Fu*kin Health Insurance!

[StaticCling]

So, my primary care Doctor referred me to a Pain Management Doctor for my back issues back in August that turned out to be Out of Network for my Insurance. No biggy right? I just did my due diligence and looked up a Provider that was In Network.

After waiting almost 2 months for the initial appointment, and another 2 or 3 weeks for the procedure, I had the procedure (Epidural Steroid).

I got the EOB today and HOLY SHIT. $4500.00. The Insurance only paid out $900.00. WTF.

:ohnoes:

I've been on the phone for an hour. Apparently the Insurance is saying that the facility is NOT IN NETWORK, even though it still shows that it is on the Website.

Chick at the Office says not to worry, and more than likely the bill will be around $600.00, but still, this is ****ing bullshit. If it's this costly, I'll live with the pain. :(

Stay Tuned...

[Burro (He/Haw)]

So, my primary care Doctor referred me to a Pain Management Doctor for my back issues back in August that turned out to be Out of Network for my Insurance. No biggy right? I just did my due diligence and looked up a Provider that was In Network. <snipped>

Hopefully NAV will find this thread. She's got a huge brain when it comes to this shit.

[island14]

I wonder what it would have cost if you were an illegal or on assistance? :island14:

The working man gets fecked.. :yesnod:

[island14]

Hopefully NAV will find this thread. She's got a huge brain when it comes to this shit.


:iagree:

How did she get to be so smart anyways? :island14:



Heck he just call her or go to her house, I think they are almost neighbors.. :lol:

[Stevedore]

Good luck, I hope it works out. My wife went to an out-of-network place for some super-special high-tech boob X-rays, and their bill translated into "We accept no insurance, don't participate in anything, don't fill out forms, and don't validate parking. Pay us." All was well, though, and I was happy that the bill was the worst of our problems. :cert:

[Datawiz]

Don't get me started on insurance. I'm still personally running without insurance, and only have catastrophic insurance for my wife and daughter. I may be on a plan come February, but this is all bullshit. O****Tard has truly destroyed the self-employed entrepreneurs.

I REFUSE to spend $15,000 per year for insurance, when paying cash out of pocket for our current health needs "might" never top $1,000 a year. HNIC wants my other $14,000 to pay for all of the indigent ****tards in this goddamn country, and keeps handing out more free healthcare to all of the Mexicans he's trying to import to pad his voting base.

When a small business owner, with no employees, makes a modest 6-figure income, but can't afford health insurance, the system is broken. Hell, the metrics for home ownership puts the cost of the home in the 25% range for being conservative. Why should healthcare rank very close to that, when we as a family, spend next to none of that?

This system is beyond broken. :slap:

[Bill]

Hopefully NAV will find this thread. She's got a huge brain when it comes to this shit.

Pics of huge brain?

[Datawiz]

Pics of huge boobs?

:iagree:

[Burro (He/Haw)]

Pics of huge brain?

:cert:

[Bill]

:cert:

Either NAV isn't aging well, or you might have misunderstood my request.

[Burro (He/Haw)]

Either NAV isn't aging well, or you might have misunderstood my request.

The important thing here is she doesn't misinterpret my post. :lol:

[simpleman68]

Don't get me started on insurance. I'm still personally running without insurance, and only have catastrophic insurance for my wife and daughter. I may be on a plan come February, but this is all bullshit. O****Tard has truly destroyed the self-employed entrepreneurs.

I REFUSE to spend $15,000 per year for insurance, when paying cash out of pocket for our current health needs "might" never top $1,000 a year. HNIC wants my other $14,000 to pay for all of the indigent ****tards in this goddamn country, and keeps handing out more free healthcare to all of the Mexicans he's trying to import to pad his voting base.

When a small business owner, with no employees, makes a modest 6-figure income, but can't afford health insurance, the system is broken. Hell, the metrics for home ownership puts the cost of the home in the 25% range for being conservative. Why should healthcare rank very close to that, when we as a family, spend next to none of that?

