tedicast Posted April 25, 2011 Report Share Posted April 25, 2011 Last month I brought Jen th the E.R, for bad stomach pain. After a couple UltraSounds and an MRI it was concluded that she has addendicitis, and surgery was scheduled for the next day. The next afternoon the surgery went as planned, and Jen was released the following day after spending about 2 1/2 day in the hospital. When we brought her to the ER, before a DR. or nurse even looked at her, a lady from billing was knocking on the exam room door, looking for my $150 co-pay. I have been going to this hospital all my life and have never been asked for a co-pay in the ER. I have always been billed for it. Ok, whatever, I paid the $150. As we are about to leave,after Jen was discharged another lady from billing comes to us, and tells us if we pay our in-patient copay, before we leave the hopsital, they will take 20% off our copay. Ok...thats $100 on $500, so I payed it and they put the $150 I payed in the ER toward it too. Really shows how much trouble hospitals are having getting copays out of patients. Fast forward a month. I get a letter from my health insurance carrier, telling me that Jens claim has been denied, and that the hospital is apealing it on my behalf. ARE YOU FREAKING KIDDING ME!!!! I was so mad I couldn't even sit still. My health insurance cost for Jen and I, is over $17,750 a year! My employer kicks in a good percentage thankfully, but it still it costs me over $10,000 a year for health insurance. And, they are going to deny my claim...why bother! I am so riled up about this I feel like I'm going to explode! I've got some phone calls to make today and I'm not looking forward to the run around I'm sure to get. Sorry, I needed to get that off my chest. Quote Link to comment Share on other sites More sharing options...
Tominator Posted April 25, 2011 Report Share Posted April 25, 2011 Definitely feel your pain. Just found out the other day our school board is proposing that we pay $900 in deductible next year. That's a guaranteed reduction in pay by $900 with the health issues I have. I'll be done paying that deductible in January, guaranteed. Quote Link to comment Share on other sites More sharing options...
92xj Posted April 25, 2011 Report Share Posted April 25, 2011 I know nothing about how health insurance works, but how in the heck does a claim get denied if you have full coverage? Apparently you had health issues and thats why there was 2.5 days spent in the hospital. Apparently something was wrong and thats why there was surgery. You paid co-pays and so on. What could the insurance company deny about that? Its not like it was plastic surgery and it was not needed. Can someone emlighten me on can causes a denial in insurance. Quote Link to comment Share on other sites More sharing options...
wtnhunt Posted April 25, 2011 Report Share Posted April 25, 2011 Reminds me of when our first born was born. Billing office would not release my wife and daughter until I either setup payments or wrote a check. Only question I see would be if the hospital was no longer a preferred provider by your insurance company. Even still most cover at at least 50% when you use non preferred. Don't think I would have paid the co pay until all was said and done and the hospital settled with the insurance. A lot wrong in this country when illegals can go in and receive treatment and never pay a dime and taxpayers who have insurance get treated like this. I would be on the phone with the insurance commissioners office and any state reps that will listen. This kind of thing right here gets me pretty irritated too. Quote Link to comment Share on other sites More sharing options...
redkneck Posted April 25, 2011 Report Share Posted April 25, 2011 A lot wrong in this country when illegals can go in and receive treatment and never pay a dime and taxpayers who have insurance get treated like this. You just said a mouthful William. Most of us that pay insurance can't afford to go to the emergency room unless it is absolutely necessary (which of course in his case it was), folks without insurance are happy to bounce right up in there and use the place like it was a clinic while the rest of us end up hundreds or thousands in bills even with insurance. It's a freakin joke.... ridiculous! Glad to hear you wife is ok now. You'll get the ins to pay up, just sad you have to work so hard to get what you're already paying others to do for you. Also it's sickening to see when you're ER bills you 10K for services then the provider gets them to write off all but 3500 of it. What a joke. Quote Link to comment Share on other sites More sharing options...
Rhino Posted April 25, 2011 Report Share Posted April 25, 2011 Also it's sickening to see when you're ER bills you 10K for services then the provider gets them to write off all but 3500 of it. What a joke. Yep...it's a scam John!!!!! Quote Link to comment Share on other sites More sharing options...
