Petty Insurance Rant

SixPapaCharlie

SixPapaCharlie

May the force be with you
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1st. I am not an unintelligent guy. I think a lot, I am good At math, I have a degree, I got the highest score possible on my Apgar exam.

I have no clue what is going on regarding my bill and I know there are people in the world that are dumber than me. It's not their fault. It just that I know there is a bell curve and they probably don't.

So do most people just pay whatever number is on a bill? If so, I am starting a random billing service.


Background (I know 1st world problems. Quit reading then):
I schedule my medical stuff, they run the numbers and tell me my out of pocket is $50. cool

I schedule it, They examine my shoulder (Had to go in through my ass. And it wasn't at a hospital. And he wasn't a doctor. And he never discussed my shoulder...)

I get a bill (this is not a bill) for $200

I call and the IVR says [robot voice]
press 1 for billing. Then the robot tells me I owe $250

So they have different numbers in their system for amounts I owe and one gets printed and mailed and the other given to a robot (Why do robots have British accents?)

I call and speak to the first line of defense from the unfortunate section of the aforementioned bell curve. Her words when asked were "I don't know where these numbers are coming from"

She tells me to call the Dr. with whom I met. "No, he billed Cigna and Cigna spit out these 3 numbers someone in your company must know how this works. You don't , I don't, and I bet most people don't but someone does."

and on and on.

I will pay whatever I owe. but I don't want to pay a bill when the system generating the bill disagrees with itself and spits out 3 different numbers for the same stuff. I worked for a few years programming at a 3rd party benefits admin so I am trying to be understanding. :mad:



*the first person that writes the word "Obama" in subsequent posts this thread is an azzhole. This stuff has been broken for a long time.

** that Apgar exam part was funny.
 
Obama sed he'd fix this stuff and you could keep your doctor and policy...
 
We're dealing with similar issues from a surgery my father had recently. So far, we've seen 7 bills with 7 different amounts. The first bill came and we asked for an itemization. So they sent a new bill. With a different amount and no itemization. Lather, rinse, repeat.
 
I wish I could help. Cigna manages the healthcare I have through work. I supposedly have a $2100 a year out of pocket maximum. According to my records I've shelled out a bit more than that. Not much in the overall scheme of things, but if I can track it, so can they.

Good luck.
 
Mail them a check for 2 bucks. Keep the billing stupidity spinning.
 
ClimbnSink said:
Mail them a check for 2 bucks. Keep the billing stupidity spinning.
Click to expand...

That's not a bad idea.
My understanding is (feel free to correct me) if you are sending in something, they won't turn it over to collections.

But then the How much is my time / effort worth comes into play.

I simplify things for a living so this insurance heck, even phone bill type stuff is nauseating.
 
I fail to understand your confusion, the $250 is the total, the $50 is out of pocket, the $200 is what the insurance pays. You don't pay the $200 (as you said, 'This is not a bill'), it's just a billing statement.
 
Henning said:
I fail to understand your confusion, the $250 is the total, the $50 is out of pocket, the $200 is what the insurance pays. You don't pay the $200 (as you said, 'This is not a bill'), it's just a billing statement.
Click to expand...

:yeahthat:

The $200 "this is not a bill" is the Explanation of Benefits from your insurance provider - this is what they cover. You pay the remaining $50 of the final $250 bill.
 
Henning said:
I fail to understand your confusion, the $250 is the total, the $50 is out of pocket, the $200 is what the insurance pays. You don't pay the $200 (as you said, 'This is not a bill'), it's just a billing statement.
Click to expand...

It is an EOB (not a bill) but the wording is this

Amount billed $300
Discount (WTH?) $100
What your plan paid: $0.00
What I owe: $200

When I called, the IVR said I owe: $250

And when scheduled they quoted $50
 
Did you pay the Dr the $50 at the office? If so, don't worry about the rest.
 
I haven't paid anyone anything.
I paid a copay for the initial consultation.

I am not giving anyone any money until I have "This is a bill" mailed to me.
And again I am talking about essentially pennies here in the grand scheme of things but I just want them all to agree.
 
Amount billed $300 - what the Dr. claims to charge.

Discount (WTH?) $100 - Insurance company thinks $300 is too high and reduced the number for you.

What your plan paid: $0.00 - what the insurance company actually paid.

What I owe: $200 - what's left

When I called, the IVR said I owe: $250 - based on what they expected the insurance company to think was the right amount to pay.

And when scheduled they quoted $50 - a number based on the assumption that the insurance company would pay something.
 
SixPapaCharlie said:
I haven't paid anyone anything.
I paid a copay for the initial consultation.

I am not giving anyone any money until I have "This is a bill" mailed to me.
And again I am talking about essentially pennies here in the grand scheme of things but I just want them all to agree.
Click to expand...

My understanding is that the Dr's office said you would pay $50, pay that 'in good faith', this is important if things go all the way stupid, which they shouldn't, but you're gonna end up paying $50 regardless so go ahead. Let the Dr's office and insurance company negotiate and settle the rest.
 