This system is beyond broken. :slap:

Holy Hell.... you're mirroring my exact sentiments from the other day.
We're a family of 4 and the math on coverage is totally screwed.

We just re-upped and will cost us $8k a year and that covers NOTHING.
Our deductible is $12k out of pocket and is good only for catastrophes.
We debated going uninsured for another period and prepared for the fines.

Self employed in this country = you're screwed, blued and tattooed.
Scott

[JRD77VET]

Holy Hell.... you're mirroring my exact sentiments from the other day.
We're a family of 4 and the math on coverage is totally screwed.

We just re-upped and will cost us $8k a year and that covers NOTHING.
Our deductible is $12k out of pocket and is good only for catastrophes.
We debated going uninsured for another period and prepared for the fines.

Self employed in this country = you're screwed, blued and tattooed.
Scott

I'm on Mary's health insurance ( she works at the local hospital in house keeping ) and in addition to a 25% increase in cost this year, they are implementing a $100 per pay surcharge in addition to the higher premium if the spouse is on the plan. :cuss:

looks like I just got my hard earned raised taken way :bslap:

[StaticCling]

I'm on Mary's health insurance ( she works at the local hospital in house keeping ) and in addition to a 25% increase in cost this year, they are implementing a $100 per pay surcharge in addition to the higher premium if the spouse is on the plan. :cuss:

looks like I just got my hard earned raised taken way :bslap:


Jeff, I hear ya. Got a MEASLY raise, Rumor mill on the Health Premiums looks like I'm gonna take that one up the butt, and then some.

One Step Forward, Two Steps Back.

:wtf:

[markids77]

12 years ago now my wife began exhibiting flulike symptoms, progressing to severe distress/hallucination and eventually wound up at Brigham and Women's in Boston in an induced coma while doctors searched for a donor liver to keep her alive. Fortunately she regained function on her own and has made a full recovery. The total bill for that little adventure exceeded 1.5 million back then. Our total copay including the deductible was about 15K. Still took us a couple years to get it paid off.

I would gladly forego all the racecars, bikes, boats, second homes, guns and vacations I may ever see to maintain insurance for us at any cost. Any of you who think you can win the healthcare lottery by avoiding catastrophic illness are deluding yourselves and risking financial ruin to save a couple thousand so you can play. Don't be a dumbass; get some kind of coverage.

[Woody]

Good luck getting that switched to in-network from out-of-network. I can't count the number of hours I spent this year talking to Cigna about billing.

[MrPeabody]

Good luck getting that switched to in-network from out-of-network. I can't count the number of hours I spent this year talking to Cigna about billing.

My sister-in-law was a vice president at Cigna. She always said the joke among the employees was Cigna stands for Call In Get No Answer.:leaving:

[StaticCling]

Great. Thanks. :(

To top it all off, I was overpaid at work today (payday). I did the honest thing and told my boss....They are apparently going to retract the Direct Deposit, and send me a hard check tomorrow via FedEx. I'm not banking on it knowing the company I work for.

Also, One of Heather's jobs starting tomorrow might be cancelled, there goes about 1k. :Jeff '79:


I'm not worried though, we will get along just fine. As they say, Shit Happens. :)

[NEED-A-VETTE]

So, my primary care Doctor referred me to a Pain Management Doctor for my back issues back in August that turned out to be Out of Network for my Insurance. No biggy right? I just did my due diligence and looked up a Provider that was In Network.

After waiting almost 2 months for the initial appointment, and another 2 or 3 weeks for the procedure, I had the procedure (Epidural Steroid).

I got the EOB today and HOLY SHIT. $4500.00. The Insurance only paid out $900.00. WTF.

:ohnoes:

I've been on the phone for an hour. Apparently the Insurance is saying that the facility is NOT IN NETWORK, even though it still shows that it is on the Website.

Chick at the Office says not to worry, and more than likely the bill will be around $600.00, but still, this is ****ing bullshit. If it's this costly, I'll live with the pain. :(

Stay Tuned...

