insurance - it's confusing

[LivingAlmostLarge]

I'm pretty sure I blogged about my tooth experience but I wanted to just put it out there my two recent experiences with insurance. First my root canal. Yep I have no idea what I'm going to pay. I was in so much pain that my dentist was like "are you really going to look up if the endontist is in network?" I sighed and said guess I can't since I'm high as a kite and pretty much dying in pain. So i went and it ended up being around $4k for a root canal. Yay...I have no clue what my portion is. I whipped my CC and paid $500. They said "well send you a bill in a few months." Thanks for the deposit. What choice did I have? Pretty much nothing.

Then few weeks ago I got into a car accident. I was rear ended but I have to pay my deductible $500. That was not the annoying part, the insurance company explained to me that I need to cover replacing my parts or "old used parts not damaged in another cars accident". Because my 2106 subaru is used so paying to replace my used car parts with OEM new car parts isn't right. UGGGH. And the other person's won't pay either because that's not industry standard.

I don't get how my dental works. I don't get how my medical insurance works. I just pay bills as they come in because it gets to be super confusing. I also usually will wait for medical at least 2 bills to let bills settle. I never had that happen with auto before that they tell me they won't pay the estimate from the car repair place.

Is it just me or is insurance getting worse?

[ua_guy]

That really sucks, sorry to hear about the bad experiences. There's nothing like trying to sort through insurance BS when you need to make decisions right away. This is what "free market" healthcare insurance is, as well as cost-driven auto insurance. The insurers make most of the rules in the name of shareholders and not in the interest of the patient/insured.

On the car thing, yes, it's true. Auto insurance policies dictate that the insurer can require aftermarket and/or LKQ (industry term for 'like kind/quality' parts from salvage vehicles). Your policy will call it out explicitly. Very rarely will they pay for OE parts unless that's the only choice available. It's a cost issue, even if the parts are only a couple of bucks cheaper. You can elect to pay the difference, but you'll need to work that out with the shop. My hope is you'll get your deductible back, if the at-fault party has insurance.

Having worked in the industry, "aftermarket" parts get a bad name sometimes. It used to be that things like aftermarket body panels didn't fit right, or they had inferior corrosion protection. But, quality has improved, and for a car that you drive daily, they are generally good parts ("meet or exceed OE specifications" and should last the life of the car. Salvage parts are OE parts, they're just coming off a used vehicle, same make/model as yours. That's not a bad thing. I worked in the industry, and I've had aftermarket parts used to repair my vehicles....if that's of any relief to you. No matter what parts, choosing a high-quality shop to do the repairs is the most important thing, IMO.

On dental stuff, I don't even pretend to know. I should know. It's similar to medical, and it comes with a policy that states exactly what your plan pays, and when, and to whom....have I ever read it? Nope. I ask my dentist if he takes so-and-so insurance and the answer has always been yes, and I've never had a bill for routine stuff.

Insurance has always sucked....somehow it seems to suck even more when you need to actually use it.

[bjl584]

Insurance is great until you need to use it for something.

We have a rep that comes to our work once a year and goes over all the changes for our healthcare coverage.
He explains how to navigate the waters for making claims and payments.
It is beyond confusing, and if you aren't in the business, the average person won't understand the mechanics of how charges are derived.

Thankfully, I'm healthy and never use my insurance (knock on wood.)

Hopefully, everything gets sorted out for you.

[LivingAlmostLarge]

Insurance is great until you need to use it for something.

We have a rep that comes to our work once a year and goes over all the changes for our healthcare coverage.
He explains how to navigate the waters for making claims and payments.
It is beyond confusing, and if you aren't in the business, the average person won't understand the mechanics of how charges are derived.

Thankfully, I'm healthy and never use my insurance (knock on wood.)

Hopefully, everything gets sorted out for you.

Well what they explain is not what is true. There is a the amount they are willing to pay and then say a % is covered of it. It's so confusing and the medical/dental office bills a certain number. Then there is the deductibles for person and family. I just gave up trying to understand it and pay when the bill comes.

[moneybags]

I have one: I just paid a bill for DH's trip to the allergist. He was tested for an allergen at the office. He had a reaction and had to be treated with several meds. One of the meds is not approved to be paid by our insurance. Was he suppose to stop in the middle of his allergic reaction, ask the doctor what was being administered, then call the insurance company to see if was covered? It was only $40, but he had no option.

[myrdale]

Mine has been an absolute mystery.

Copays, I fully understand. $25 to visit the doctor, $150 for the ER, $15 for medicine.

