Another inane health insurance story

[disneysteve]

Wow. This doesn't make sense to me.

Lots of things health insurance companies do make no sense so don't let that bother you.

[kv968]

Steve, I have no idea how medical billing works (especially when you need a degree to do it) but maybe they're wanting you to do the different procedures on separate days as a way for you to itemize the cost of both instead of just one bill?

Not sure if that makes sense but what you describe doesn't either so I'm just taking a shot in the dark.

[Gailete]

I managed to get my hubby on this new Obama insurance deal. Since it made my head want to explode trying to understand everything, I forgot one thing and that was to check if our doctor was on the list. Big oops. He walked into the doctor's office yesterday and hadn't yet gotten his new card, but as soon as they knew what kind he had, they had whipped out paperwork discharging him from that practice (owned by the hospital)! He did get to see the doctor that day. He asked if he paid in full for seeing the doctor they said they would refuse him. Hopefully I can cancel the one policy and get him on another one. But that is absolutely crazy. I guess at this point out of network doesn't mean what it used to. Now out of network means, we won't see you at all and you can sink or swim, we don't care. Now the doctor herself is a bit more compassionate and is going to be discussing this with someone else, but this whole things is insane, especially since my hubby is on painkillers and most docs won't touch him with a ten foot pole.

In the midst of typing this the lady from the Doctor's office called and confirmed that he needs to find a new doctor unless I can cancel the insurance and get him on one that they take. Total absolute nonsense.

[Joan.of.the.Arch]

Gailete, is it the company selling the policy that they do not deal with? Or is it the specific policy? I'd be surprised if the practice picks and chooses among policies issued by a given company.

One day when I walked into my doctor's office there was a sign up saying that they no longer worked with Aetna. It wasn't any specific policy; it was the whole darn company that was not working right for the practice.

Sure hope you can get switched to something the doctor's office can work with.

[Gailete]

In our area of the country there are two main insurance suppliers (and they now own the 2 main hospitals as well--talk about a monopoly! I accidently got the policy that from the 'other' side and so my doctor can't take it nor will the hospital that we usually go to.

My doctors office is willing to keep him on if he gets a new policy. The insurance that he is signed up on is willing to cancel the policy, BUT the government won't allow him to drop the policy until the next enrollment period or if there were certain changes in his life. The only way to maintain our doctor is for him to drop the insurance completely and go without for yet another year until we can sign him up again. I feel terrible, but from what the girl at the doctor's office said, a LOT of people have come in with this policy and are now needing to find a new doctor. Apparently I'm not the only one to forget to double check which doctors were on the policy, especially since you had to download the list for each insurance you are considering and I couldn't get it to download at all. We could search for a new doctor, but it is rare to find one that is willing to give out narcotic pain medicine routinely and our doctor will. Since he gets his prescription filled monthly, that would mean finding a doctor, seeing him, and getting him to agree to the usual pain meds within lest than 30 days at this point! with all the people scrambling for new docs at this point, what is the chance of that??

All frustrating beyond words.

[Goldy1]

wow that's just strange. silly. Doubt you can have two dates on service in the same day.
I used to do some minor billing. The doc I worked for would try to bill for multiple things in one day.
He would see a patient and want to get paid more than one office visit a day. He thought he would get paid $100 for talking to the patient about dry eye, another $100 for talking to the patient about cataracts etc. IT seemed a little greedy on the doc's part but I was able to bill a longer doc visit for one dx and he would get paid more than he would with just one short visit(he'd bill two short visits and have to get one rejected from being paid by the insurance.
Another thing that I thought was crazy is he would have me bill for a half hour office visit and he'd be with the patient for 5 minutes. Funny how that stuff works
I don't miss it.
TI was crazy. I had multiple computer systems and methods for each insurance company!

[Gailete]

Sounds like that doctor was plan cheating the system. And driving up costs for all the honest doctors.

I've run into so questionable things over the years with my various illnesses. Following one knee surgery, I had to have injections of a blood thinner for 14 days. We picked it up at the drugstore paid through my MC-D program and I gave myself the injections (I was a nurse I certainly knew how) and so was rather surprised to get a copy of a home health agencies bill for 14 injections given!!!! No nurse ever came and gave me an injection but would look like to the provider a normal bill is they didn't know that I was giving them to myself, although I certainly would have liked to have been paid what they were charging.

A year after a knee surgery I got a bill for a CPM machine rental for $800. I was 'wait a minute' on that one too. Why so long and it had already been paid for. My theory on that one is, little old ladies and men normally get these bills (instead of younger people like I was at the time)and would think it was a bill that they had to pay and would pull out their checkbook, and so the company was double dipping getting paid by MC and then trying for a payment from the patient as well. It is rotten what some companies do to steal a few more dollars.