Health insurance help please

[deere755]

As most of you probably know I had a TIA back in July. After many tests they found out I had some blockages in my heart also. September the 3rd I had a Quadruple by pass surgery. I am recovering great according to all my Doctors and will probably have a second surgery the first week in October. For 24 hours the Dr. ordered blood draws every 3 hours. My insurance company has ther own lab for this. The problem is it is not in the hospital and it is not open 24 hours a day. I was in CCU and there was no way I could go to there lab. The insurance company will only pay like $8 per draw. I can't tell you how many chest x-rays I had but the insurance company is only wanting to pay $10 on each one, they run about $70 a piece. The surgeons bill was $9400 the insurance company paid him $478. This is just a tip of the iceberg. All of these expences they are saying do not apply to my out of pocket expence and do not apply to my $1500 deductable. My total bill so far is around $130,000. It looks as if right now I may be stuck with $40 to $50 thousand of my total bill. Is there anything I can do to get more out of them. Is there an agency that would help me with this. Any suggestions would be appreciated.

 

[WayneB]

Call your congressman is good advice.

One has to wonder about these health insurance companies and hospitals.

I recently took a fall and decided to go to the hospital emergency room (it was July 3) My insurance company was fine with it even though I went without their approval and only paid 25 dollars. Saw the total bill this weekend and the hospital charged a total of $925 to the insurance company. Guess they are both out to get is much as possible.

 

[BungeeII]

You're just going to have to be patient and work through this with the insurance company and medical provider.

Do what you can to fix things (without paying a dime), then get a lawyer. Every family needs a good lawyer. If you don't have one yet, now's as good a time as any to find one. Fortunately, we have a family friend that I trust more than most anyone, including some family.

 

[randy41]

you should look for a health insurance advocate in your state. google health insurance advocates or health care advocates. otherwise, read your policy and find out what its supposed to pay for. also, all states have an insurance commission that oversees insurance business in your state. if you have a legitimate complaint (after reading and understanding your policy)you should contact them or the better business bureau.

 

[dave1949]

You're just going to have to be patient and work through this with the insurance company and medical provider.

Do what you can to fix things (without paying a dime), then get a lawyer. Every family needs a good lawyer. If you don't have one yet, now's as good a time as any to find one. Fortunately, we have a family friend that I trust more than most anyone, including some family.

Bungee, I think that is good advice, there really aren't many options. I think it's good to inform your Sen/Rep and tell them there are are problems out there they are not fixing. But I wouldn't expect them to help individual cases.
Dave.

 

[charlz]

you should look for a health insurance advocate in your state. google health insurance advocates or health care advocates. otherwise, read your policy and find out what its supposed to pay for. also, all states have an insurance commission that oversees insurance business in your state. if you have a legitimate complaint (after reading and understanding your policy)you should contact them or the better business bureau.

This may help... depending on what they charge. Your insurance only paid 5% of the surgeon bill which sounds like a bad joke. Having someone who knows what they are looking at go over your insurance plan sounds like a good idea.

 

[Bedlam]

Glad you are getting better, and good luck on the next surgery Hopefully that will get you back to 100 percent.

 

[Big Bri]

how is a congress man going to fix an insurance problem that an individual purchased and signed on their own.

by the way i am sorry for the spot you are in, Talk to your doctors and the hospital. They will work with you. When i first got married i had no maturnity insc. The Doctors, and hospital worked with us and set up a payment plan for us to pay them back. They were very understanding, i never got calls or reminders of out standing payments (i did pay the bill on time every month) and after we payed the final bill we got a nice thank you card

 

[riptides]

Find each doctor or service supplier and ask them to drop the charges.

 

[MossRoad]

Folks. Keep the politics out of this thread. Several posts have already been removed and a few more will be edited or removed. Please just answer the man's questions without the politics. Thanks.

 

[EarPlug]

I have no experience with this group but you might want to try them.

Medical Billing Advocates of America

ADVOMED


Jack

 

[dmccarty]

This thread threatening to go political?

Your state likely has an Insurance Commission or some such. See if they can help. A coworker had trees fall on his house twice over the years. After a tree fell on the house a second time, the insurance company dropped him. We were talking about different companies and I suggested he call the Insurance Commission about his problem. He did. His policy was NOT dropped and the rate did not go up.

Its worth checking.

What does you policy say about what the company is paying?

I was looking at some of the medical bills this weekend from our accident earlier in the year. The insurance company is paying about third less than billed. Our portion was about a half of what the insurance company did not pay so the provider is getting roughly 75-80% of what they charge.

