Medical billing hodge podge thread.

collage1
Mon, 09 May 2016 15:14:53 +0000

A few people have stated that they do not have problems with their claims. Others have shared horror stories. I’d love to hear which insurance companies tend to NOT play these insane games and which are bad offenders. If people wish to share, it’d be great to include some detail (i.e. HMO vs PPO or which state if it’s not a national company). I live in California and have found Cigna easy and pleasant to work with. We’re pretty new to Anthem Blue Cross (HMO) and, so far, so good.

Incidentally, I negotiate managed care contracts between insurance groups and providers (hospitals and physician groups) and this thread makes for a fascinating (albeit depressing) read. FYI, regardless of what a hospital bills, the vast majority of hospital inpatient claims (commercial, Medicaid/Medi-Cal, Medicare) are paid on a per diem basis (a fixed amount per day).

Someone else mentioned this upthread but last time I went for a physical, my PCP told me that, if she found anything that required a diagnosis (don’t remember her exact wording but anything other than “well” issues, my visit would be billed twice–once for my “well” visit and once for whatever was “wrong” with me. I go to a large clinic and the clinic (system) had discovered that they were entitled to a second payment from the insurance companies if they billed this way. No copay from me for my physical (“well” portion of the visit); my regular physician visit copay for the other.

Insurance payments tend to be low. Providing medical care is costly. I understand providers need to do what they can (legally) to recoup costs and make a reasonable living. The administrative costs of implementing their contracts are very high. I agree that our system is broken.