Progress is not made by everyone joining some new fad,
and reveling in it's loyalty. It's made by forming coalitions
over specific principles, goals, and policies.
Unfortunately, what happened to you is a common occurrences. And it's not just BCBS - it's the same situation with all health insurance companies. I wouldn't blame the provider; they're doing the best they can to figure it all out just like the patients are.
I work for a large hospital system and deal with a particular population of patients. Unfortunately, it has become necessary for me personally to call their insurance companies to confirm their benefits and make sure everything is billed properly so they don't get stuck with big bills. It's an impossible process. First, you get 20 minutes worth of an automated system that won't let you through to an actual person (BCBS is particularly bad about this). Then you spend 20 more minutes on hold. Then you ask your question and get transferred several times.
Once you do get the correct person, there are so many aspects of health insurance that it's nearly impossible to ask all the right questions in all the right ways. I used to just ask the obvious question: "Is ___ procedure covered for this patient?" They would just say yes and I would relay that information to the patient and we would think all was good. But turns out it's not that simple. It all depends on exactly which billing code you use.
Then you learn to ask whether we (the provider) are in-network. (We don't know for sure any more than the patient does. Just because BCBS said we were last week, doesn't mean we are this week for this particular patient's plan.) They may say yes or no or whatever, but it turns out it's all a matter of exactly which provider # is used. And then they sometimes try to tell you that even though your hospital is in-network, provider ___ isn't in-network or that they don't even work for your hospital (even though they do).
Then, if they say ___ procedure is covered and ___ provider is in-network for this patient, turns out there are many other things to consider. Maybe it's all "covered" but the patient has a $5000 un-met deductible - so that means they'll get the whole bill up to $5000. Or maybe it's covered, you're in-network, the deductible has all been met, but the patient has 20% co-insurance - meaning they'll still have to pay 20% of the total bill. Or it's covered, you're in-network, the deductible has all been met, there's not coinsurance, but turns out one part (or all) of your appointment required a prior authorization. Or there could be any number of other technicalities.
Now, let's say you've asked all the right questions and the person at the insurance company tells you it's all good (or bad). You could call again the next day and talk to a different person at the same company and they might tell you something entirely different.
But that doesn't matter anyway since "confirmation of benefits is not a guarantee of payment." And also since there are plenty of bills that are erroneously denied.
It's impossible - even for the providers, much less for the patients. Not to mention the amount of money my employer has to pay me to spend hours of my time dealing with insurance companies when I could be doing more productive things. But they pay much, much more to employ people whose sole job is to figure out what is covered, obtain prior authorizations, make sure the billing is exactly the way the insurance company wants it, and then fight with them when they deny bills they should have paid. Providers must spend all this money just to be able to interact with the insurance companies and then the companies don't even reimburse us at full price anyway!
The most important things to remember are:
1. Ask the doctor's office what's covered, etc., but also call the insurance company yourself and try to understand all the subtle details of how it works and how you might get screwed.
2. This is a really fucked-up system and it needs to be changed.
and it's all supplemented by the U.S. You can thank us for your prescription drugs that we created and that we sell to you for cheaper than we sell to ourselves.
Your welcome.
Classic. Respond with an insult, smarty pants...US has nothing to do with our health care system. Nice try...(and before you send me some slanted media story, know that I won't read it...)...PS...take care of your war vets...
To the original poster - I am very sorry about your situation. It sucks. You have my empathy. Sounds terribly confusing...but I hope you get it all sorted out...Too many cooks, it sounds like...
and it's all supplemented by the U.S. You can thank us for your prescription drugs that we created and that we sell to you for cheaper than we sell to ourselves.
Your welcome.
In what strange world does the US government sell drugs instead of the big drug corporations?
Yep sooo been there. I had my twins taken 6 weeks early by an emergency c section. I mean emergency, I didn't even have time for an epidural, they just knocked me out.
So I wake up a bit later and they are taking one of the babies by helicopter to the children's hospital. Stupid me(sarcasm) didn't think to ask if said helicopter was in my network. I mean I had just come back from being unconscious, she had been resuscitated twice and they HAD to get her to the other hospital ASAP.
How much was this 13 minute flight to the other hospital for her? $8000, yep that is eight thousand dollars!
We pay over $300 every two weeks for health ins. We really have to have it with her ongoing medical issues now but man it sucks to pay so much and it is soo wonky sometimes.
Oh can I just bitch about them one more time. While I was pregnant, it is really preferred that if you are pregnant with identical twins to get an ultrasound every two weeks. Once a week would be wonderful. My ins said one a month! That is all they would pay for. So because they wanted to be so cheap she was born with all kinds of problems and spent about 4 months in the NICU. I can only imagine what that ended up costing them. She has had several surgeries too.
Of course if I had known then what I know now I would have paid for the us myself. Then maybe we could have caught the TTTS sooner. :(
To 10c; "Your PJ tshirt should be tight enough to show you're a woman and loose enough to show you're a lady." - bionicamy
Yep sooo been there. I had my twins taken 6 weeks early by an emergency c section. I mean emergency, I didn't even have time for an epidural, they just knocked me out.
So I wake up a bit later and they are taking one of the babies by helicopter to the children's hospital. Stupid me(sarcasm) didn't think to ask if said helicopter was in my network. I mean I had just come back from being unconscious, she had been resuscitated twice and they HAD to get her to the other hospital ASAP.
How much was this 13 minute flight to the other hospital for her? $8000, yep that is eight thousand dollars!
We pay over $300 every two weeks for health ins. We really have to have it with her ongoing medical issues now but man it sucks to pay so much and it is soo wonky sometimes.
