This is such crap - insurance and billing

Are you pregnant again after having preeclampsia once already in a previous pregnancy? Post your thoughts/concerns here - there are others who share your feelings. This is also the home of our Bedrest Buddies Support group.
missgamecock
Registered User
Posts: 6064
Joined: Tue Mar 26, 636712 9:03 pm

Re : This is such crap - insurance and billing

Postby missgamecock » Wed Oct 16, 638289 10:50 am

No update. I have been waiting for a bill from my ob's office and it hasn't arrived yet. Insurance paid for each appt. However, the billing clerk is such a jerk with my ob's office. I am so glad I don't usually deal with her, she is probably waiting for my appt tomorrow to mail it out thinking I won't talk to my ob about it. Well she is wrong because I absolutely intend to discuss it with my ob tomorrow and I intend to discuss with him all of the trouble that I have had with the billing clerk since August in getting referrals. I had to get a referral for an endo specialist in Aug. Then I had to get my peri appt in February a referral. I literally had to get my insurance company involved and do a three way both times that took several days to get her to do her job. My pcp even personally called his billing clerk in August and told her if she couldn't do it or wouldn't do the referral that my ob ordered, she was more than happy to. The clerk told her it was unnecessary. The good news is that I still have my peri referral that is good till August. It could be when I come in tomorrow that she leaves a note that I need to pay the balance, if that is the case, then I will tell them that I will discuss it with the dr first. I think I'll bring my plan booklet in with me to prove it. I don't really care how they got the insurance company to pay them, but I shouldn't have to pay but the one copay for the pregnancy.

fnaz
Registered User
Posts: 280
Joined: Tue Mar 28, 637656 1:30 am

Re : This is such crap - insurance and billing

Postby fnaz » Sat Oct 05, 638289 4:07 am

Sabrina, Is there any update from billing department yet? I am in your boat too..I received a bill of $115. Hospital clerk said that I should contact my insurance company ..I will call them tomorrow morning. As I read your thread few days ago, You were the first person who came into my mind after receiving the bill.

melly
Registered User
Posts: 473
Joined: Wed Mar 31, 638286 4:06 am

Re : This is such crap - insurance and billing

Postby melly » Thu Jul 04, 638289 1:50 pm

My husband and I watched Michael Moore's film Sicko last week. The movie is about the health insurance industry. You think that once you have insurance you are covered, but they just want to make more money by denying your claims. It made me angry and scared at the same time. We spend so much money just to have insurance and yet they may not even be there for you when you need them. I hope you get this resolved without any more headaches.

mrs. sagara
Registered User
Posts: 311
Joined: Tue Jan 15, 637669 3:55 pm

Re : This is such crap - insurance and billing

Postby mrs. sagara » Wed May 29, 638289 6:05 am

Hey I hear you.
I get a referral to see an RE and then they call me and tell me I have to pay 50%.
I also had to pay for progesterone suppositories because my insurance didn't cover it.
Does that make sense?
I just never know what will come next.
I thought changing insurance provider would help because I would have more options.
However I have an HMO that also acts as a Point of Service and that fact makes it hard for me to know how much I will end up paying.
I heard on the radio recently that one of the most profitable companies right now are health insurance companies.
They make so much money declining our claims that it actually makes sense to me.
Hope all goes well.

missgamecock
Registered User
Posts: 6064
Joined: Tue Mar 26, 636712 9:03 pm

Re : This is such crap - insurance and billing

Postby missgamecock » Fri Feb 18, 638287 6:27 am

Apparently it is legal to do this. No where in any of the plan books that I have that they say they only pay the global fee after the fourth visit. First visit doesn't count as that is a problem focused visit. So say you are pregnant. First visit at 6 weeks. That doesn't count. Then 10,14, 18 weeks. So they won't pay the global fee till the 20-22 week visit??????? That sounds awful. I have an email ready to send to all the members of the executive board of my insurance company. I am just waiting to see how my dr's office will handle the copays.

kelly w
Registered User
Posts: 1120
Joined: Sun Jan 25, 637339 12:37 am
Location: Georgia
Contact:

Re : This is such crap - insurance and billing

Postby kelly w » Fri Feb 18, 638287 3:45 am

Sabrina, I'm just so sorry you have to deal with this right now. With everything else going on, you shouldn't have to be fighting your doctor's billing clerk to get her to do her job right. That is SO frustrating. [:(!]

