<p>D recently went to a PPO for a…um…let’s say ACA ‘free’ procedure. After several rounds with the front office of WHO was able to determine level of coverage it was ‘cleared’ and ‘known’ that the procedure was covered at 100%.</p>
<p>I keep track of all the EOB’s via our online account. An electronically billed EOB will show up in the system usually within 48 hours. So, it was strange that nothing was showing under D’s account for weeks. I finally get a BS EOB which says ‘it appears this person has no coverage’. Well, it was clear in about 1/2 nanosecond that there was an error in the ID. I called the provider…nope, we did it right. Called BS…said they would contact provider, which they did. </p>
<p>I’ll make this the short version…it’s now 90+ days and the issue still has not cleared. The provider keeps resending the same buggered electronic claim, which of course goes nowhere. BS keeps telling them to send it via USPS. I keep calling the provider’s billing department to remind them not to send this to collections (I am using less polite words these days).</p>
<p>What is frustrating in the examples giving by all the posters is …we do the things we are supposed to do, we file the paperwork, research the coverage options etc…and still…in the end when the bytes and the bits don’t line up, we are stuck with the problem…</p>
<p>“I recently went to a specialist who made me pay for my entire appointment up front in cash because they said I had no coverage because my deductible hadn’t been met. I didn’t know, but I told them I found that strange since every other specialist I had ever been to just charged me my copay-- they said the copay didn’t apply because the deductible wasn’t met and were REALLY combative and mean about it, and I wasn’t arguing, I was just confused”</p>
<p>I don’t blame you. When I go to any doctor in my network and I pay the co-pay, if there is one - that is all I ever have to pay. There is no deductible if I stay in my network. It sounds like your insurance is similar to what I have. </p>
<p>Maybe I am lucky since my insurance is a plan state workers get and living in the capital region - where so many state employees live and have this insurance (practically every doctor is in the network, too) - they are just extremely familiar with my insurance plan. </p>
<p>My only dealing with my insurance carrier is once a year when we have to submit the form saying I don’t have my own insurance. </p>
<p>Even going to an out of network dentist - where I pay up front - my insurance sends me a check for what they would cover if it was an in network dentist. Usually only takes a few weeks to get the check. The portion I pay does go towards my dental deductible, but I don’t have satisfy the deductible before my dental work is covered for the portion the insurance pays.</p>
<p>I have high deductible insurance (no co-pay) and we’ve been told by HR that even if the deductible is not met, we are not supposed to pay anything upfront.</p>
<p>My dentist billing department always tries to collect up-front whatever my insurance does not cover, but I always refuse. I say I don’t have my credit card with me and we can re-schedule. Never had to re-schedule.</p>
<p>When my wife had cataract surgery, insurance would cover a single focal lens but not a multi-focal lens. OK. But if we went with the multi-focal, they wouldn’t pay the single focal rate. Why???</p>
<p>This thread makes me feel strangely better… just knowing I am not the only one. </p>
<p>The lengths I go through to protect the $1.56 or $11.56 or $111.56 or $1,111.56 I KNOW I do not owe. </p>
<p>I have the same 6-month later issue with co-pays. (Why can’t I just pay my co-pay that I know I owe when I am there??) Recently my PPO denied a claim because I cut my finger pretty badly and needed stitches. The urgent care facility listed it as an accident. the insurance company sent me a letter wanting me to return a questionnaire with all the info about my “accident” - including drawing pictures of the vehicles or the ladder I must have fallen off of at work, and listing the other driver’s insurance info, or all the workers’ compensation benefits I must be getting from my employer. Huh? I cut my finger in the kitchen. I called the insurer, explained, and was told oh, okay, no problem, you’ve let us know, so don’t worry about it. A month letter, bill and insurance letter arrived within days, saying I owe full amount because coverage denied because I didn’t return the letter they told me NOT to bother returning. I have had the same insurance for over 20 years. Since when does getting stitches in your finger constitute a major life upheaval? Oh brother. (I returned the letter anyway)…</p>
<p>And the dentists with the upfront billing. The dentists never used to do this; they just billed you after the insurance statement was issued and paid. Now they all do (I have switched 3 times, only to revert back to the first office since at least all my records are there). I know for a fact that the amount they quote me is NOT the amount I will ultimately owe, since they contract with the insurer for a lower total cost for the filling, or crown, etc. So consequently my portion of the co-pay is lower than what they are telling me. And when I have paid the amount they tell me to, I ALWAYS ALWAYS have to contact them, with copies of paperwork in hand, showing that the procedure total was charged at a lower rate, so I deserve a refund. </p>
<p>Thanks for that suggestion lerkin; I’m going to do that from now on. After 25 years, they can’t see that I pay my bills?</p>
<p>It goes on and on and on - merchants, doctors, service companies… I’m so tired of it. But so, so glad I am not alone. Thanks for letting me rant!</p>
