Community Chat

[Mz iMac]

@lulu2

If BC/BS is your PRIMARY, you need to contact them ASAP to relay what the manager for the neuro told you.  Then let them deal w/the primary to secondary ins discripancy.

[151949]

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@lulu2 wrote:

I had a call from the business manager for a neurologist I will be seeing.  She said they will take my Medicare as a primary provider but will bill my secondary, NJ Horizon Blue Cross/Blue Shield, as an out of network provider.  I will be responsible for the balance after insurance.  This is their way of getting around the paltry sums they are reimbursed  by Medicare and private providers.

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This is exactly how it is supposed to work. What way do you feel you are being ripped off? No one here is "getting around " anything. If you don't want to pay it - pick an in network provider.

[LTT1]

@Jordan2
Thank you for the up-front warning!
For my colonoscopy, which was done two weeks ago, I asked from the beginning about the anesthesiologist being in-network.
That practice has stopped using OON within the same procedure.

[hckynut]

I won't make any specific charges against any particular entity, but I can tell you this. Being able to know Medical coding, not me but my wife, has saved me many thousands of dollars over years, and even at the present time.

Where the "so called" coding mistakes(?) money ends up and in whose pocket.  I am not sure. Some like to blame new employees on the job. That's possible, but either way these wrong codings take lots of money from lots of people.

Read every EOB you receive and take note of the coding. If you think you were over billed for services rendered? My advice would be to follow up until you are 100% satisfied. Does it take time? You bet it does. I recently spent 3 months following up from a doctor that prescribed a brand name instead of my many years on genetics. The difference for a 3 month supply was $150, but I got it back.

Just a PSA for anyone that wants to know that this isn't THE exception, but almost the norm.

hckynut(john)

[Allegheny]

In December I had to go to the ER to an in network hospital.  Low and behold I get a bill from an ER doctor group who are independent providers.  Luckily they were considered in network for my insurance, but didn't have to accept the payment rendered.  So I did end up paying the balance.

Did I know this ahead of time?  Absolutely not.  In time of emergency you don't readily have that information.  So you could have all kinds of providers within your network approved hospital who are not in the network and end up getting huge bills.  That in my eyes is wrong, wrong, wrong.

[azgal]

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@KathyPet wrote:

When my daughter gave birth to my grandson her insurance company refused to pay for the anthesologist because he was "out of network".  Now you can be sure to,pick a doctor that is in your network but when you go into the hospital for any type of surgery or procedure that requires a anthesia be given you surely do not get a choice of people.  You get whoever is on duty that day.

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I had that happen to me. I even talked to the hospital administrator who told me to appeal it, which I did. I told the insurance company I went to an in network hospital, it was an emergency situation and I had no control over who they assigned to me. The hospital had the insurance information and I was too sick to ask a bunch of questions. I won the appeal. 

If its not too late, maybe your daughter can appeal.

[azgal]

@Allegheny They should have fixed this problem when they did the affordable care act. This is such a common problem. I think if you use a network facility everything in that facility should be in network.

[Mz iMac]

The majority of people does not know medical codes nor their meaning(s) in order to scrutinize their medical bills & EOBs (Explaination Of Benefits) from a hole in the ground.

This website link will help you as all of you have access to the internet......

LINK---> Medical Billing Code Search

I refer to the above website if I run across a code I am unfamiliar with.  When I do, I am on the phone to my dr office manager for an explanation on the "code change."

[lulu2]

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@151949 wrote:

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@lulu2 wrote:

I had a call from the business manager for a neurologist I will be seeing.  She said they will take my Medicare as a primary provider but will bill my secondary, NJ Horizon Blue Cross/Blue Shield, as an out of network provider.  I will be responsible for the balance after insurance.  This is their way of getting around the paltry sums they are reimbursed  by Medicare and private providers.

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This is exactly how it is supposed to work. What way do you feel you are being ripped off? No one here is "getting around " anything. If you don't want to pay it - pick an in network provider.

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Where did I say I felt I was being ripped off?

[MalteseMomma]

Watch your eye Dr too...............(just sayin)