"OUT OF NETWORK" - Page 5

151949 · ‎03-09-2010

@Nuttmeg wrote:
@151949 wrote:
if you have a PPO you can go out of network and they pay it but I have an HMO and they do not pay anything for out of network.NOTHING.
I have a PPO plan with Medicare. We are warned to be careful to stay in network, because the charges can get very expensive.

I agree - when we had our PPO my DH wanted to go to a certain out of network ENT doctor and he was shocked when he got billed $275. He thought it was only going to be around $50. But he did have to pay it.

151949 · ‎03-09-2010

The reason we decided to change from a PPO to the HMO was that UHC HMO has what they call passport which allows you to travel to certain areas where they have contracted providers and it is in network. Recently, UHC has moved into the Pittsburgh area, were we spend our summers, and we saw that our old PCP is now in network with them. So if we were ill while we are there we could go to him. The PPO did not have the passport in the Pitts, area yet. Also the HMO has silver sneakers which pays our YMCA membership so that saves us $60/month, and the PPO does not.

patbz · ‎03-10-2010

Talk about "out of network": several years ago DH had a persistent neck pain, I checked him into our local "in network" hospital where he had a stroke. He was air evaced to Mayo Clinic where he immediately went into ICU for eight days. At that time they told me he was out of network. Two more months at 3 facilities (last 2 in network). The Mayo bill was $450,000 and BCBS denied a significant part of it. I fought back, including 2 visits to their Phoenix administrative complex (where my conferences going line by line over repetitive and often incorrect bills were overheard by on-site armed guard!). End result is that we ended up responsible for only $10,000 (ugh) of Bill.

151949 · ‎03-09-2010

@patbz wrote:
Talk about "out of network": several years ago DH had a persistent neck pain, I checked him into our local "in network" hospital where he had a stroke. He was air evaced to Mayo Clinic where he immediately went into ICU for eight days. At that time they told me he was out of network. Two more months at 3 facilities (last 2 in network). The Mayo bill was $450,000 and BCBS denied a significant part of it. I fought back, including 2 visits to their Phoenix administrative complex (where my conferences going line by line over repetitive and often incorrect bills were overheard by on-site armed guard!). End result is that we ended up responsible for only $10,000 (ugh) of Bill.

I was wondering what happens when you are taken, unconscious to an out of network facility.It's not like you have a choice. Very scary.

Melania · ‎06-12-2013

@151949 wrote:
@patbz wrote:
Talk about "out of network": several years ago DH had a persistent neck pain, I checked him into our local "in network" hospital where he had a stroke. He was air evaced to Mayo Clinic where he immediately went into ICU for eight days. At that time they told me he was out of network. Two more months at 3 facilities (last 2 in network). The Mayo bill was $450,000 and BCBS denied a significant part of it. I fought back, including 2 visits to their Phoenix administrative complex (where my conferences going line by line over repetitive and often incorrect bills were overheard by on-site armed guard!). End result is that we ended up responsible for only $10,000 (ugh) of Bill.
I was wondering what happens when you are taken, unconscious to an out of network facility.It's not like you have a choice. Very scary.

That's true. You have no choice so why should one get penalized for it? I bet some of these places have a first choice to take patients to and the patient has no control.

KarenQVC · ‎05-13-2010

Following one's health insurance has become a part time job. Yes, the patient is responsible for knowing. That is why we got Plan F. Even with that I got caught twice.

gardenman · ‎03-09-2010

Much of modern medicine looks at patients as cash cows just waiting to be milked. The more money they can milk out of the patients, the happier they are. Using "out of network" costs is just one way they can milk more cash from patients. The "in network" providers aren't losing money on each patient they treat, so the "out of network" providers could accept the same payment if they chose to and become "in network" but they won't because then they wouldn't be able to milk as much cash out of the patients.

The cost differences between "in network" and "out of network" is ludicrously high. I've seen "out of network" chrages that are five times or more the "in network" cost.

From a purely financial standpoint, why shouldn't a provider accept any and every insurance? Turning away paying customers is generally a bad idea. As long as you're making some money from each patient, shouldn't you treat every patient?

Medical care is the only place where we have wildly fluctuating prices based on who you are and what insurance you have. When you go to buy a car the price of the car doesn't vary depending on what type of auto insurance you have. When you buy a home the price of the house doesn't vary depending on your homeowners insurance. Why should the price of an MRI vary depending on the type of insurance you have?

Our current medical system is a big mess that needs to be seriously changed. We wouldn't tolerate the nonsense that goes on in medicine in any other field. In nearly every other part of our society, the price is the price regardless of who you are, what insurance you have, how much money you have, etc. The price is the price. Only in medicine do we have wildly fluctuating prices and it needs to be stopped.

Fly!!! Eagles!!! Fly!!!

Lucky Charm · ‎03-09-2010

Such fluctuating pricing takes away from affording everyone a health insurance opportunity.

Makes no sense.

MomCat · ‎09-12-2010

@Lipstickdiva wrote:
If you were getting a screening mammogram, all things considered they really aren't that expensive, in case you do have to pay for it.

That's true. I know ladies who pay for these out of pocket.

I don't think I would check if my mammo location that I've gone to for years was still in network, but I know for a fact that the person I'm checking in with certainly knows if I'm covered, or not. That discussion actually starts when I make the appt. They always confirm that my insurance is still the same.

KarenQVC · ‎05-13-2010

I assume the business model is working for all the businesses involved--they make $. If there is no control on the costs, the costs will continue to go up. There is no end in sight.