Oh can I just bitch about them one more time. While I was pregnant, it is really preferred that if you are pregnant with identical twins to get an ultrasound every two weeks. Once a week would be wonderful. My ins said one a month! That is all they would pay for. So because they wanted to be so cheap she was born with all kinds of problems and spent about 4 months in the NICU. I can only imagine what that ended up costing them. She has had several surgeries too.
Of course if I had known then what I know now I would have paid for the us myself. Then maybe we could have caught the TTTS sooner. :(
Really? I've had BCBS in two different states and I think it is the best/easiest to use health insurance I've had. I don't need referrals and the prescriptions are ultra cheap. What state are you in? BCBS is actually a whole bunch of different companies, that's why it's called BCBS of [state]. I think it also makes a BIG difference which network your company signs up for. If you have the PPO you can pretty much go anywhere you please.
I'm with you. I have it too, and never had a problem. I have a low deductible (like 200 bucks), and I just had an $18,000 surgery in February, and owed nothing because I had already met my deductible. Best health insurance I've ever had. In the past they've paid the full amount for a couple of MRI's also!
Comments
Sorry to hear it.
someone needs a punt in the head at the top
and reveling in it's loyalty. It's made by forming coalitions
over specific principles, goals, and policies.
http://i36.tinypic.com/66j31x.jpg
(\__/)
( o.O)
(")_(")
I work for a large hospital system and deal with a particular population of patients. Unfortunately, it has become necessary for me personally to call their insurance companies to confirm their benefits and make sure everything is billed properly so they don't get stuck with big bills. It's an impossible process. First, you get 20 minutes worth of an automated system that won't let you through to an actual person (BCBS is particularly bad about this). Then you spend 20 more minutes on hold. Then you ask your question and get transferred several times.
Once you do get the correct person, there are so many aspects of health insurance that it's nearly impossible to ask all the right questions in all the right ways. I used to just ask the obvious question: "Is ___ procedure covered for this patient?" They would just say yes and I would relay that information to the patient and we would think all was good. But turns out it's not that simple. It all depends on exactly which billing code you use.
Then you learn to ask whether we (the provider) are in-network. (We don't know for sure any more than the patient does. Just because BCBS said we were last week, doesn't mean we are this week for this particular patient's plan.) They may say yes or no or whatever, but it turns out it's all a matter of exactly which provider # is used. And then they sometimes try to tell you that even though your hospital is in-network, provider ___ isn't in-network or that they don't even work for your hospital (even though they do).
Then, if they say ___ procedure is covered and ___ provider is in-network for this patient, turns out there are many other things to consider. Maybe it's all "covered" but the patient has a $5000 un-met deductible - so that means they'll get the whole bill up to $5000. Or maybe it's covered, you're in-network, the deductible has all been met, but the patient has 20% co-insurance - meaning they'll still have to pay 20% of the total bill. Or it's covered, you're in-network, the deductible has all been met, there's not coinsurance, but turns out one part (or all) of your appointment required a prior authorization. Or there could be any number of other technicalities.
Now, let's say you've asked all the right questions and the person at the insurance company tells you it's all good (or bad). You could call again the next day and talk to a different person at the same company and they might tell you something entirely different.
But that doesn't matter anyway since "confirmation of benefits is not a guarantee of payment." And also since there are plenty of bills that are erroneously denied.
It's impossible - even for the providers, much less for the patients. Not to mention the amount of money my employer has to pay me to spend hours of my time dealing with insurance companies when I could be doing more productive things. But they pay much, much more to employ people whose sole job is to figure out what is covered, obtain prior authorizations, make sure the billing is exactly the way the insurance company wants it, and then fight with them when they deny bills they should have paid. Providers must spend all this money just to be able to interact with the insurance companies and then the companies don't even reimburse us at full price anyway!
The most important things to remember are:
1. Ask the doctor's office what's covered, etc., but also call the insurance company yourself and try to understand all the subtle details of how it works and how you might get screwed.
2. This is a really fucked-up system and it needs to be changed.
Classic. Respond with an insult, smarty pants...US has nothing to do with our health care system. Nice try...(and before you send me some slanted media story, know that I won't read it...)...PS...take care of your war vets...
To the original poster - I am very sorry about your situation. It sucks. You have my empathy. Sounds terribly confusing...but I hope you get it all sorted out...Too many cooks, it sounds like...
So I wake up a bit later and they are taking one of the babies by helicopter to the children's hospital. Stupid me(sarcasm) didn't think to ask if said helicopter was in my network. I mean I had just come back from being unconscious, she had been resuscitated twice and they HAD to get her to the other hospital ASAP.
How much was this 13 minute flight to the other hospital for her? $8000, yep that is eight thousand dollars!
We pay over $300 every two weeks for health ins. We really have to have it with her ongoing medical issues now but man it sucks to pay so much and it is soo wonky sometimes.
Oh can I just bitch about them one more time. While I was pregnant, it is really preferred that if you are pregnant with identical twins to get an ultrasound every two weeks. Once a week would be wonderful. My ins said one a month! That is all they would pay for. So because they wanted to be so cheap she was born with all kinds of problems and spent about 4 months in the NICU. I can only imagine what that ended up costing them. She has had several surgeries too.
Of course if I had known then what I know now I would have paid for the us myself. Then maybe we could have caught the TTTS sooner. :(
I hope your girls are doing better now... :(
I'm with you. I have it too, and never had a problem. I have a low deductible (like 200 bucks), and I just had an $18,000 surgery in February, and owed nothing because I had already met my deductible. Best health insurance I've ever had. In the past they've paid the full amount for a couple of MRI's also!