My new Health Insurance sucks you guys...

[8manpick]

Venom for everyone!

[star seed 7]

What if your venom guy is out of network 

[catastrophe]

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.

[chum1]

Medicare is also very regulated, complicated, and slow. Simply changing the source of funding doesn't resolve those sorts of issues.

[ben ji]

What if your venom guy is out of network 

If you raise your own bee's you'll never have to go out of network. Snake venom could be an issue.

[michigancat]

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

[chum1]

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.

[michigancat]

I finally received acknowledgement that they received my claim! It's "pending"!

[michigancat]

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

[8manpick]

Sounds like your health insurance works perfectly. Another satisfied customer!

Mods lock this thread, TIA

[catastrophe]

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.

[michigancat]

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.