Who's website does it show in-network? The health plan's website? Or the website for the doc's office?

If it's on the health plan's website, log back on and do a screen shot immediately. This will be your leverage for an appeal.

Actually, if it's on the doc's website, take a screen shot of that, as well. Couldn't hurt. You could file an appeal with DMHC for misleading and egregious billing.

Here's what I need to know: Who is showing the doc as in-network? Did your doc re-issue a referral for the "in-network" specialist? Was the referral approved? Who approved the referral? Which health plan is this? What does the patient responsibility portion state on the EOB (dollar amount)? What is the date on the EOB? What does you evidence of coverage say, in terms of your deadline for filing an appeal?

It sounds like someone either (1) mistakenly approved a referral for for an out-of-network doc or (2) never received a proper approval for the referral.

Which medical group are you enrolled with?

[NEED-A-VETTE]

Pics of huge brain?

:iagree:

:cert:

Either NAV isn't aging well, or you might have misunderstood my request.

The important thing here is she doesn't misinterpret my post. :lol:

:leaving:

[Burro (He/Haw)]

Who's website does it show in-network? The health plan's website? Or the website for the doc's office? <snipped>

See?!?! Giganticus Brainabus!!! :cert:

[NEED-A-VETTE]

Scott, one more question...did you get a letter from your medical group saying your referral was approved?

Just call me later or tomorrow. Managed Care Financial Operations is my thing. On the group side. :D

[Hoog]

Hopefully NAV will find this thread. She's got a huge brain when it comes to this shit.
I myself have benefited from that big brain. NAV is good people.

[StaticCling]

Who's website does it show in-network? The health plan's website? Or the website for the doc's office?

If it's on the health plan's website, log back on and do a screen shot immediately. This will be your leverage for an appeal.

Actually, if it's on the doc's website, take a screen shot of that, as well. Couldn't hurt. You could file an appeal with DMHC for misleading and egregious billing.

Here's what I need to know: Who is showing the doc as in-network? Did your doc re-issue a referral for the "in-network" specialist? Was the referral approved? Who approved the referral? Which health plan is this? What does the patient responsibility portion state on the EOB (dollar amount)? What is the date on the EOB? What does you evidence of coverage say, in terms of your deadline for filing an appeal?

It sounds like someone either (1) mistakenly approved a referral for for an out-of-network doc or (2) never received a proper approval for the referral.

Which medical group are you enrolled with?

Sandy, I'll PM you.

[mrvette]

These damn health care companies send so much crap in the mail, how in hell can I bother to read books almost 1/2" thick 8x11 size, plus all the constant mailers?? so wife's mother is on United Healthcare the AARP plan but no AARP membership, not required....So wife is handling her Mom's affairs, and something was always screwed up about my enrollment by State of Florida in the Humana plan......and something changed that looks as if I be screwed yet again, like about 16 months ago.....So this agent for United calls and we go over the plan and he looks up if my prime care doc and a few other guys are in the circle for them, they were listed in the book he pulled out to check, so I signed up for United several months ago, effective Jan 1st......I fully expect some screw up :issues: because the .gov is involved.....

Wife herself is only age 64 and is doing nothing about health insurance, has no where to go with it, and is self employed, not making enough $$$, she not and nore are her kids going to shell out some thousands/year.....two of the kids work for companies, so have something, but her oldest son who is my height at 6'5" has the same sort of lo sack back aches, sometimes disabling he damn sure not able to shell out for anything...he workd independently, paint/repair of houses for investors and mgmt. cos......

Thing that bugs ME is when wife got hauled to hospital about 3 years ago, when her car was totalled out by a texting illegal at 45 mph, her trip to the hospital was 18,500 bux, no broken bones, just all beat up, and of course lost her car......due to lousy Florida No fault insurance laws, the guilty party pays out ten grand in the hospital bill, leaving US OWING 8500 bux.....then we get a note about between the hospital and some charity picking up the 8500 bux......BS....I think it's crooked billing from ground up.....Ambulance service is City of Jax....sent a bill for 500 bux or so, wife paying 25 bux/month....be doing that for rest of her life at that rate.....