<p>This specialist had a sign posted saying that co-pays would be due at the time of service, so I assumed my $60 copay, but they didn’t want the payment until AFTER the appointment and that was when they said I owed the whole like $250 or so, and had a complete cow when I questioned it. I am actually out of my inhaler and don’t want to go back there for a refill and I haven’t found a new specialist yet, I have to see if my new internist would be comfortable refilling the inhaler for me. The doctor apparently thinks this practice is correct, too, because he was trying to get me to do all sorts of extensive and (imo) unnecessary allergy testing and I was saying I’d have to wait because I didn’t have the money, and he scoffed at me and was like “what? if youve already been to so many doctors this year how has your deductible not been met?” I have a $1,000 deductible and I never come even close to meeting it because I only ever have to pay my co-pay anywhere I go… I think I almost met it once because I went to an in-network ER and was assigned to an out-of-network doctor and his fees were not covered and applied to my deductible (while we are on the subject of medical billing rants, throw THAT one on the pile!)</p>
<p>A few years ago my wife had to have liver surgery. At the time, I had really, really good insurance (where have those days gone?). The whole thing (pre-surgery visit, surgery, hospital stay and post-surgery visits) cost me $50.00 out of pocket. </p>
<p>A year and a half later, I get three notices from a collection agency trying to collect $100, $102 and $114 for the doctor. Contacted doctor’s office and told them insurance should have taken care of everything. Contacted the insurance and they said it was the doctor’s office who was at fault but no one would tell me what the issue was. </p>
<p>Got tired of the back and forth and finally got a supervisor at the insurance company who told me that the issue was that the doctor’s office was submitting the claim on the wrong forms and that was why they were being rejected. She also emailed me the history of the claim showing they contacted the doctor’s office 4 different times in the previous year. </p>
<p>She then told me that this doctor’s office (and she said many others did this as well) would send to collections any claims that were not settled in a timely manner, irregardless as to who was at fault. They had a tendency to do this towards the end of their fiscal year. </p>
<p>When I contacted the doctor’s office back and told the office manager it was their issue and not the insurance company, she got very upset. Until I told her what forms she was submitting and what the insurance company required, when they submitted the wrong ones and the dates the insurance company attempted to contact to correct the problem. </p>
<p>Needless to say, it was resolved very shortly after.</p>
<p>See, but this is also part of the problem. If an office accepts 20 different insurances, they have 20 different forms to fill out FOR THE SAME THING. Why insurances have been allowed to dictate that they have to have THIS form when THAT form gives all of the same information is dumb. Or the insurances where the clinician has to be credentialed with THAT insurance. As if a state license and Medicare license number isn’t enough. It’s stupid.</p>
<p>I agree with you on the numerous different forms. The issue I had was that the doctor’s office failed to fix the issue after four responses and then them dumping it to the collectors as their fiscal year ended.</p>
<p>How about this one-- my fiance’s first name is a perfectly normal first name, but there is a celebrity who has it as her last name and so people ALWAYS get his first and last name mixed up-- even though on no planet in this solar system would fiance’s last name pass for a first name. He went for a physical and his insurance was billed $250, but they accidentally billed it to lastname firstname instead of firstname lastname, so there was no record of him in BCBS’s system and they denied the claim. We found out about this when we got a letter from a collections attorney threatening to sue us. When fiance called the hospital, completely flabberghasted, they told him, “oh, that letter is completely fake, please ignore it. We send it to anyone who has any past due balance.” It turned out he didn’t owe anything after all once his names were placed in the correct order and they were able to connect him with his insurance policy.</p>
<p>I wonder if they would have covered me if I’d had a HEART ATTACK because of their pretend attorney!</p>
<p>DH went for his annual “free” checkup (we have high deductible insurance). He gets billed a few weeks later for the blood test work! Double checks w/ ins. and doc. Those are not included in checkup? What’s the doc supposed to do - shake his hand? Listen to his lungs (it’s a well visit annual Fugoonessake)? Isn’t cholesterol and stuff part of a well visit? Nope. Not anymore.</p>
<p>I have a $2 charge on my Macy’s and assumed I misread the bill; I’m being told I paid short of $2 on my last bill; either I misread the bill or it’s the same $2 as OP but Macy’s is telling me I mispaid last month. Of course I don’t have the bill from last month. I will not be using this card again.</p>
<p>What about tax stories? My mother moved from state A to our state B more than a decade ago and has been in a nursing home with advanced Alzheimers many years. Couple of months ago I received a letter from state A’s rev. dept. stating that they had evidence she should be filing taxes there, most particularly in 2010. If within 30 days she did not send them copies of all tax returns and relevant documents from the past several years and prove she didn’t owe them money, she would be billed for the $500 they calculated she owed. What? She hasn’t stirred from the nursing home in all those years. No bank accounts, property, shared accounts. Nothing. What can you do? I obligingly dug out everything and laboriously copied it all, and paid the postage. I did include an irate letter to make myself feel better about being forced to comply with such a strange out-of-the-blue demand. They looked the stuff over and sent a reply letter that everything seems in order and she doesn’t owe the money after all. And noted that it was the IRS who notified them that she might be a tax dodger, not their fault.</p>
