Vent about health insurance and how screwed up it is

[hamchan]

I had that happen to me too NetSkyBlue. To the tune of 20K. I was 19 years old and a full time student at the time and it destroyed me financially.

[shaggy]

I don't mind paying for a simple test, but it ticks me off when doctors (mostly surgeons) try to push me or other patients into invasive procedures just to line their pockets with insurance company dough.

[disneysteve]

I had a minor procedure done, and I called my insurance company ahead of time to find out if it was covered, and what it would cost me out of pocket. I was told it WAS covered, I had a "specialist" co-pay of $60. So I had the procedure done, and the Dr's office asked for payment after. I said Huh? My insurance company said this was covered. Dr said noooo.... I called the insurance co again, and they said "we see where so and so told you that, but she was mistaken. She didn't realize that blah blah blah..." So I ended up owing over $700 for a procedure I was told would cost $60.

That's exactly the kind of BS that shouldn't be allowed to happen. If you tell me it is covered, then you need to cover it.

There are certain tests and procedures that require "prior authorization" from the insurance company. My staff needs to call, give all the clinical information, and be granted approval to do the test. HOWEVER, the "approval" that we receive clearly says, "Authorization is not a guarantee of payment." Well then what the hell is it? If jumping through hoops to get a procedure "authorized" doesn't guarantee that it will be paid for, what is the point of getting it authorized? What exactly have you authorized if not payment for the requested service? "Sure, go ahead and do the test. We may or may not pay for it, but thanks for calling."

[sblatner]

DS, the fist case is obviously a problem...can the patient tell the insurance company they weren't incarcerated.

The second case, can you send the patient a bill? Maybe they should have to deal with the insurance company and get it changed back to your practice retroactive to May.

Both cases are ridiculous!

[DRILLINDK]

Amen DS! Amen Brother!

My office began accepting two insurances as of 2012 b/c the slow economy was starting to affect the bottom line. People need to stop relying on their insurance company for their health. I want to reach out and slap people that ask, "what does my insurance cover?" I always try and remind people, that their insurance company is a BILLION dollar company. With hundreds of millions in profits every year. They are not your friend, they are not in the game to help you. They are in it to collect as much $$$ as possible and deliver to shareholders HUGE profits.

Being in the healthcare field I can make a few suggestions to the consumer. Find a great physician, dentist, pediatric whatever based off of recommendations from co-workers, friends, church members, etc. Don't rely on your insurance to cover any. If they do, great. Most of the time, what insurance covers isn't always what is BEST for YOU!

[Blessed]

DS, the fist case is obviously a problem...can the patient tell the insurance company they weren't incarcerated.

The second case, can you send the patient a bill? Maybe they should have to deal with the insurance company and get it changed back to your practice retroactive to May.

Both cases are ridiculous!

Makes sense to me! I have spent about 3 hours a week on the phone between insurance and the clinic since having a member of my household ill for the last few months. I sure don't get out of a bill if insurance doesn't pay. I pay. Heavens one can't even dare not pay your bill while it is being disputed within 10 days of statement or date or this world famous clinic system threatens collections. Interesting since we have never not paid them in full on time. We actually got a phone call the day after the bill came asking if I wanted to pay over the phone. Nope I would pay online as always and would at least like a few days to look over the bill.

They billed us several times for a special $40 lab handling fee for transport when it all stayed right in their lab. They coded these as a specialist visit with insurance so we had the largest co pay possible. After hours on the phone our ins co got this fixed with them and the fraudulent charges were removed. The clinic refused to review them for me until I Got the ins co involved. We were also billed several times for an office visit with a Dr never seen. The latest is finding they did experimental testing without our knowledge. The ins co notified us we are not liable unless we signed saying we would pay for experimental testing. It would be nice to be told this by the Dr when we were told it was routine blood tests. Experimental is not routine . I have had great help from the ins co but the clinic believes they are incapable of mistakes. Very frustrating.

[JoeP]

How about a cash-only model?

[moneybags]

I don't mind paying for a simple test, but it ticks me off when doctors (mostly surgeons) try to push me or other patients into invasive procedures just to line their pockets with insurance company dough.

Last year my two teens went for their annual visits to the pediatrician. They had their blood drawn to check their cholesterol level. They are both slim and athletic with no family history of high cholesterol. Even my 15 year old thought it was nuts (I would have foregone the test, but DH took them & didn't question it).

[hamchan]

When I was 19 (and clearly a healthy weight as well) I had to have a fasting blood sugar because my toe got a minor infection after having surgery on it. I wish I had realized how ridiculous that was. I'd have refused.

[bUU]

How about a cash-only model?

I worry that such a thing would just be a "poor people dying on the streets" model.

[JoeP]

I worry that such a thing would just be a "poor people dying on the streets" model.

Applied globally, possibly. As an option, I might consider such a model.

[disneysteve]

Last year my two teens went for their annual visits to the pediatrician. They had their blood drawn to check their cholesterol level. They are both slim and athletic with no family history of high cholesterol. Even my 15 year old thought it was nuts (I would have foregone the test, but DH took them & didn't question it).

The National Institutes of Health and the American Academy of Pediatrics recommend that ALL children be screened for cholesterol. The recommended age is 9-11. If your 15 year old had never been screened, your doctor was following the latest practice guidelines and practicing good medicine.

[disneysteve]

When I was 19 (and clearly a healthy weight as well) I had to have a fasting blood sugar because my toe got a minor infection after having surgery on it. I wish I had realized how ridiculous that was. I'd have refused.

What was ridiculous about screening you for diabetes?

[hamchan]

My risk was very low, I had no other symptoms, and having a minor infection on a surgical wound is not unheard of. If the infection were severe or not responding to treatment then it would make sense to test for diabetes, but generally speaking I already pay too much in medical bills to be testing for every single minute possibility. I have already had to file bankruptcy once because of medical bills building up faster than I would ever be able to pah them.

[moneybags]

The National Institutes of Health and the American Academy of Pediatrics recommend that ALL children be screened for cholesterol. The recommended age is 9-11. If your 15 year old had never been screened, your doctor was following the latest practice guidelines and practicing good medicine.

There are several articles out there indicating that many physicians don't agree with these guidelines. If I had taken them to the doctor that day, I would have skipped the test. I am not going to put my teens on cholesterol meds.