Health Insurance-update I am so mad!

[transformed]

Where do I go for an education on my health insurance? I feel completley uneducated on everything. There are a couple of specific issues going on right now but its pretty much ALL the time that something new comes up and I am like "Huh?"

Is there like a class I can take or something? I need some serious continuing education if I am going to continue to handle our familys medical issues. Its costing us a FORTUNE.

The latest thing that happened is that I got a bill for $200 from a lab. I called my insurance company and said "Why arent you paying this?" They said "Its out of network and the deductible hasnt been met yet." I said "I have a PPO though, doesnt that allow me to go wherever I want?" She said "No." (So basically I have no clue what my coverage is....and the insurance company wont send me a breakdown. My dh's HR department doesnt retuen phone calls and he has tried for months to get something from them to no avail.)

The thing about the lab bill is that I didnt even GO to the lab. My DOCTOR ran the tests and sent them to the lab.

So basically I was somehow supposed to ask my doctor about the labritory he uses for testing and then do MY OWN check of whether or not my insurance would cover it, and then opt to request a different lab.

:

Does that make any sense?

I need an education. FAST.

Or I need to cancel my insurance because it doesnt effing cover anything and I cant afford it.


******* UPDATE*******

:

Dh talked to the insurance company for a half an hour and learned that we have 6 different deductables adding up to roughly $5000 a year. There is a "dh" deduct, a "family" deduct, a "MISC" frigging dedut, a "in network" deductable...etc etc.

So basically we pay $600 a month for nothing.

I told dh "I URGE you to vote in the next election" (He doesnt usually vote, but is starting to form a political opinion)

He said "I feel cheated."

I said "You are not the only one right now."

Everyone feels like that. Whether its the person who is scared EVERYDAY because they dont have insurance (That was us) or the person who finds out that insurance isnt *always* what its cracked up to be. (Us too!)

We are formulating a new plan because this just seems silly to pay this amount of money to an insurance company that isnt covering anything!

[frog]

Originally Posted by transformed

Where do I go for an education on my health insurance?

Their website. If you still have questions after reviewing it, call the company.

[lillian]

call the customer service number. then just start asking questions.

[homewithtwinsmama]

I have this too. Between copays, deductibles and coinsurances we have to come up with 5 grand a year. With a higher risk pregnancy and a daughter having two surgeries we will have paid every cent. I did talk the doctor into moving up the second surgery to Dec 31st so that my stupid deductibles wouldn't start over for that one! She was very accomodating. I keep thinking to myself how we are the "lucky" ones in this country for having what is supposedly "good insurance" through work. 47 million have nothing. I can't even imagine how stressful it must be to try to prejudge if this is the time you really need to see the doctor. I hope your dh is going to vote. Its important that we get a president committed to universal healthcare!

[Iris' Mom]

Your doctor's office should have checked with your insurance to see what lab to use. I would complain to them. It's pretty ridiculous. I've had Cigna and Blue Cross and each of them had exclusive contracts with a particular lab. My doctor always told me what lab I had to go to based on my insurance. This is what they do, for pete's sake.

[Black Orchid]

its a scam. we finaly went to a plan that has some astronimal deductible ($10K per person or something totally ridiculous like that) but a low premium- $250/month. Can you do that?

We were paying $810 a month for coverage like you describe... everytime we'd turn around SOMEONE would want money for some random thing (we never really even go to the doctor) and we couldn't pay them because of the mortgage on our health insurance .

So now we just go when it is really bad and take the hit, but at least we know its coming and don't feel like we're getting totally ripped off because the premium is low.

[apple_dumpling]

that sucks. I actually had the same exact thing happen to me when I was just out of college - I went to a doctor and he ran some tests. His nurse drew the blood and they said they would send it out to the lab, and honestly I didn't think twice about it. I just assumed since it was done in the doc's office (who was covered under my insurance) that he would send it to a lab that was also covered. Nope - he sent it out to some lab in California (I was on the east coast at the time) and a few months later I got a bill from the lab for almost a thousand dollars!!! Oh I was pissed - but there was nothing I could do, that lab wasn't covered by my insurance and the tests had been ran.

Needless to say I dropped that doctor - and he was totally unwilling to admit the slightest bit of wrongdoing on his part (he could have at least told me that it wouldn't be covered, or sent them somewhere that was covered).

I hope you can find a solution for healthcare that works for your family.

[theretohere]

Originally Posted by Black Orchid

its a scam. we finaly went to a plan that has some astronimal deductible ($10K per person or something totally ridiculous like that) but a low premium- $250/month. Can you do that?

We were paying $810 a month for coverage like you describe... everytime we'd turn around SOMEONE would want money for some random thing (we never really even go to the doctor) and we couldn't pay them because of the mortgage on our health insurance .

