Re: Health IInsurance Insanity

Laura14 · ‎06-09-2014

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

kitty60 · ‎03-13-2010

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,

Carmie · ‎10-25-2010

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.

hckynut · ‎03-10-2010

@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

hckynut(john)

chrystaltree · ‎05-10-2010

@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.

ccassaday · ‎10-21-2010

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

Carmie · ‎10-25-2010

@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.