Wait for the statement that indicates they're going to send you to collections and that your insurance has paid their required portion ... about that time it MIGHT be accurate
 
You are not allowed to look behind the curtain. You might realize the insurance "Wizards" are pulling a scam and out them. Expect AIG assassin-ninja attacks shortly.
 
Cigna covers aircraft insurance? Renter's insurance? I'm confused, because this is in the "Flight Following" forum. Or has "Hangar Talk" exceeded its thread capacity?
 
SixPapaCharlie said:
I haven't paid anyone anything.
I paid a copay for the initial consultation.

I am not giving anyone any money until I have "This is a bill" mailed to me.
And again I am talking about essentially pennies here in the grand scheme of things but I just want them all to agree.
Click to expand...

They'll all agree eventually. It'll be 9 months from now when you've forgotten about all this and finally get the actual bill in the mail.
 
SixPapaCharlie said:
I schedule it, They examine my shoulder (Had to go in through my ass. And it wasn't at a hospital. And he wasn't a doctor. And he never discussed my shoulder...)
.
Click to expand...

No one is going to comment on this part? Just let it slip by?
 
Architecture school son pulls 2x8 down from rack and directly into his forehead at college shop. Needs stitches and, perhaps, more common sense:
  • 5/18 Get insurance company explanation of benefits saying that I “saved” $314.31 per a negotiated discount, and that I only owe the provider $386.69
  • 6/25 Get bill #1 from clinic for $701 and decide to wait for updated bill
  • 7/25 Get bill #2 from clinic, still for $701
  • 8/8 Send check for $386.69, with handwritten note re $314.31 discount
  • 9/19 Get “Collection Notification” re $314.31
  • Make multiple phone calls, still an open issue.
Sigh
 
Brad Z said:
Cigna covers aircraft insurance? Renter's insurance? I'm confused, because this is in the "Flight Following" forum. Or has "Hangar Talk" exceeded its thread capacity?
Click to expand...


whoops. sorry.
 
ClimbnSink said:
Mail them a check for 2 bucks. Keep the billing stupidity spinning.
Click to expand...

Buy this man a beer! :rofl::rofl::rofl:

This crap has been broken long before Obama...really.

Back in 93 or so, I negotiated the price and got the quote in writing on a test from the local hospital. I too kttya amount it in cash and you should have seen the meltdown this caused. They couldn't take the cash...no mechanism in place to deal with it. So I got the test and waited for he bill. Came in about two months alter at 4-5x the quoted price.

I went in person to the same administrator who wrote and signed the quote and she was indignant that the bill I had was correct and the quote was an estimate...I raised hell and she took the old "I am doing you a favor" route.

The Affordable Health Care Act is not going to fix this crap...
 
Sounds like you have a deductible. You should have a book that explains all this or you can find it online........ usually.... Obama.
 
I told you in another thread to be very careful. You urinated on my suggestion.

Soooooo: ObamaObamaObamaObamaObamaObamaObamaObaObamaObamaObamaObamaObamamaObamaObamaObamaObamaObamaObamaObamaObamaObamaObamaObamaObama

Yes, I am an azz. I guess you're smarter than me mr bell shaped curve. OBTW, the billing issues have nothing to do with math, I think that's pretty straightforward. This is an INSURANCE coverage issue, which - no one on the planet understands, and if you start to understand it, the rules will instantly be changed.

neener, neener. :yesnod:
 
Kinda sounds to me like the insurance company denied the claim. They did that to is for routine tests that were covered before obamacare...azzhole me...i wasn't the first, but I admit i'm an azzhole....my wife would agree....they said the tests were not medically necessary. Six months, three letters, about 12 phone calls later, they finally saw it my way and adjusted the bill to reflect that we only owed the copay, which we paid at the exam.


Sent from my iPhone using Tapatalk
 
It is just all so confusing.

I am seriously considering the surgery.
I had one hospital take the CPT codes and procedure and tun it by my insurance and my portion came back $1100

I had another one run the exact same thing and my portion came back $4800

I don't understand.

I feel like there should be a site where I can put my codes out and hospitals can bid on them and I choose the one with the right combination of price and reviews like on freelancer.com
 
No matter what you do to prepare, no matter the opinions you get, once the work is done, it will always be HIGHER.

You have to tell the facility in writing in advance that you will not pay anything that is not discussed up front. No consults, no helpers, no watching, no training, no switching, no swapping, no nothing but a straight up shoulder repair by the guy that's getting paid and the facility it's being done in.

That's what I had to do, and I kept a copy of the statement signed by the intake rep at the hospital. It came in handy when I got tons of bills from people I never saw, never talked to, and didn't authorize their work in advance.
 
docmirror said:
No matter what you do to prepare, no matter the opinions you get, once the work is done, it will always be HIGHER.

You have to tell the facility in writing in advance that you will not pay anything that is not discussed up front. No consults, no helpers, no watching, no training, no switching, no swapping, no nothing but a straight up shoulder repair by the guy that's getting paid and the facility it's being done in.