So now we just go when it is really bad and take the hit, but at least we know its coming and don't feel like we're getting totally ripped off because the premium is low.

This is exactly what we've had to do, as well. It's really worth looking into.
If at all possible I wouldn't drop insurance completely that way you have continuous coverage.

[Penelope]

Anybody seen Sicko? (We just watched it this weekend.) Some of this is intentional on the part of the insurance companies.

I don't think dropping insurance altogether is a good idea, though - unpaid/unpayable medical bills are a huge cause of bankruptcy.

[MissLotus]

I'm going through something similar. It's really alarming to get these big bills in the mail when you thought they were covered by the astronomical monthly fee you already pay! But no. I had my tonsils out in October and the bills have been rolling in ever since...they're claiming I hadn't met my deductible before surgery, etc...all this stuff...and I see the same lab fee listed on my hospital bill AND in a separate bill from the lab. Each time I call the insurance company I get a different sort of answer, so I just keep calling back till I get someone who can coherently explain things to me. So now I'm waiting for them to re-process the whole thing...I guess. I've found that the important thing is just to let your doctors (whoever is billing you) to periodically know that you're "working on it", so that your credit won't get messed up on top of it.

Hang in there...and I will too!

[Equuskia]

I think stabbing yourself in the eye with a hot skewer is more productive than trying to understand insurance.

[angie7]

Thats why you have to read the fine print and before you sign up, ask LOTS of questions! I have been in that boat before, got smart and now I have ins that pays 100% and only costs us just over $200 a month for a family of 4. This is through my dh company, not a private ins. They screw you big time if your not careful!

[lillian]

Originally Posted by Equuskia

I think stabbing yourself in the eye with a hot skewer is more productive than trying to understand insurance.

\

yes, but would that be covered?

[AEZMama]

We have had to go with a company that doesn't care about pre-existing conditions because of ds, we pay $200 for the family per mo and they did the same thing to us. We have a bill for $200 from dh's first doc (total UAV-we switched to a doc that returns calls ), now that office visit we have a bill for AND ds' first ped's visit in this new office. All others have gone through without issue. Total PITA. But we need coverage because of ds, and we don't qualify for state coverage.

[USAmma]

I'm so sorry! There are actually people who can help you within the insurance company but you have to keep going through other reps to get to them. I think ours are called "conflict resolution specialists."

I learned the hard way to read through the entire policy every year during open enrollment to find out exactly what is covered and under what circumstances. It can be very confusing. Next year when it comes up for renewal, ask the HR rep for a copy of every policy offered by the employer and find out which one works best for you.

It's tough to have to jump through hoops with these people. For example my dd has special medical formula-- we can buy it ourselves from the manufacturer. It's still expensive but less so than through the contracted home health provider. However, insurance will only cover it if it's through home health provider that they contract with, and the HH provider marks up the formula's price by about 40%. We have to pay 50% of the cost of the formula so it doesn't save a whole lot to have 50% coverage. AND we have to pay 50% unti we spend $2000 out of pocket, then insurance will cover it 100% until they spend $5000, and then after that we pay 100% until the end of the year. It's like rocket science. Seriously.

When my dd broke her arm I took her to an in-network hospital ER. However the orthopedist on call at that hospital who looked at the xrays was out of network. I did not know to ask for that-- like "Wait! I know my dd has a broken arm and is in pain, but is every doctor here in network? If not, don't treat her." Come on! Who is going to say that? We got it settled and it was eventually paid for by insurance, but not before we got a bill from the ortho.

[KMK_Mama]

We are going through the very same thing. We pay about $875 per month through DH's work for our family of 5. I have had a headache for almost 2 years so I have been seeing different doctors, neurologists, ND's, etc. I just found out that we have a really high deductible and a bunch of services I have had are "covered" but are going towards my deductible....which means I am expecting about $1000 worth of bills to come in the mail very shortly. Also, our dental insurance does not cover "specialists." Who knew that pediatric dentists were considered a "specialist?" We took our girls to get their first dental exam and found out a few weeks later that it was not covered when we got the bill for $400. Ridiculous.

[Equuskia]

Originally Posted by lillian

\

yes, but would that be covered?

yes, but only until you've met your $5k deductible!

[madmacksmommy]

Insurance companies make me soo mad! Last Feb I took my sick girls to the dr's. The DD2 was really sick and needed transport to the hospital. Our ped wanted us to be at the great Children's Hospital where they could come see her and be in charge of her care. But because there were hospitals in between the one we wanted to go to and where the peds office was, insurance wouldn't cover the ambulance ride all the way. DD had to be on oxygen b/c her stats were down to 76% so she had to be transported by ambulance. There was no way we could have driven her ourselves. We ended up having to stop at the local ER. We chose the hospital without the peds unit so we could be transported out again. We finally got transported to the children's hospital after sitting in the ER for over 6 hours. Ugghhhh!

