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Esteemed Contributor
Posts: 5,660
Registered: ‎03-09-2010

Re: You Have To Be Aware Or Get Taken Advantage Of

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.

Honored Contributor
Posts: 13,401
Registered: ‎03-10-2010

Re: You Have To Be Aware Or Get Taken Advantage Of

[ Edited ]

 

I started handling big amounts of money (big in that era) when I was 12 years old. Took me lots of hard work to earn every penny I put in my pocket. Had high school car loads try to beat me out of a nickel here, a dime here, and they were unsuccessful.

 

Over many decades I have had many try the same. Some seem to look at easy going laid back men as an easy target, a fish. They would throw in there lure, and sometimes I would bite just to amuse myself. They found out will I bit the lure they could never complete their attempted catch.

 

When it comes to my money transactions, the only one I trust is myself. For people to do otherwise I see as a mistake. Know everything you need to know to understand every transaction of money from your hands to another. Knowledge is power, the more you secure the better off you will be, especially when it concerns your $$$$.

 

@jordan2. I hope everyone reads this very carefully. Nice of you to tell your story to try to help/warn others.

 

 

hnj

Esteemed Contributor
Posts: 7,118
Registered: ‎06-10-2010

Re: You Have To Be Aware Or Get Taken Advantage Of

[ Edited ]

Yes there is a lot of checking to be sure these days.  Now, not only for ourselves but for both my parents.  One of them is in a nursing home and that has been a fiasco beween Va benefits, what Medicare covers.... Medicaid.  Medicaid and the VA fighting with each other, medication programs and mishaps..... Honestly, some weeks I go a little brain dead!

Honored Contributor
Posts: 25,929
Registered: ‎03-09-2010

Re: You Have To Be Aware Or Get Taken Advantage Of


@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.


They recently passed a law in Florida making this practice illegal. Any time you have no control over it the insurance has to pay like it is in network. I had the same situation at the oral surgeon several years ago and I believe I had to pay $800.

Honored Contributor
Posts: 14,484
Registered: ‎07-26-2014

Re: You Have To Be Aware Or Get Taken Advantage Of

Interesting article from AARP for those of us on Medicare....

 

 

The War on Medicare Fraud

"Never argue with a fool. Onlookers may not be able to tell the difference."


220-AuCC-US-CRM-Header-Update.gif

Honored Contributor
Posts: 8,420
Registered: ‎03-09-2010

Re: You Have To Be Aware Or Get Taken Advantage Of

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.

Honored Contributor
Posts: 31,212
Registered: ‎03-09-2010

Re: You Have To Be Aware Or Get Taken Advantage Of

@lulu2

 

Isn't this called "balance billing?"

If it falls under this category, you are not responsible for the the remaining sum.  The provider signed up to participate, and so the provider must comply with the agreed amounts for procedures?

Correct me if this is wrong....

~Have a Kind Heart, Fierce Mind, Brave Spirit~
Honored Contributor
Posts: 31,212
Registered: ‎03-09-2010

Re: You Have To Be Aware Or Get Taken Advantage Of

@151949
I have never had to pay for a procedure that used an "out of network" provider without my consent
~Have a Kind Heart, Fierce Mind, Brave Spirit~
Honored Contributor
Posts: 8,420
Registered: ‎03-09-2010

Re: You Have To Be Aware Or Get Taken Advantage Of


@LTT1 wrote:

@lulu2

 

Isn't this called "balance billing?"

If it falls under this category, you are not responsible for the the remaining sum.  The provider signed up to participate, and so the provider must comply with the agreed amounts for procedures?

Correct me if this is wrong....


@LTT1

 

I have to investigate.  I had the call just a bit ago and was busy so forgot about it until I saw this thread.  The office apparently does not take any insurance, other than Medicare. (and only certain doctors take it)

Respected Contributor
Posts: 3,890
Registered: ‎03-19-2010

Re: You Have To Be Aware Or Get Taken Advantage Of

[ Edited ]

You know, I am just tired of all the jumping through hoops.  I have had health insurance all my adult life and it has never been more complicated than it has been in the past 8-10 years.  One has to almost become an expert, when there are people working and being paid to do this.

 

And don't get me started on the insurance companies.  Two years ago I had a simple surgical procedure scheduled.  It had to be cancelled.  

 

Somehow the insurance got billed and paid.  I notified them that the surgery did not take place.   They told  ME to call the biller and have it corrected.  So I did.

 

Months went by and I kept checking to see if there was a reimbursement.

No....I must have made six calls to both the biller and the insurance company.  In the beginning the poor biller admitted they made an error, contacted the insurer and sent the payment back, but the insurance company sent the check back and told them they did not follow procedures to return the funds.  It took 4 months to get this simple issue resolved.  

 

This January I changed plans within Aetna.  I elected one that had no dental health fund along with some other changes.  Every time I reviewed my plan on line it was showing a dental health fund.  I went round and round with their agents, sent them emails, etc.  I knew what plan I had, my insurance card reflected the plan I had as did my reduced monthly premium.  In their own brochure, it specifically said my plan did not have a dental health fund!

 

Normally I wouldn't have given a hoot, it was their problem, but  during this time I was having extensive dental work done and it was creating problems for my providers and my secondary dental coverage personnel.

 

Does anyone wonder why people get irate?