Has your Health Ins Co ever called you to get you to change where a test was to be done?

[LuvOrlando]

I had my BRCA2 breast MRI today at MGH and it was clear, thank goodness. The whole thing is incredibly nerve wracking until I am on the other side of the testing. As a BRCA2 patient all I think of is this the day I discover it happened so I do my best to stay calm. So normally I don't pick up for insurance because they are always trying to get me to participate in some kind of health "perk" but with the MRI the next day I answered the call thinking maybe they need paperwork of some kind. Whole conversation was weird. The person told me this was my ins who wanted to discuss something with me about the testing tomorrow. Out of the gate I asked, "Why would you be calling me not my Dr, go call my Dr." They pressed for me to verify before telling me why they were calling so I did, and then they started to try to get me to answer questions, just basic stuff. Again, I threw up a boundary and told them, "Hold up, I am not discussing a thing until you tell me why it is you are calling me instead of talking to my Dr. Then the woman tells me she wants to discuss other options for my testing location...ummmm whaaaat? I told her, "I'm going exactly where my Dr wants me to go and if insurance wants to debate that I would invite you to call my Dr because I am not an expert but I am going exactly where he says and when he says. Thanks for calling but this conversation is over."

I was flustered at the time and only now that my mind is relaxing a bit because it is over and I got the results am I considering what an appalling breach that was, I feel like it was a sucker punch to get me the night before a test like that, messed up

 

[LoveDaisy]

Did you ask why they wanted you to change locations? Is it possible where your doctor recommended was out of network? I have had my insurance company contact me in this situation.

 

[Judique]

I had my BRCA2 breast MRI today at MGH and it was clear, thank goodness. The whole thing is incredibly nerve wracking until I am on the other side of the testing. As a BRCA2 patient all I think of is this the day I discover it happened so I do my best to stay calm. So normally I don't pick up for insurance because they are always trying to get me to participate in some kind of health "perk" but with the MRI the next day I answered the call thinking maybe they need paperwork of some kind. Whole conversation was weird. The person told me this was my ins who wanted to discuss something with me about the testing tomorrow. Out of the gate I asked, "Why would you be calling me not my Dr, go call my Dr." They pressed for me to verify before telling me why they were calling so I did, and then they started to try to get me to answer questions, just basic stuff. Again, I threw up a boundary and told them, "Hold up, I am not discussing a thing until you tell me why it is you are calling me instead of talking to my Dr. Then the woman tells me she wants to discuss other options for my testing location...ummmm whaaaat? I told her, "I'm going exactly where my Dr wants me to go and if insurance wants to debate that I would invite you to call my Dr because I am not an expert but I am going exactly where he says and when he says. Thanks for calling but this conversation is over."

I was flustered at the time and only now that my mind is relaxing a bit because it is over and I got the results am I considering what an appalling breach that was, I feel like it was a sucker punch to get me the night before a test like that, messed up

Having gone through some of this testing last summer and needing to make my next follow up appointment, I'm thinking some kind of scam call but I can't piece it together. My doctor gives me the paperwork and I choose where I want to go. I'm using a company with multiple offices and I'm usually choosing from them.

Until I make the appointment the facility doesn't even know I'm coming. Insurance usually finds out when the facility needs to get paid. I'm on Medicare with private insurance as well. When I call for an appointment I usually make sure they accept my 2nd insurance so I have no out of pocket costs or copay, and that's about it. No facility has said no to my extra insurance yet.

I did have a different health situation where my chosen facility couldn't do my procedure because of my condition and they informed me of a sitting and standing MRI in another town. One call, Doc sent my paperwork over and mission complete. My insurances both paid and hopefully that's over for good. But the breast screenings will continue. Good luck in your journey - nothing like having extra things to worry about when the stress is already there.

 

[tvguy]

Until I make the appointment the facility doesn't even know I'm coming. Insurance usually finds out when the facility needs to get paid. I'm on Medicare with private insurance as well. When I call for an appointment I usually make sure they accept my 2nd insurance so I have no out of pocket costs or copay, and that's about it. No facility has said no to my extra insurance yet.

If the second insurance is a Medicare Part G Medigap plan, they have no choice. If they accept Medicare, they HAVE to accept any qualified Medicare Part G plan.

 

[barkley]

Did you ask why they wanted you to change locations? Is it possible where your doctor recommended was out of network? I have had my insurance company contact me in this situation.

we've had that too-in fact we got a letter and a phone call from our insurance recently b/c they changed one of their primary medical supply providers and wanted to make sure their insured that used the coverage were aware. it suddenly made sense why the newly non covered company had pummeled us with calls, texts and emails seeing if we had wanted to refill supplies (right before their contract expired).