:issues::kick::shots::shots:

[MikeB]

65% rate increase starting in 2 weeks.

20% of my pre-taxed income.

My democratic Senator (Tammy Baldwin) says "I appreciate knowing of your concerns about increased premiums. In general, premiums rise each year as health costs, including costs of medical services and drugs, increase and vary by region. Before the Affordable Care Act was enacted, most families saw double-digit rate increases every year particularly in the individual market, as health insurance companies had the freedom to charge high prices for health insurance"

Blah Blah Blah.

65% increase starting Jan 1st, 2016.
Since 2009, when I lost my career to India, and 33% of my income, my insurance rates have gone up 477% for crap-coverage

My republican Senator (Ron Johnson) says:
And instead of the ‘Affordable Care Act’ making health care more affordable, the evidence shows that it has actually made health coverage more expensive.

“As a result, I voted yes tonight with 51 of my colleagues to repeal most of Obamacare’s harmful provisions. The president should sign this bill so we can begin moving toward free market reforms that devolve power from Washington toward doctors and patients

Pretty much the same story from my republican House or Rep Jim Sensenbrenner.

No Help.


Oh well, good bye to an extra $75.00 dollars per week for the increase.
I have no idea what I'll cut back on, but it's a good thing my mortgage is paid off.

[Jeff '79]

I feel your pain.
With both my daughters away in DC and NY, you really have to ask if:

#1 they accept your insurance
#2 and MOST IMPORTANTLY, are they IN NETWORK.
My wife does all of that BS for them prior to a visit, however we still get burned on occasion.
Let's say you see the doc and then he sends you for tests in the same building.
YOU HAVE TO THEN ASK THE SAME TWO QUESTIONS OF THE LAB.....
It's such a PITA that my daughters are afraid to go to the doctor now because of the possibility of a crazy bill.
That being said, I have talked those crazy bills down to nothing in certain instances.
GET APPROVALS AND LETTERS STATING THE ANSWERS TO THOSE TWO QUESTIONS IN WRITING. They can't bill you if you have them.
You need to call the # on the bill and negotiate. You'd be really surprised as to the result. Do not take no for an answer and if they refuse, agree to pay $5 a month until the debt is paid. They will then settle for a lot less than you were billed.
Ask me how I know.

[stingraymyway]

So, my primary care Doctor referred me to a Pain Management Doctor for my back issues back in August that turned out to be Out of Network for my Insurance. No biggy right? I just did my due diligence and looked up a Provider that was In Network.

After waiting almost 2 months for the initial appointment, and another 2 or 3 weeks for the procedure, I had the procedure (Epidural Steroid).

I got the EOB today and HOLY SHIT. $4500.00. The Insurance only paid out $900.00. WTF.

:ohnoes:

I've been on the phone for an hour. Apparently the Insurance is saying that the facility is NOT IN NETWORK, even though it still shows that it is on the Website.

Chick at the Office says not to worry, and more than likely the bill will be around $600.00, but still, this is ****ing bullshit. If it's this costly, I'll live with the pain. :(

Stay Tuned...

Hope and Change. It ain't what it use to be.

[CertInsaneC5]

I feel your pain.
With both my daughters away in DC and NY, you really have to ask if:

#1 they accept your insurance
#2 and MOST IMPORTANTLY, are they IN NETWORK.
My wife does all of that BS for them prior to a visit, however we still get burned on occasion.
Let's say you see the doc and then he sends you for tests in the same building.
YOU HAVE TO THEN ASK THE SAME TWO QUESTIONS OF THE LAB.....
It's such a PITA that my daughters are afraid to go to the doctor now because of the possibility of a crazy bill.
That being said, I have talked those crazy bills down to nothing in certain instances.
GET APPROVALS AND LETTERS STATING THE ANSWERS TO THOSE TWO QUESTIONS IN WRITING. They can't bill you if you have them.
You need to call the # on the bill and negotiate. You'd be really surprised as to the result. Do not take no for an answer and if they refuse, agree to pay $5 a month until the debt is paid. They will then settle for a lot less than you were billed.
Ask me how I know.



