topic Re: Health IInsurance Insanity in Wellness

Health IInsurance Insanity

I am still oxox — Wed, 12 Dec 2018 21:45:50 GMT

Last week I was checking my EOB's on line and I see a few unpaid bills. The following morning I spend 90 minutes on the phone with the insurance company trying to figure out the error. First I was told our insurance started and ended on 1-1-17, my answer well you paid for my husband's 3 surgeries that year, the answer is oh well you will have to pay us back for what we paid out. i was put on hold to be told oh there were are error and your insurance is fine.

In the meantime 8-10 bills were returned to the provider as unpaid. I have alerted my doctors but this is a huge needless hassle and the insurance company refuses to send me a letter to send to my doctors.

I was so livid I could not even think straight

Re: Health IInsurance Insanity

Peaches McPhee — Wed, 12 Dec 2018 21:52:56 GMT

Wow, you are sure more patient that I am. I wouldn't have even bothered, figuring they'd catch up with themselves sooner or later.

Re: Health IInsurance Insanity

spiderw — Wed, 12 Dec 2018 21:54:12 GMT

I am sorry you had to go through all that stress. I am not going to say a lot except wouldn't it be nice if EVERYONE had access to health care without hassles or stress. I do hope one day this will happen as our health is number one priority. Everything else falls into place behind good health.

Re: Health IInsurance Insanity

I am still oxox — Wed, 12 Dec 2018 21:55:00 GMT

@Peaches McPhee

I am glad I knew before I started getting bills of over $1000 from my doctors offices

@Peaches McPhee wrote:
Wow, you are sure more patient that I am. I wouldn't have even bothered, figuring they'd catch up with themselves sooner or later.

Re: Health IInsurance Insanity

BirkiLady — Wed, 12 Dec 2018 21:56:10 GMT

If the bills have already been paid, your Dr. isn't involved is he? So far, you are probably the only one who has been notified you need to repay the money. Which as I now understand it, has been corrected to "Everything is fine. You don't owe us the money we have already paid."

Therefore, your Dr. probably knows nothing about your letter or today's communication. Get a good nights sleep. Tomorrow everything will be fine. You don't owe that money! Relax. It was a mistake. They happen. Peace.

Re: Health IInsurance Insanity

I am still oxox — Wed, 12 Dec 2018 22:14:11 GMT

@BirkiLady

Bills were not paid originally EOB;s were sent out saying I owe the full amount, this happened with at least 3 providers.

I had to call them and make them aware that it was being taken care of

@BirkiLady wrote:
If the bills have already been paid, your Dr. isn't involved is he? So far, you are probably the only one who has been notified you need to repay the money. Which as I now understand it, has been corrected to "Everything is fine. You don't owe us the money we have already paid."

Therefore, your Dr. probably knows nothing about your letter or today's communication. Get a good nights sleep. Tomorrow everything will be fine. You don't owe that money! Relax. It was a mistake. They happen. Peace.

Re: Health IInsurance Insanity

graciesmom1003 — Wed, 12 Dec 2018 22:28:34 GMT

try the state insurance commissioners office, they may be able to help advocate with insurance. you could also speak to employer's benefit manager. insurance companie are the devil incarnate!!

Re: Health IInsurance Insanity

BirkiLady — Wed, 12 Dec 2018 23:02:50 GMT

@I am still oxox Sorry. I misunderstood your original post. My apologies. From what I understood, it is now taken care of and you do not owe any monies. Correct?

Re: Health IInsurance Insanity

Misplaced Parisian — Thu, 13 Dec 2018 00:37:27 GMT

@I am still oxox Whatever state you live contact the insurance commissioner's office of that state. Each state has one and it has a complaint department. File a complaint! You should be able to do this online. The insurance department will force the insurance company to respond, pay what it should pay, etc. Most states demand a response from the insurance company withtin 10 business days. If you have questions, ask and I'll do my best to guide you.

Re: Health IInsurance Insanity

jlkz — Thu, 13 Dec 2018 13:48:18 GMT

I was sorting and organizing the different monthly and EOB reports for my and DH’s health insurance so I can get things ready for storing 2018 things.

Noticed that 2 of the EOB’s had notations that items that were not being paid by insurance. When I called my insurance customer #, they reviewed the 2 items and said the provider had dropped the charges.

Really ? One was for a blood test my doctor ordered and was recommended to protect against liver cancer ( Hepatitis C ) and should have been covered.

Mistakes and miscoded information can happen at any point in the process. I usually eyeball the monthly statements to make sure I had something done on the dates noted ( I make brief notes on my paper desk calendar and file it with the year’s bills, bank statements, etc. ).

Now, I will highlight any notations that deny payment so I can check on them later.

Re: Health IInsurance Insanity

Laura14 — Thu, 13 Dec 2018 13:55:58 GMT

Don't get me started on stupid people.

Anyone with a hint of common sense (I know it's getting harder to find) can tell that no one has insurance that starts and ends same day. I know of no insurance policy that is paid daily.

I just had someone come to me yesterday with a transaction that showed him doing the same thing twice in one day. It's a rare bird that can even do this thing twice in one day.