 

[ruadisneyfan2]

deleted

 

[ruadisneyfan2]

Having gone through some of this testing last summer and needing to make my next follow up appointment, I'm thinking some kind of scam call but I can't piece it together. My doctor gives me the paperwork and I choose where I want to go. I'm using a company with multiple offices and I'm usually choosing from them.

Until I make the appointment the facility doesn't even know I'm coming. Insurance usually finds out when the facility needs to get paid.

I've worked in radiology for decades. Usually MRI or CT requires a pre-cert to make sure insurance will cover it. This is done several days before the appointment.
For a while we had dh's insurance which was an HMO. We were capitated to a private imaging group so I couldn't go to the hospital where I worked when I needed an MRI. They wouln't even let me make an appointment without a precert. They said call us back once you have it.

 

[Judique]

If the second insurance is a Medicare Part G Medigap plan, they have no choice. If they accept Medicare, they HAVE to accept any qualified Medicare Part G plan.

No not anything like that.

 

[barkley]

I've worked in radiology for decades. Usually MRI or CT requires a pre-cert to make sure insurance will cover it. This is done several days before the appointment.
For a while we had dh's insurance which was an HMO. We were capitated to a private imaging group so I couldn't go to the hospital where I worked when I needed an MRI. They wouln't even let me make an appointment without a precert. They said call us back once you have it.

I have an MRI next Monday. the large multi location imaging practice in our region wont even make an appointment until they've verified that the doctor's referral has cleared a person's insurance company criteria AND that the imaging center has received THEIR authorization. there's a recording on the practice's phone line/documentation on their website that boils down to 'don't call us-we'll call you'.

 

[LuvOrlando]

I have Cigna PPO through DH's job so I can go whenever I want whenever I want, so no brakes there.

The caller was "Informed Choice Team" from Cigna and that's a real thing so I suppose it could be understandable if I did not yet have an appointment AND requested assistance, but the appointment was next day and planned last year so plainly I didn't need help.

Because this is BRCA2 related I think insurers are bound to cover it, can't wiggle out.

The oncologist watching me at MGH set it all up last year and this has been standing since then so I don;t think there is even the most remote signal that I wanted help in any way, the timing felt interfering to be honest and I'm really bothered by it.

 

[sam_gordon]

Have you called your insurance company to ask why they called? Or to at least express your feelings of the call?

 

[lanejudy]

My insurance has called to “make sure you are aware” of a specific chain of labs or outpatient ambulatory facilities or even pharmacies. Claiming my out-of-pocket will be less at those locations. The challenge of being rural is that none of those are close so I tell them to forget it. I’ll stick to my local providers/facilities unless they are also reimbursing for my time and travel. 45 minutes one-way to the suggested pharmacy when my local one is 5 minutes drive or even walkable distance.

The best was when they suggested another ER that was in-network and “only 20 miles away.” Yeah - as the crow flies but unfortunately I don’t have wings to fly across the lake. It would be minimum 90 minutes to drive around or at the mercy of the ferry to maybe shortened that by 15 minutes if my timing is perfect. I told them they’ll have to cover the local ER which is 7 minutes away.

 

[TiggerTrigger]

I had something in this vein happen recently. Not sure if this will help or not, but I'll share just in case.

I had my standard annual mammogram. I got conflicting reasons on WHY but a few days later, both the radiology center and my OBs office called to set up a secondary scan and ultrasound. It took a while for them to work me in, but about a week before my appointment, I received a notice stating how much the procedure was going to be out of pocket. I also received a phone call, but I was in a meeting and they never left a message. So, I assumed all was good. I waited nearly a month and a half for this follow up appointment but when I got there, they couldn't find me in the system. It turns out they went ahead and canceled me because...
- My insurance would only cover a standard mammogram at their facility
- My insurance would not cover the more in depth scan and ultrasound at their facility and I'd be paying 100% out of pocket with whatever their cash price was.
- My insurance would cover most of this procedure at one of their other facilities... same exact radiology company and hospital system, just coded a little differently from a medical and insurance standpoint.

Thankfully, they were able to work me into a different facility next day, but it was so bizarre that insurance would only allow certain locations of the same company to do the test. There were other issues...like them failing to leave a voicemail about this and not catching this up front so I didn't have to wait forever to get this done. It was extra nerve wracking because I wound up needing a biopsy. I have Aetna but I guess this can happen with any insurer.