<p>Not that state B is much better in this regard. Several years ago after filing mother’s taxes, I received a letter from state B rev. dept. to the effect that I’d botched the job and she owed them several hundred dollars. I was sure I had done things correctly, went back through and couldn’t find any errors, but didn’t want get in trouble with tax authorities, so sent the check without arguing. A month later they refunded the money with no explanation.</p>
<p>I had a billing/insurance problem a few years ago after my husband’s hospitalization. The hospital kept billing and the insurance company wouldn’t pay. Turns out my husband has an ego problem and when admitted said his name was Rev. XY. The hospital was submitting the correct insurance ID number, but had Rev as his first name, and XY as middle and last names. Stupiid insurance company and hospital couldn’t figure out that problem until I took a more careful look at the bill.</p>
<p>Can we discuss COBRA? H was downsized as of 10/31, however he was old enough and been there long enough to qualify for retiree medical and dental (yeah!). The retiree medical was retroactive to 11/1, however retiree dental coverage didn’t start until we got the paperwork and paid 3 months premium in advance. Also, the retiree dental plan is weaker than the regular plan and S1 needs his wisdom teeth out. We got the COBRA package around 11/15 and filled it out and paid the $$. S1 surgery was scheduled for 11/27. Oral surgeon couldn’t confirm the insurance, so we had a choice to either pay $3000 or reschedule. We rescheduled for 12/26 (only day open rest of year where he wouldn’t miss lots of school) because insurance contract rate is $1500 and we pay only 40%. Got a call today from dentist, as d1 had a filling earlier this week. They couldn’t confirm insurance either. Called COBRA and was told it would still be a week before we were in the system. H raised a stink and they said they would try to manually override the system.</p>
<p>My other current headache…property taxes on beach house. Assessor was measuring neighbors house because of a small addition and saw our split ac unit and changed our property tax card to reflect full house central air. Unfortunately we only have the first floor cooled. </p>
<p>Since it didn’t change our valuation more than 15% we can’t appeal to the county tax board for relief. I’m going nuts about this and getting ready to start calling politicians.</p>
<p>Medical insurance (Cigna) - while I was still paying for my deductible, one of my out of network doctor’s fee was $225, which they determined was reasonable and customary. As soon as I met my deductible, a month later, they determined the amount is $200. So aside from having to pay for my co-pay, I have to pay 25 out of pocket.</p>
<p>Same insurance company. They were paying for a service for a year, then they determined it wasn’t a covered service any more.</p>
<p>This is not nickel and dime. My father passed away few months ago. He had life insurance for my mother. The insurance company said they need additional information. The government (my father’s employer) benefit agency said they have provided all necessary information. Every time I called the government it was over an hour hold then they transfer me to 2 or three people and each time they tell me there is nothing they need to do.</p>
<p>“didn’t want get in trouble with tax authorities, so sent the check without arguing”</p>
<p>I’ve been a CPA for 25 years. They are banking (pun intended) on this. Between IRS and my state, I’d guestimate 70% of notices are incorrect. Lots of notices are computer issued without human eyes ever seeing them. Call if you aren’t sure. I know, sometimes if they are small, it doesn’t seem worth the hassle. If you have a CPA, definitely call them before paying. I’d always rather someone call me than pay.</p>
<p>My mom was in the hospital for several days recently. After spending 11 hours in the emergency room on Sunday, she was finally admitted at 10:30 that night. When DH and I visited first thing Monday morning, we walked in on a cheery young lady from the collections department telling my mom the hospital estimated that her bill after insurance would be around $4000 (not sure how they came up with that number since they had no idea how long she would be there–she ended up being released 2 days later). The hospital was offering a “wonderful deal”–if she paid the estimated amount within 5 days of being released, she could deduct 25% so she’d only have to pay $3000!</p>
<p>DH and I were outraged that the hospital would try to pull that garbage on a 79-year-old who was hooked up to IV and a nasogastric tube and felt like crap. Mom got upset and worried about coming up with that much money. We kicked the collections lady out of the room and told Mom not to even think about money until she was well, and to forget about the “wonderful deal.”</p>
<p>Mom got her EOB this week. The hospital billed $14,000, and the insurance paid less than $3000. Mom’s out-of-pocket was $900, and that was only because she still had $450 of her deductible left to pay. So much for the hospital’s “wonderful deal” of paying $3000 and waiting heaven knows how long for a refund… :rolleyes:</p>
<p>A few years ago we got a statement from United Health Care from our vacation timeframe. DH had gone to a clinic for a required regular blood test. He showed his UHC medical card. A few days later the associated hospital accidentally (?) billed $10,000 worth for MRI for somebody with our last name and same first initial as DD. There was not bill to us, just statement. Still we felt it didn’t seem right to not get it corrected. DH and I made many calls trying to get it fixed.</p>