Deductible on the other hand? Who knows. Mine is $2,000. But in my recent experience with the bat, insurance covered mostly everything except for an out of network billing ($1,200) at an in network location and an additional $900 of $20,000 from the hospital. When discussing this with the insurance company, they said "go ahead and pay it, it will go towards your deductible". When discussing with the hospital they said "you should never have been charged this, don't pay it". I have disputed it with medical group that billed me. I went ahead and paid the $900. Also what good is paying half of your deductible in December anyway?

[Like2Plan]

So sorry you had to have a root canal and your car was rear ended! I hope no one was hurt.
On the root canal- yikes! I'm glad they could get you in quickly and it sounds like you received good care. That might have been the criteria your dentist was using for a referral. In my area it can take several weeks to get an appointment with a endodontist for an initial consult.

I haven't had much luck picking dental insurance. DH and I have tried 4 different companies in the last 4 years. Prior to that DH had pretty good coverage for about $10/month with his company picking up the majority of the expense. The company got bought out and the coverage cost went to $100/month (with a $1500 max benefit per person, per year). I figured with co-pays, etc that we might be better of paying OOP than using that ins.

Anyway-- a couple of years ago during open season I called both DH's and my dental office (I had a new dentist because my old dentist retired) and asked what insurance did they take. I found coverage that both accepted and signed up. Then, a few months later my dental office said they would no longer accept the insurance I had just signed up for on their recommendation (they did accept through the end of the enrollment period, though, thankfully).

So, we are on dental insurance #4. We haven't used it yet this year, so I'm still not sure if self pay instead of insurance is going to work out better for us. Sometimes the negotiated rate is a pretty good discount even though there may be co-pays.

On the car accident, I have never heard of the "old used parts not damaged in another cars accident" scheme. I don't know how you can possibly exactly match used parts (how many miles compared to your vehicle/was it exposed to similar conditions-UV light corrosive materials -salt on highway, washing cycles, garaged etc). Also, once your car is repaired- will it be the same? Possible sprung frame/alignment issues. Will the resale value be less because it was repaired? (Something to discuss in the settlement negotiations, I guess) Hopefully, you get a guarantee on the after market parts.

[Like2Plan]

I have one: I just paid a bill for DH's trip to the allergist. He was tested for an allergen at the office. He had a reaction and had to be treated with several meds. One of the meds is not approved to be paid by our insurance. Was he suppose to stop in the middle of his allergic reaction, ask the doctor what was being administered, then call the insurance company to see if was covered? It was only $40, but he had no option.

That is really crazy!

[disneysteve]

I have one: I just paid a bill for DH's trip to the allergist. He was tested for an allergen at the office. He had a reaction and had to be treated with several meds. One of the meds is not approved to be paid by our insurance. Was he suppose to stop in the middle of his allergic reaction, ask the doctor what was being administered, then call the insurance company to see if was covered? It was only $40, but he had no option.

I wonder if that was a billing/coding issue. The way we treat allergic reactions is pretty standard: Benadryl, a steroid, maybe epinephrine. I'm wondering if what they used truly wasn't covered or it was just billed in such a way as to have it not covered.

As for hospital bills, never, never pay a hospital bill without first reviewing an itemized charge list. Most hospital bills contain errors. One time when DW had surgery, I reviewed the bill and found a $1,000 error. Since the insurance company had already paid their share, that $1,000 came fully off of our out of pocket cost.

Also, hospitals will often give you a discount for payment in full just by asking. I got 30% off a hospital bill that way.

And yes, paying hundreds toward your deductible in December is worthless since it resets January 1.

[LivingAlmostLarge]

So sorry you had to have a root canal and your car was rear ended! I hope no one was hurt.
On the root canal- yikes! I'm glad they could get you in quickly and it sounds like you received good care. That might have been the criteria your dentist was using for a referral. In my area it can take several weeks to get an appointment with a endodontist for an initial consult.

I haven't had much luck picking dental insurance. DH and I have tried 4 different companies in the last 4 years. Prior to that DH had pretty good coverage for about $10/month with his company picking up the majority of the expense. The company got bought out and the coverage cost went to $100/month (with a $1500 max benefit per person, per year). I figured with co-pays, etc that we might be better of paying OOP than using that ins.

Anyway-- a couple of years ago during open season I called both DH's and my dental office (I had a new dentist because my old dentist retired) and asked what insurance did they take. I found coverage that both accepted and signed up. Then, a few months later my dental office said they would no longer accept the insurance I had just signed up for on their recommendation (they did accept through the end of the enrollment period, though, thankfully).