This. ^^^^ I have had to do this twice in the last 3 years. :seasix:

[JRD77VET]

I'm staying on my wife's insurance. Ran all the numbers and looked at deductibles. What she is currently paying $207.41 every two weeks will now cost $341.69

I seem to remember somebody saying costs would go down and we could keep our current doctors if we wanted :issues:

I'm going to do payroll deduction and transfer $75 EVERY WEEK to keep her pay check close to the same.

[NEED-A-VETTE]

Sandy, I'll PM you.

Got it. :cheers:

[yell01]

Don't get me started on insurance. I'm still personally running without insurance, and only have catastrophic insurance for my wife and daughter. I may be on a plan come February, but this is all bullshit. O****Tard has truly destroyed the self-employed entrepreneurs.

I REFUSE to spend $15,000 per year for insurance, when paying cash out of pocket for our current health needs "might" never top $1,000 a year. HNIC wants my other $14,000 to pay for all of the indigent ****tards in this goddamn country, and keeps handing out more free healthcare to all of the Mexicans he's trying to import to pad his voting base.

When a small business owner, with no employees, makes a modest 6-figure income, but can't afford health insurance, the system is broken. Hell, the metrics for home ownership puts the cost of the home in the 25% range for being conservative. Why should healthcare rank very close to that, when we as a family, spend next to none of that?

This system is beyond broken. :slap:

Holy Hell.... you're mirroring my exact sentiments from the other day.
We're a family of 4 and the math on coverage is totally screwed.

We just re-upped and will cost us $8k a year and that covers NOTHING.
Our deductible is $12k out of pocket and is good only for catastrophes.
We debated going uninsured for another period and prepared for the fines.

Self employed in this country = you're screwed, blued and tattooed.
Scott
For f*cks sake Craig, I had a few cocktails and was chillin' reading forums and see this. Now I'm pizzed as f*ck again because of this POS socialist, clueless f*cktard!!! The plan I had was eliminated by our insurance company so we had to switch plans. The new plan we had to pick that's comparable is 28% more than the old one. I pay more each month for motherf*cking insurance than I do for my mortgage. I'm sick of this wealth redistribution b.s.!!!! I make what I do because I work hard!

I called about offering insurance to my employees and there are no discounts unless your over 50 people. F'n hell, I need another drink now!!!!!!!!!

[NEED-A-VETTE]

I feel your pain.
With both my daughters away in DC and NY, you really have to ask if:

#1 they accept your insurance
#2 and MOST IMPORTANTLY, are they IN NETWORK.
My wife does all of that BS for them prior to a visit, however we still get burned on occasion.
Let's say you see the doc and then he sends you for tests in the same building.
YOU HAVE TO THEN ASK THE SAME TWO QUESTIONS OF THE LAB.....
It's such a PITA that my daughters are afraid to go to the doctor now because of the possibility of a crazy bill.
That being said, I have talked those crazy bills down to nothing in certain instances.
GET APPROVALS AND LETTERS STATING THE ANSWERS TO THOSE TWO QUESTIONS IN WRITING. They can't bill you if you have them.
You need to call the # on the bill and negotiate. You'd be really surprised as to the result. Do not take no for an answer and if they refuse, agree to pay $5 a month until the debt is paid. They will then settle for a lot less than you were billed.
Ask me how I know.

Yeah, this is important. There's a difference between accepting your insurance and being in-network. If they accept your insurance, but are not in-network (contracted) the doc is not obligated to take the payment (that your insurance makes) as payment in full (minus copays or coinsurance, of course).