Obvious error= fix it= happy customer

Re: Health IInsurance Insanity

kitty60 — Thu, 13 Dec 2018 15:01:36 GMT

I pay personally for health insurance through a major provider and constantly have to contact them regarding what they are not paying as it is covered in my policy. It usually takes several reprocessings and then there is the argument about preventative or wellness? That is their reason to turn down annual mammogram. Again, they fixed. I dislike this process so much! Fortunately annual physical is about all I have. My son on the other hand with a couple of kids is always at the dr. Their is such a discrenpency between providers, insurance companies and indivuals. His major health systems responce is we don't care, we just attach your tax refund! Great attitude,

Re: Health IInsurance Insanity

Carmie — Thu, 13 Dec 2018 15:24:59 GMT

Insurance mistakes happen all of the time. It is a given. Sometimes the error is made because the provider sends in the claim with an error on it..perhaps a number transposed or an incorrect date of birth or gender of the patient.

This might seem like a silly reason for a claim to deny, but you have to remember that human eyes never look at your claims.everything is done electroncally.

Sometimes the provider has old insurance information on file or the patient is using an old Insurance card. Because many providers share information on their billing systems, claims from several sources could be sent in incorrectly.

The insurance company could have updated your records and wrong dates could have been used ( human error)

Anyway, there are hundreds of reasons why claims deny. As long as the problem has been reported and the claims are reopened or the provider resubmits the claims correctly, there is no reason to report anything to the insurance commission.

The state Insurance Commission is there for real problems that are not getting fixed or fraud. When I worked as a Customer Service Rep for a health insurance company , I reopened or adjusted claims every day.

I understand how upsetting this this can be for the patient, but in the insurance side of things, it is business as usual.

There are hundreds of thousands of claims that are processed daily..every day. The majority are processed with no issues.

Re: Health IInsurance Insanity

hckynut — Thu, 13 Dec 2018 16:59:18 GMT

@I am still oxox

My wife spent all of her working career as a Health and/or Dental Insurance Claims Analyst, which has lots of different hats just in those capacities. Most Dental or Medical Insurance Mistakes? They were either mistakenly "coded wrong", or intentionally "coded wrong".

A PCP visit wrongly coded might say $1,000, for just a simple visit. Proper coding might say $10, depending on insurer. The whoppers my wife told me some Dentists were trying to get his/her insurer to pay. Even going so far as sending her insurance company a claim for pulling a tooth she/he had already pulled in the past.

With my head high stack of EOB's? My wife has saved me(us) in the high 5 figures of $$$ because of incompetent staffs, or knowingly trying to stiff their insurers and/or their patients.

This is not something new, or rare. It has been happening for decades and the only difference is the "number figures" are much higher.

My suggestion is to check every single EOB for accuracy, some errors(?) are very easily detected without having the expertise of someone like my wife.

hckynut

Re: Health IInsurance Insanity

chrystaltree — Thu, 13 Dec 2018 22:44:22 GMT

@hckynut wrote:

@I am still oxox

My wife spent all of her working career as a Health and/or Dental Insurance Claims Analyst, which has lots of different hats just in those capacities. Most Dental or Medical Insurance Mistakes? They were either mistakenly "coded wrong", or intentionally "coded wrong".

A PCP visit wrongly coded might say $1,000, for just a simple visit. Proper coding might say $10, depending on insurer. The whoppers my wife told me some Dentists were trying to get his/her insurer to pay. Even going so far as sending her insurance company a claim for pulling a tooth she/he had already pulled in the past.

With my head high stack of EOB's? My wife has saved me(us) in the high 5 figures of $$$ because of incompetent staffs, or knowingly trying to stiff their insurers and/or their patients.

This is not something new, or rare. It has been happening for decades and the only difference is the "number figures" are much higher.

My suggestion is to check every single EOB for accuracy, some errors(?) are very easily detected without having the expertise of someone like my wife.

hckynut

You tried, I'll give you that but "medical coding" has absolutely, postively nothing to do with the charges. That's not what "coding" entails. Coding is ONLY refers to diagnosis codes and procedure codes. There are indeed mistakes in charges but that's a charge error. Sometimes, the billers intend to bill 5 units of a particular lab and and the fingers slip and they bill 50. Everything is automated and done online and people do make mistakes. Again, that's not coding.

Re: Health IInsurance Insanity

ccassaday — Thu, 13 Dec 2018 23:05:21 GMT

Don’t worry about a EOB. They are typically not correct. Only worry if you get a actual bill from a provider.

Re: Health IInsurance Insanity

Carmie — Thu, 13 Dec 2018 23:57:28 GMT

@ccassaday wrote:
Don’t worry about a EOB. They are typically not correct. Only worry if you get a actual bill from a provider.

That is so untrue. Many people get an EOB showing that the claim has been paid and the provider will bill the patient thinking they will get a second payment.

I caught many billing errors over the years on my and my family's claims, especially my Husband's. I finally told the doctor's office that they were crooks. I still think they are.

They have a habit of billing you for lab charges and stating they are not covered by insurance. They are covered, but the payment is low and they are in network and must accept pennies on the dollar, so they try to get the patient to pay.