Author Topic: My new Health Insurance sucks you guys...  (Read 4130 times)

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Offline Rage Against the McKee

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Re: My new Health Insurance sucks you guys...
« Reply #75 on: December 12, 2019, 02:03:26 PM »
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?

Online michigancat

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Re: My new Health Insurance sucks you guys...
« Reply #76 on: May 02, 2020, 01:46:10 PM »
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.

Online michigancat

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Re: My new Health Insurance sucks you guys...
« Reply #77 on: May 02, 2020, 01:58:33 PM »
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!

Offline Kat Kid

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Re: My new Health Insurance sucks you guys...
« Reply #78 on: May 02, 2020, 02:06:44 PM »
Glad to see that private sector efficiency working for you.
@bentren

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Re: My new Health Insurance sucks you guys...
« Reply #79 on: May 02, 2020, 02:07:25 PM »
onto the next section!

Quote
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?

Offline Institutional Control

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Re: My new Health Insurance sucks you guys...
« Reply #80 on: May 02, 2020, 02:14:48 PM »
You only need to fill that out if there’s other insurance.


Sent from my iPhone using Tapatalk

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Re: My new Health Insurance sucks you guys...
« Reply #81 on: May 02, 2020, 02:31:32 PM »
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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Re: My new Health Insurance sucks you guys...
« Reply #82 on: May 02, 2020, 02:33:36 PM »
You only need to fill that out if there’s other insurance.


Sent from my iPhone using Tapatalk

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"?

Online chum1

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Re: My new Health Insurance sucks you guys...
« Reply #83 on: May 02, 2020, 02:36:42 PM »
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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Re: My new Health Insurance sucks you guys...
« Reply #84 on: May 02, 2020, 02:45:45 PM »
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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Re: My new Health Insurance sucks you guys...
« Reply #85 on: May 02, 2020, 02:48:24 PM »
on the plus side, I spoke with a human about which form I needed and got an answer within 10 minutes.

Online chum1

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Re: My new Health Insurance sucks you guys...
« Reply #86 on: May 02, 2020, 03:09:08 PM »
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.

Online chum1

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Re: My new Health Insurance sucks you guys...
« Reply #87 on: May 02, 2020, 03:10:17 PM »
Obviously, this is a great example of how complicated things are.

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Re: My new Health Insurance sucks you guys...
« Reply #88 on: May 02, 2020, 03:16:13 PM »
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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Re: My new Health Insurance sucks you guys...
« Reply #89 on: May 02, 2020, 03:18:29 PM »
I mean, if I could get this in network I'd go back to my cheaper plan

Online chum1

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Re: My new Health Insurance sucks you guys...
« Reply #90 on: May 02, 2020, 03:24:40 PM »
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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Re: My new Health Insurance sucks you guys...
« Reply #91 on: May 02, 2020, 03:28:55 PM »
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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Re: My new Health Insurance sucks you guys...
« Reply #92 on: May 02, 2020, 03:51:56 PM »
Eh we mostly chose to go out of network

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Re: My new Health Insurance sucks you guys...
« Reply #93 on: May 02, 2020, 04:05:32 PM »
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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Re: My new Health Insurance sucks you guys...
« Reply #94 on: May 16, 2020, 10:29:43 AM »
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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Re: My new Health Insurance sucks you guys...
« Reply #95 on: May 16, 2020, 10:47:54 AM »
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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Re: My new Health Insurance sucks you guys...
« Reply #96 on: May 22, 2020, 10:06:48 AM »
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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Re: My new Health Insurance sucks you guys...
« Reply #97 on: May 28, 2020, 12:59:14 AM »


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.

Offline Tobias

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Re: My new Health Insurance sucks you guys...
« Reply #98 on: May 28, 2020, 01:08:29 AM »
this health care sounds amaze

Offline ben ji

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Re: My new Health Insurance sucks you guys...
« Reply #99 on: May 28, 2020, 10:21:36 AM »


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)