Later,
Dan

 

[tanglefoot]

After reading one of the posts concerning politics, I went back to re-read all of it to see if I missed something. I DID NOT see anything that hinted of politics to me. A couple of the posters suggested that the originator seek help from a congressman, and that's it.
I have dealt with the same problems discussed here. It seems as though all my wife and I need at our stage of life is a major medical policy. We could handle the small charges. But what we are offered is supposed to be a major medical policy with added frills. Any time we need to use our supposed benefits, we have to haggle to get the company to pay what it is supposed to pay. Sometimes we are successful, sometimes not. It should not be this way. If anything I have said seems political to anybody, I'm sorry.
Butch

 

[300UGUY]

how is a congress man going to fix an insurance problem that an individual purchased and signed on their own.

by the way i am sorry for the spot you are in, Talk to your doctors and the hospital. They will work with you. When i first got married i had no maturnity insc. The Doctors, and hospital worked with us and set up a payment plan for us to pay them back. They were very understanding, i never got calls or reminders of out standing payments (i did pay the bill on time every month) and after we payed the final bill we got a nice thank you card

I asked a doctor about a payment plan once, and he blew up at me - asked me "Do I look like a ******* bank?? " I found another doc, but there are a lot out there that just want the money.

 

[Kfbeal]

Is it Lab One that you are referring to? If so, ours is the same way. The hospital will draw the blood but no tests are performed and sent to Lab One. If the hospital is aware of your insurance and they knew about the Lab, then I wouldn't believe you should be liable for the costs. It would be the hospital's mistake for not sending those to the appropriate facility.

I have found with 3 pregnancies (of my of course) that even doctors that aren't in our network will be paid if admitted since we did not have any choice who performed the procedures. Radiology, etc.

Best of luck with that and keep us posted. IF you find you are liable, if you make an attempt to pay small amounts, many times they may settle with you. I wouldn't see you having to foot the bill, it's what we have insurance for right?

 

[BungeeII]

I DID NOT see anything that hinted of politics to me.
...

If anything I have said seems political to anybody, I'm sorry.
Butch

My post was edited by Mossroad, so the offending comments had likely been removed by the time you opened the thread. I made a snide comment that expressed my concern for a couple of the previous poster's misplaced trust. (how's that, mossroad?)

 

[tanglefoot]

Thanks for the clarification.
Butch

 

[WarrenF]

You will have to look at your policy very carefully....this is one area I have had copious experience. The fundamental principle you need to understand is this. IF your health care provider accepts payment from your insurance company....it means they have an agreement with the insurance company as to what they will agree to be paid for any procedure. That means this, if the Doctor bills you for the unpaid balance....you are not obligated to pay.

I am speaking in generalities here. There are many health care providers who have done some serious jail time, and or paid a serious fine for participating in that type of practice. You surely need to read and understand your policy....so pull out the policy and start reading. Pick up the phone and have your agent come and explain what you don't understand.

Trust me when I say, do not call your Congressman! All you will be doing is adding more stress in your life. Calling your Congressman is kind of like wetting your pants while wearing a rain coat....gives you a nice warm feeling but no one else knows.

Generally speaking when you purchase health insurance....It will say things like $1500 out of pocket pay and 20% up to $5,000.....your total personal exposure would be $6500.00. Any bill AFTER you have met your obligation, at that point in time is not your concern. The fight should and must be between your insurance company and the health care provider. GET OUT OF THE MIDDLE OF THE FIGHT.

 

[Chuck52]

Sounds cool Warren, but if YOU had the service performed, YOU are who the service provider, be it doctor or hospital, will look to for payment assuming they are not satisfied with what they receive from your insurance provider.

I have personally had no problems with health insurance, probably because I have had almost no claims! I'm one of those people who balance the books for the insurance companies...I pay and pay and make very few claims. However, my son and his wife caught a big one three years ago when their son was born three months premature. Imagine the cost of three months in the premie intensive care! The worst part of their experience was in trying to get an actual bill to pay. They got no bills or requests for payment for months and then were contacted by a collection agency. The hospital is known for its screwed up billing, but this was ridiculous. Apparently, they dealt with the insurance company for an extended period of time, and then when they were not satisfied with payment they gave it to a collection agency which then went after my son and his wife, with no information about the charge except the amount. Imagine being dunned by a billing agency and never knowing precisely what you are being billed for!

My wife, two children, and daughter-in-law are all nurses. While they all make decent money, believe me that the incredible, amazing, dramatic increase in medical costs is not trickling down to the people actually providing services. Remember, the nurses are those folks who keep the doctors from killing you.

Chuck

 

[MossRoad]

My post was edited by Mossroad, so the offending comments had likely been removed by the time you opened the thread. I made a snide comment that expressed my concern for a couple of the previous poster's misplaced trust. (how's that, mossroad?)

Wonderful!