send them electronically by logging in and sending it via the insurance's messaging system. He said he sent it while he was on the phone but it usually takes about 30 minutes to go through. This call had already taken over 15 minutes to get to that point so I let him go. I waited. And waited. No message in the little shitty messaging system. So I call this morning. "oh, you can't send them electronically, but you can send them via fax!" so let's see if I can send a fax online.
Good news, I just got an identical 12 page claim denial explaining I needed to have diagnostic codes on invoices which means they received my fax! This rejection only took 10 days to get to me! Progress! I can just hop across all the free fax services now (they have page limits) and get quicker service.
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this health care sounds amaze
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UPDATE: So I mailed these in May 6. After mailing them, my HCP said they often needed to show that it was paid before I could get reimbursed, which I didn't have. So that was great.
I've been logging in every day this week to see if the claims had been processed. Of course they hadn't. So I called, and the guy said that I could actually send them electronically by logging in and sending it via the insurance's messaging system. He said he sent it while he was on the phone but it usually takes about 30 minutes to go through. This call had already taken over 15 minutes to get to that point so I let him go. I waited. And waited. No message in the little shitty messaging system. So I call this morning. "oh, you can't send them electronically, but you can send them via fax!" so let's see if I can send a fax online.
Good news, I just got an identical 12 page claim denial explaining I needed to have diagnostic codes on invoices which means they received my fax! This rejection only took 10 days to get to me! Progress! I can just hop across all the free fax services now (they have page limits) and get quicker service.
This sounds awful
What are some ways besides Medicare for all/single payer to fix our healthcare system? Seems like the answer is always KEEP IT HOW IT IS or MEDICARE FOR ALL but there has to be more options than that right?
(I say this as someone who consumes very little medical care and have no strong opinion either way)
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Venom for everyone!
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What if your venom guy is out of network :curse:
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Small gov proponents will say that the healthcare and insurance industry is over regulated to the point that it makes actual competition impossible which means there’s no incentive to improve prices or service.
The counter is that both industries have a history of taking advantage of individuals who have basically no leverage to negotiate when its for services they physically need.
Both sides probably agree that the system currently in place (a bastardized version of Obamacare) sucks complete ass.
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Medicare is also very regulated, complicated, and slow. Simply changing the source of funding doesn't resolve those sorts of issues.
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What if your venom guy is out of network :curse:
If you raise your own bee's you'll never have to go out of network. Snake venom could be an issue.
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Medicare is also very regulated, complicated, and slow. Simply changing the source of funding doesn't resolve those sorts of issues.
in theory, wouldn't this particular issue would be resolved because every provider would be in-network under M4A? I'm only jumping through these hoops because it's out of network. I think it would be pretty simple for in-network
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Medicare is also very regulated, complicated, and slow. Simply changing the source of funding doesn't resolve those sorts of issues.
in theory, wouldn't this particular issue would be resolved because every provider would be in-network under M4A? I'm only jumping through these hoops because it's out of network. I think it would be pretty simple for in-network
In the simplest possible version, I suppose. It's hard for me to imagine that we'd actually get anything close to the simplest possible version, though, even assuming that everyone is on board with m4a.
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I finally received acknowledgement that they received my claim! It's "pending"! :excited:
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we are getting off topic but entering the world of health care billing and insurance is extremely intimidating and stressful. Starting with MiR's easy step one of going to the website of your provider. OK, I'll find a doctor listed on their site. Are they REALLY in my network? do I even need an in-network provider? Are they in my network for my level of plan? are they actually taking patients?
And then you start to get bills (maybe). I actually upgraded to a plan that covered out-of-network treatment this year. When I went to the website to figure out how to file an out-of-network claim, I learned you could do it VIA MAIL ONLY. WHAT THE eff. Of course I haven't done it yet, and that's 100% the intended result by requiring you to mail in claims.
so this inspired me to spend my Saturday morning trying to file an out of network claim. First step: log into my account. I look around for instructions on how to file a claim. Maybe there's a link when I'm logged in? Nope, nothing. I google "how to file out of network claim with my insurance" and am able to find a link to a pdf form to fill out and an address to send it to. Then there's a field for "Account Number (front of ID card)" that I'm supposed to fill. I look at my ID card and there is NO ACCOUNT NUMBER there, just Group, Issuer, and ID. So now I'm worried that I have the wrong form. Let's see what happens next.
this was resolved! I mailed the initial claim May 6 and received a check in the mail June 16. In the process, I submitted a second claim that I also received a check for on June 16. They were both in the same envelope, and I almost threw away the second check because it was in the stack of papers in every language that they send with every mailed correspondence. I learned that I can fax the claims but not submit electronically, and not once did I receive any electronic communication acknowledging that they received my claim or sent payment.
So here's the process:
-HCP weekly visit
-I pay HCP in full
-HCP sends invoices at the end of the month
-I use a free e-fax to send the invoice and claims form (that I just change the date on and resend every time)
-I digitally submit invoice to FSA for reimbursement (is this legal since I'm going to also be reimbursed by health insurance?), usually get a direct deposit within 5 days
-Health Insurance mails the check for coinsurance amount
Love it
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Sounds like your health insurance works perfectly. Another satisfied customer!
Mods lock this thread, TIA
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I’m not sure, but I think paying with FSA and then getting reimbursed from insurance is fine. Doesn’t seem much different than paying with a credit card and then withdrawing from HSA, which I know is ok.
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I’m not sure, but I think paying with FSA and then getting reimbursed from insurance is fine. Doesn’t seem much different than paying with a credit card and then withdrawing from HSA, which I know is ok.
In this case I paid cash in full, then got reimbursed by FSA for the full amount, then got reimbursed by insurance for the coinsurance portion after deductible. Of course given the way this process went there was no way of knowing if or how much I would be reimbursed and FSA reimbursement is like a 5 day all-digital transaction.