VermontHunter Posted April 25, 2011 Report Share Posted April 25, 2011 Just be thankful you don't have CIGNA for an insurance carrier ,,, Tammy and I had a $3000.00 deductible ,,, that's right NO joke a 3 grand deductible and 50/50 perscription plan ,, and we paid good money for this joke of a policy. With Tammys heart issues, lets just say CIGNA turned down almost every claim, and we had to fight to get them covered ... YEP, our country has some serious issues ... Hope everything works out for you John, this is stuff you shouldn't have to be concerned with ... Quote Link to comment Share on other sites More sharing options...
elkoholic Posted April 25, 2011 Report Share Posted April 25, 2011 I would think that in this case part of the issue with getting the insurance to pay has to do with the way it was coded. Insurance coding is an interesting thing. In an effort to get medical procedures and diagnoses in a standardized format for billing purposed, numbers are assigned that identify what is going on. These numbers can be found in coding books which are constantly being updated and currently ICD-9 is being used while ICD-10 is being worked on. An example would be code 250.50 which is diabetes mellitus non insulin dependent and 250.51 is diabetes mellitus insulin dependent. There are many variations and riders (that can modify original codes) so it all gets very complicated and without an experienced insurance coder and medical practitioners who document thoroughly getting the insurance to pay can be a chore. All of this wasted time and staffing adversely affects health care costs. Very few people understand how complicated all of this is, or how frustrating it is to the practitioners who are trying to get paid for services provided. The blame for this incredibly inane system lies with our government, basically Medicaid and Medicare. At this point I would let the hospital work with the insurance company to find out why the claim was rejected and not worry about it a whole bunch. Finding out the reason it was denied is the path to solving the problem. Hopefully it all works out. Quote Link to comment Share on other sites More sharing options...
tedicast Posted April 25, 2011 Author Report Share Posted April 25, 2011 Well...called the Ins. co. and they wouldn't even talk to me. Hippa regulations. But I don't understand...It's my freaking policy. I paid for it...so frustrating. Called the hospital...talked to the ins. billing dpt..... Told me not to worry about it...my company denies everything! That makes me feel good! Hosp. told me that it would get paid and to let them worry about it, as long as my deductible was paid, i'm off the hook. Still nervous about it though. Quote Link to comment Share on other sites More sharing options...
wtnhunt Posted April 25, 2011 Report Share Posted April 25, 2011 Well...called the Ins. co. and they wouldn't even talk to me. Hippa regulations. But I don't understand...It's my freaking policy. I paid for it...so frustrating. Called the hospital...talked to the ins. billing dpt..... Told me not to worry about it...my company denies everything! That makes me feel good! Hosp. told me that it would get paid and to let them worry about it, as long as my deductible was paid, i'm off the hook. Still nervous about it though. You probably already know this, but be sure to get names of those you speak with and write down dates and times you talked with them and keep that info in a file with all your billing paperwork. Helps later on when if questions come about to be able to say who you talked with on what day and when and what they said. The hippa stuff should be something you should be able to resolve, anytime we do any medical paperwork for the kids or wife or myself we list my wife and I as those who can be shared information with., does not make any sense that the insurance would not talk with you about billing though. Quote Link to comment Share on other sites More sharing options...
mikebohio Posted April 26, 2011 Report Share Posted April 26, 2011 would rather wrestle a grizzly than deal with the insurance company. Quote Link to comment Share on other sites More sharing options...
Shaun_300 Posted April 26, 2011 Report Share Posted April 26, 2011 Sorry to hear that John, sounds like an absolute scam to me too! One thing I'm very thankful for is Canada's good heath care system. Basically do anything in a hospital without paying a cent. Sure we pay for it in more taxes than the US has, but it's worth it IMO. Don't have to worry about any of that BS. Only insurance I have through work to do with health care is for prescriptions, dental and optical. Quote Link to comment Share on other sites More sharing options...
swohiodave Posted April 26, 2011 Report Share Posted April 26, 2011 We see a lot of people from Canada coming to the US and privatetly paying for healthcare. Atleast where I work we do. Let the hospital do their job and they should resolve the issue for you. Did they authorize your wifes admission in time? You should be alright once they appeal the claim...that happens multiple times every day. Quote Link to comment Share on other sites More sharing options...
Nut Posted April 26, 2011 Report Share Posted April 26, 2011 I've dealt with this stuff for years. It's funny but while unemployed I cut better deals with hospitals and doctors than while covered and employed. Quote Link to comment Share on other sites More sharing options...
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