So, we are on dental insurance #4. We haven't used it yet this year, so I'm still not sure if self pay instead of insurance is going to work out better for us. Sometimes the negotiated rate is a pretty good discount even though there may be co-pays.

On the car accident, I have never heard of the "old used parts not damaged in another cars accident" scheme. I don't know how you can possibly exactly match used parts (how many miles compared to your vehicle/was it exposed to similar conditions-UV light corrosive materials -salt on highway, washing cycles, garaged etc). Also, once your car is repaired- will it be the same? Possible sprung frame/alignment issues. Will the resale value be less because it was repaired? (Something to discuss in the settlement negotiations, I guess) Hopefully, you get a guarantee on the after market parts.

Yes for endodontist was I could go see them THAT day. That was huge they had called around to the few places they referred out too. And i'm not sure about the car.

DS I will start to review charges. I wanted to review my root canal but felts really weird saying I'm not going to pay a deposit and instead I'll wait and see the charges. It was so off.

Does anyone else feel that way? That when they ask you for money right there standing in the office you do it. Even without a bill to look at????

[disneysteve]

DS I will start to review charges.

I will warn you that it's not a simple process. There are typically a ton of abbreviations and medical terminology that the average person won't understand (by design, I suspect).

In the case of my wife's hospital bill, I discovered that there was a piece of medical equipment that got billed twice even though she only actually used it once. What happened was they delivered the equipment to her room before surgery, but then they applied the equipment in the OR before returning her to her room, so the first one was never touched but both were billed to her account. Most people wouldn't have caught that.

[ua_guy]

Does anyone else feel that way? That when they ask you for money right there standing in the office you do it. Even without a bill to look at????

It's a practice called "point of service collections" where they may ask you for an estimated amount, a prior balance, copay, or coinsurance when you go to check in. Medical practices do it because the likelihood they will collect patient portions of payments become less likely over time. That increases their administrative costs, cost to collect, and ultimately more accounts end up with debt collectors when they don't do point of service collection up front. There's good incentive for medical practices to do so....it's a hard conversation to have: Pay before the service, or while you're feeling unwell, can we also get you to pay a bill right now? Some people find it offensive and/or demeaning. Some patients worry about their quality of care if they can't or don't pay their bill up front.

On the upside, there is a benefit to patients. If you're only going to be on the hook for a copay or a small percentage/coinsurance for a routine visit with an easily estimated cost, it saves you the hassle of paying a bill online or via mail. You can usually swipe a card (HSA, credit, debit, etc) right there and get a receipt to prove the medical expense. Some practices may even offer a prompt-pay discount for paying up front.

[moneybags]

I wonder if that was a billing/coding issue. The way we treat allergic reactions is pretty standard: Benadryl, a steroid, maybe epinephrine. I'm wondering if what they used truly wasn't covered or it was just billed in such a way as to have it not covered.

Thanks for this info. I spent a lot of time deciphering it. The Rx was not paid by the health insurance. They said our pharmacy plan (separate from medical) should cover it. I have submitted a claim to the pharmacy plan. Now I shall wait and see.

The frustrating part is that 1. I would have just paid this if this thread did not pop up and 2. I spent a lot of time on what should be an automated process.

[disneysteve]

Thanks for this info. I spent a lot of time deciphering it. The Rx was not paid by the health insurance. They said our pharmacy plan (separate from medical) should cover it. I have submitted a claim to the pharmacy plan. Now I shall wait and see.

The frustrating part is that 1. I would have just paid this if this thread did not pop up and 2. I spent a lot of time on what should be an automated process.

It's definitely a frustrating process (as is true of most all insurances; their job is to not pay you whenever possible).

In this case, yes, it might need to go through the prescription plan even though it came from the doctor's office and not a pharmacy. I've often had Medicare patients have a prescription for asthma medicine for their nebulizer get denied because those products actually are covered under Part B and not Part D like all other drugs. I have no idea why. It just is.

[Like2Plan]

Yes for endodontist was I could go see them THAT day. That was huge they had called around to the few places they referred out too. And i'm not sure about the car.

DS I will start to review charges. I wanted to review my root canal but felts really weird saying I'm not going to pay a deposit and instead I'll wait and see the charges. It was so off.

Does anyone else feel that way? That when they ask you for money right there standing in the office you do it. Even without a bill to look at????

Be sure and keep track of what the insurance pays. I track this pretty closely. I had the same deal-where the endodontist wanted a deposit. I paid. Then, at that time I had 2 dental insurances that covered a higher amount than their estimate. The endodontist office didn't automatically refund the overage. I had to call a few times (took several months) before I finally got my refund.