HEll yea I want the public option I have good insurance and am still getting screwed...

[greenbriar]

I spent 5 days in the hospital the insurance company TOLD me I had to use...


cost me 500 bucks which I felt wasn't so bad since the bill is almost 30 grand


got a bill today

they took my blood like 5 times a day and the pathology lab is "OUT OF NETWORK" so I get to pay the excess amount because of that


like I had a choice?

shit you would think that if you were in the "correct" hospital that everything would be in network

[anarch]

1. I agree

I have "good" insurance too, and I'm still mired in medical debt and have had to choose between medicine and food more than a few times.

[dem mba]

2. what BS

I would raise a stink about it, who knows, maybe the squeaky wheel will get some grease?

threaten to send your case to your congressman. I bet they will go out of their way to avoid any bad press at this key moment.

[Ironman3476]

3. And once you get them to pay it,

Go ahead and send the details to your congressman anyway.They're still lowlifes.

[greenbriar]

4. good idea

My first call is to the insurance company

[Hawkowl]

5. Don't pay

Really. Contest the charges. Negotiate civilly. Scream fraud, call your congressman, do whatever it takes. We need to stop laying down and simply taking it. This is robbery and we all need to stop it.

[renate]

6. keep calling until you get the answer you want

In my (fortunately, limited) experience with dealing with insurance companies, the satisfaction you get will vary with the competence of the person on the other end of the line.

[Ruby the Liberal]

7. Call your state insurance commissioner.

You have no control over labs (or hospital staff for that matter).

File a formal complaint with the state. It isn't quick, but it may be effective.

Oh, and one thing I did when fighting Blue Cross over a similar issue? I didn't threaten to call an attorney (or the state) -- I told them my first call was going to be to the local news. That was several years ago, but may work wonders in this politically charged climate. They straightened everything out within the week.

[greenbriar]

8. sounds like GREAT advice

it is not like I even had a choice...at the time it felt like I was dying and the hospital and doctors treated it very seriously as well

I even had a private room due to the severeness of my issues


what did the insurance company want me to do, go to a different lab every 5 hours for the blood work?

please, for 3 days I coudln't even get out of bed

[Ruby the Liberal]

9. Good luck and go get 'em.

I know it may sound strange, but have fun with it. Make it into a game in your mind that you will win -- they are just delaying the inevitable. (and remind them of that. Their call on how much time they want to waste, etc...)

[greenbriar]

18. thank you

bookmarking this thread to help me remember

[eridani]

10. With current public option plans on the table, plan on getting screwed until 2013

That is, unless they allow anyone to buy into Medicare, which could happen right away.

[greenbriar]

11. sigh

I know

[dysfunctional press]

23. which will give the repug president installed in 2012 the ability to shit-can it completely.

nt

[Ms. Toad]

12. Appeal - I've appealed that kind of decision plenty of times

and always won, with at least three different insurance companies. Anesthesologists, radiologists, pathologists are the typical offenders who are generally not on the network (and sometimes not on any network) with the hospital. (Won twice with anesthesiology, once with radiology, and once with pathology). With pathologisis and radiologists, another thing to watch out for is reading on a day different from the activity that was approved (one successful appeal on each of those, as well).

Hold your temper, find out specifically why they denied full coverage (sometimes the numeric coded reason isn't the real one and it takes speaking to a real person to get the full story). The most recent win was an ER radiologist who coded his bill as an office visit. It was marked as out of network. His ER work was covered; his office work wouldn't have been. Once the coding was straightened out, the bill vanished. Another vanished because the pathologist used a different service date than the biopsy. Once the service date was straightened out, the issue was resolved.

If they really meant that the pathologist was out of network, point out that you had absolutely no control. Blame it on your doc who should have sent the samples to the right pathologist, if the one they used wasn't covered. He is under contract with them, and it is his obligation to know which labs he can use, and which one he can't. Our GP goofed, and my share of the payment came out of what the insurance company would otherwise have paid him for treating me. The others have just accepted the logic and (so far as I know) not passed a penalty on to the doc. You may get scolded, and told it is your responsibility to check up on the doctor, but I've only had to go beyond that argument once.

Good Luck!

[greenbriar]

13. thank you for that info

great points to make

and as far as me having control...haha for the first 3 days I was barely alive

[Ms. Toad]

14. Make sure to add that in

if you get to the point where you have to convince them that there was nothing you could have done to alter where the bloodwork/biopsies/whatever was sent.

[greenbriar]

16. exactly I didn't even know why they were drawing blood so many times

until like day 4 when they told me they thought I might be a diabetic

which I am NOT

[Ms. Toad]

22. I assume this is in connection with your problems

earlier this year...

One of the common first line treatments to get IBD under control is prednisone - which has the side effect of bumping up blood sugar. If they gave that to you, even if you don't have diabetes, it can mimic it (and I believe occasionally even trigger it) - and if you already have diabetes you need someone very closely monitoring your blood sugar to make sure the elevation isn't doing damage.

[WillowTree]

20. Chances are they won't put up an argument about this.

I worked at a medical billing service for awhile a few years ago and would run into this fairly frequently. This is what usually happens in this case:

Their system is no doubt programmed to know the difference between "in-network" and "out-of-network" providers and if the claim gets auto-processed, which it probably did, it just gets handled as out-of-network. If you call in to Customer Service and point out that the lab work was sent to that lab by the in-network hospital and you had no choice in the matter, they almost always agree to re-process at the in-network payment level without much of any discussion because you were in a network facility.

[greenbriar]

21. thank you for that

I feel like you all have given me great points to use

[laughingliberal]

15. A common tactic

This is one I with which I dealt a few times. Called them and stated I was in an in network institution and it was inherent on the institution to use the correct lab. In each case they took care of it without balking. I believe this is one of their, "throw it out there and see if it floats," tactics. A lot of people will just pay it without questioning, thereby saving them a little change for the summer home.

[greenbriar]

17. well, I am not going to let them

I will fight this

[greenbriar]

19. bumped to remember to bookmark

again, thanks all for the great pointers