Kelly

missgamecock
Registered User
Posts: 6064
Joined: Tue Mar 26, 636712 9:03 pm

Re : This is such crap - insurance and billing

Postby missgamecock » Thu Feb 17, 638287 8:53 pm

Thanks guys. I hear this happens a lot from the miscarriage boards. It is such a slap in the face. I decided to wait and see what the office bills me. It could be that they billed the visits so they get reimbursed. Then they "waive" those copays. It's a possibility my mil says. She used to work for a doctor's office doing coding (internal med). I am going to be pretty upset if I have to pay all those copays. I figure wait and see what pops up on the statement. If I don't have a statement by the 14th, talk with my ob about it and see how it is handled. Like I said, this clerk does not have the best personality. She is not inclined to share anything like a possibility of a waived copay. It just really upset me to log into my insurance account and see all these visits with copays attached. Grrrrrr. I still have the surgery copay to do as well (that will be hospital and is only $15). I was actually checking to see if my ortho had charged my insurance for my steroid shot and that's what started all this. I am still playing games with no fault from the accident 2 years ago. No fault will pay hither thither. Sometimes they pay and sometimes they don't. They never tell me if and when they pay. I find out by calling the drs, hospital, and checking insurance online. I try to keep on top of that because I had thought a bill was being paid when it wasn't and went to collections (I got it taken care of and off my report). So that's when I saw all those appts and they had an office charge that insurance paid and all these copays that were due from me. I'll wait and see what happens.

kezt777
Registered User
Posts: 262
Joined: Fri Jun 09, 637995 1:05 pm

Re : This is such crap - insurance and billing

Postby kezt777 » Thu Feb 17, 638287 7:26 pm

im sorry you are having these issues on top of everything else that you have been going through. but i am glad that you are in contact with someone who will help straighten it out. but it certainly does make you wonder how many people out there are being wrongly charged and they might not know who to contact for help, or may not realize they are being charged incorrectly at all. its hard enough to go through this sort of situation without added difficulties! hugs!

kathyc
Registered User
Posts: 1114
Joined: Sat Jan 12, 636718 7:08 pm

Re : This is such crap - insurance and billing

Postby kathyc » Thu Feb 17, 638287 7:24 pm

Sabrina,

I'm sorry you're having this headache on top of everything else. I had this happen too, and was pretty upset by it. We ended up having to go ahead and pay for all the visits, which, like you, added up to quite a few by 13 weeks. And we had paid $90 initially that was supposed to cover all the visits plus the birth. It did seem a bit like a slap in the face that we had to pay more because we lost our baby. Maybe I could have fought it harder, but at the time, I just didn't have it in me.

I hope you get it resolved.

alicias2005
Registered User
Posts: 57
Joined: Sun May 16, 637345 7:02 am

Re : This is such crap - insurance and billing

Postby alicias2005 » Thu Feb 17, 638287 5:32 am

I'll throw in my two cents for what it's worth (I have some insurance experience). For an evaluation and management (E/M) service for a physician there are a series of codes that can be billed. For established patients (99211-99215) can be billed for office visits..depending on the complexity of the visit and the length of time MD has spent w/the patient (the higher the E/M code the more $$ insurance reimburses). For new patients, codes 99201-99205 can be billed. If you were referred to a specialist by another MD, that specialist would use the consultation E/M codes which are series 99241-99245 which covers both new and established patients. The other ancillary lab charges have their own CPT codes as well. Hope that helps and you can get this resolved soon.


Return to “Pregnant Again?”

Who is online

Users browsing this forum: No registered users and 11 guests