DD spent 5 days at the hospital. My oldest was also admitted at the same time. She was also really sick and needed some oxygen thereapy to. Both girls had RSV. We got so many bills in the mail for both girls. The bill that ticked me off the most was for the ER visit. Usually when your child is admitted to the hospital, your ER copay is waived with the hosptial admission (our ER copay is $200). But in our situation, we were transported and admitted to a different hospital. So it didn't matter to the insurance company that dd was admitted. It was 2 different hospitals. I fought and fought and still had to pay the ER copay.

We ended up paying close to $5,000 out of pocket for both kids being in the hospital. My dd2 was again admitted to the hospital in Nov for having low oxygen stats due to pneumonia. She spent 4 days in the acute peds unit. We were a direct admission though so no ER fee. Our portion of the bills were close to $2400. Our max out of pocket for the family is $10,000. Believe it or not we are sooo close to meeting that (hubby had a few things done this year that count towards the max OOP) And it starts fresh again in Jan....

I am thankful though that we have insurance. And that hubby's comapny pays 75% of the insurance for all of us.

[phatchristy]

OK, I share your frustrations.

Our insurance is insane expensive. Every year, the costs have gone UP and the coverage has gone down. If I want a 4th baby I'd better hurry up soon because I have a feeling soon they're going to make maternity care insane (and I'm a *good* birther, they only shelled out $2,500-3.000 for my births total, no hospital expenses)

I had an episode in February where I twisted and broke my food. Called my insurance company to find out what the coverage costs were for ER vs urgent care. They gave me the deductables/co-pays. I decided to go for the urgent care as it was half as much. Then, I wound up with a prescription for an orthotic.

OK, so the first issue...they insurance company's computer wasn't updated. They had DOUBLED our copay amount that year, and hadn't updated the computer system yet when we called. I made my decision to go to the urgent care because of the call. So, I call them up when I get the bill...they say, oh, yeah...I see it's in our computer that we quoted you half as much...la de da.

OK, so they do an appeal. It gets approved. I call intermittently. The appeal goes through but they never reprocess the claim. More calls. Then, it finally shows up in the system for the corrected co-pay amount as if they sent out a check. But, according to the urgent care center billing nope...they never sent out a check. More calls from the both of us (the billing person there and myself). A few more months. OK, it took about 7 MONTHS to get it worked out. So many calls I can't tell you.

If that wasn't bad enough...then there was the orthodic. It was billed incorrectly under the wrong name. Got the name fixed, then the computer didn't recognize the code. Back and forth...talking to multiple people, everyone telling me something different. This too went on for MONTHS. The insurance company sending me a letter saying that I don't owe anything (yet, I had already paid as it was subject to deductible...I just wanted my money back).

So, another 8 months of stress...annoyance...YES...OUT OF THE BLUE we get a check for the full amount I paid.

Honestly I think that whole ordeal took years off my life.

There have also been two laboratory mistakes this year (we quickly discovered that the computer did NOT seem to recognize things sent to outside labs properly based on the billing codes that the computer used).

I became good friends with the billing department person for the urgent care center. Her take on it...they put you through hoops with the hopes that you will give up. They wait a certain amount of time and when it is obvious to them that you're not going away then they pay it.

Most people wouldn't put up with the crap that I did over a few hundred dollars.

She shared this with me because she's seen it happen OVER and OVER. When the insurance companies make mistakes they are VERY slow to correct them and pay out the money they owe. But, when they overpay to a medical office they are on the medical office CONSTANTLY demanding immediate payment.

I don't know what to say, other than give you a and tell you I know, I've been there. The first time I used rescue remedy was after a call I had with the health insurance company. Bought it for the births...apparently birthing is less stressful to me than talking to health insurance representatives.

[heyitstwins]

Originally Posted by Equuskia

I think stabbing yourself in the eye with a hot skewer is more productive than trying to understand insurance.

Originally Posted by lillian

\

yes, but would that be covered?

I have nothing substantial to add, I just thought this exchange was frikkin hilarious.

Second thought, actually I do. Get copies of your medical records and also pay attention to those EOBs (explanation of benefits) they send you. Compare them and make sure you aren't being charged for boxes of free tissue and private rooms when you were in a semi-private one. This does happen. I have access to my own electronic medical records at work and I will go looking through them if I think something isn't adding up.

Also, I think insurance companies get over because of how quick some of us are to throw those EOBs in the file cabinet or garbage without really looking at them.