That's what I had to do, and I kept a copy of the statement signed by the intake rep at the hospital. It came in handy when I got tons of bills from people I never saw, never talked to, and didn't authorize their work in advance.
Click to expand...

Interesting approach.... Did they hold to their price???:dunno:
 
SWAG from someone BTDT.

What is the deductible on your plan? Co pay or co- insurance?
On your EOB, is there a line that says what is applied to your deductible? Depending on the plan, co pays are not applied to the deductible, but your out-of-pocket for covered services are.
Sounds to me like $200 is for services applied to deductible, $50 is co- pay or coinsurance, or non-covered expense. Your insurance company should supply you with details if you request them. Never, ever pay a medical bill without some declaration of benefit from your insurance co in hand.
 
docmirror said:
No matter what you do to prepare, no matter the opinions you get, once the work is done, it will always be HIGHER.

You have to tell the facility in writing in advance that you will not pay anything that is not discussed up front. No consults, no helpers, no watching, no training, no switching, no swapping, no nothing but a straight up shoulder repair by the guy that's getting paid and the facility it's being done in.

That's what I had to do, and I kept a copy of the statement signed by the intake rep at the hospital. It came in handy when I got tons of bills from people I never saw, never talked to, and didn't authorize their work in advance.
Click to expand...

Had a buddy who tried that approach for his vasectomy. The quoted price was affordable for him, so he scheduled the surgery. Literally, in the pre-op consultation a day or two before the surgery, the story changed. "Oh, that's just the hospital charge. The anesthetist, the surgeon, yada yada yada will be more. "Um, how much more."

"About twice as much."

"Is this for real?"

"Yep."

"Cancel the surgery."

IMO, it is virtually impossible to preemptively pin medical folks down on the bill.
 
SixPapaCharlie said:
It is just all so confusing.

I am seriously considering the surgery.
I had one hospital take the CPT codes and procedure and tun it by my insurance and my portion came back $1100

I had another one run the exact same thing and my portion came back $4800

I don't understand.

I feel like there should be a site where I can put my codes out and hospitals can bid on them and I choose the one with the right combination of price and reviews like on freelancer.com
Click to expand...

We have that here in MD, but only because the state negotiates all rates for services between hospitals and insurance cos. You can walk into any hospital in the state and find out to the penny what your portion will cost and get a 5% if you pay cash up front. That includes all ancillary services the hospital will provide like anesthesia, tech, labs etc. Medical services provided outside the hospital like rehab services are not included.
 
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I have a policy which covers all preventive care. As soon as something is treated in the "visit" then I owe. It gets complicated and I just keep saying that all preventive care is covered so submit everything to the insurance company under a preventive care code.

Don't pay anything that is out of line (tough to figure sometimes) and dispute any claims. The collection agencies won't make a collection entry on your credit record when you write them a letter saying why the claim isn't valid (insurance company set value or whatever). BTDT teeshirts threadbare.
 
kyleb said:
Had a buddy who tried that approach for his vasectomy. The quoted price was affordable for him, so he scheduled the surgery. Literally, in the pre-op consultation a day or two before the surgery, the story changed. "Oh, that's just the hospital charge. The anesthetist, the surgeon, yada yada yada will be more. "Um, how much more."

"About twice as much."

"Is this for real?"

"Yep."

"Cancel the surgery."

IMO, it is virtually impossible to preemptively pin medical folks down on the bill.
Click to expand...

I always like the word 'virtually'. If you look it up it's having the appearance of an attribute without the actual fact of that attribute. Always good to use in a defense of a position.

So, sure there are no guarantees in the world, it's the first world problem all over again. We CAN afford it, but no one likes to be gouged. Like I already said, I got plenty of bills from people that I never talked to, heard of, or saw. They were for all kinds of things, and they usually said stuff like 'well, we are not associated with that facility, and we bill separate'. To which I replied; 'well, if you are not "associated" with that facility, and I didn't call you, and ask you to come in, how did you wind up billing me? Was it some kind of karmic guess that I was in there, and you're guy was around, and he just stumbled by?' Only one of them said they were going to send it to collections. I told them they better have a signed work order approved by me, because that's what the requirement said on the intake form, I will fax it to you and you can proceed as you see fit. They went away.

YMMV, closed course, pro driver, contents have settled, and may cause anal leakage. If you don't want to do this, I really don't give a wet, dribbly spit. I can tell you it worked for ME.
 
My deduct is 500 then it is an 80/20

The weird thing is I went online, logged in, and searched for "in network"
The guy giving the injection which I understand is now called "surgery" was in network.

The guy that read the results is not in network

The person giving the MRI, in network, the person reading the results, out of network.

what a cluster...
 
In most insurance contracts there is usually a clause that specifies that any billing disputes for covered services are between the provider and insurance company and specifically instructs the policy owner not to pay any disputed amount. Only pay what is detailed in the EOB. If you have a dispute with the coverage, you have recourse there through arbitration.
 
In which state do you live?
 
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