Fu*kin Health Insurance!
 

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...

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

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

The working man gets fecked.. :yesnod:

: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:

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:

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. OfuckTard 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 fucktards 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:

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:

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:

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:

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.

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:

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. :)

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?

:leaving: