I just hate dealing with insurance(health)

[Dznypal]

Last month my DH had a herina repaired.

It was day surgery--he was in at 830 home about 330

no problems

today (sat) we get a statement from the hospital (not the insurance) that they want they $300 deductiable

and 450 for co-ins we dont have any other insurance--

it also said it was an estimate that this was no guranetee of the amounts

I never heard of prepaying for a surgery!!!! sort of like prepaying for gas--where the station wants their money before you fill!!!!!

why do they make insurance so hard to understand

and of course we always get these kinds of things on sat when there not opened!!!!

just needed to vent

happy mothers day

 

[ennazus]

coinsurance means sharing of payments w/ the insurance company...for instance maybe you have a $300.00 deductible and then the insurance company pays 80% and you pay 20% up to another limit .

As far as the paying up front!? Talk to your insurance company and ask if the provider can do that!

 

[OhMari]

I have to pay a co-pay for anything dealing with medical, whether we are visiting a dr, going in for a procedure. And I just read we would have to make a co-payment for any surgery.

Your husband must be meeting your family deductible, so the hospital has forseen this and wants the deductible paid too. They really can't make you pay your deductible before surgery, but I can see paying the co-payment.

I'm on your side, something really needs to be done with health care cost in our country. At least you have insurance, can you imagine paying for the whole procedure.

 

[mickeyfan1]

My husband had surgery 3 weeks ago. The surgeons office sent us a bill for 319 before the surgery, saying it was for the deductible and the 10% after. I went a little off, called the insurance company and asked them if this was SOP, she said they could get the deductible, but nothing else because they don't know what is going to happen in surgery and they can't "make up" a claim. So I paid the 250, and now just need to see the bill for the additional 70 or so.

I would call your insurance company and ask them what they think you need to pay for. Until the Hospital bills the insurance company, it is hard to tell what your part will be.

 

[terri01p]

Not to highjack your thread but you think that's bad, I had an MRI done last month for dizziness and I got a bill for 830.00 from the hospital ( this is after my insurance paid it's 80% ), and yesterday I got a bill in the mail for 600.00 (after insurance ) , when I called about it they said it was for the MRI being read. I could have crapped , 1430.00 so I could received a postcard in the mail saying my MRI was normal.

 

[DebbieB]

The surgery was last month? So why is getting a bill now prepaying? They got an estimate from the insurance company and are billing you for the difference. They probably have a hard time with collections and want to start getting some of the money now.

 

[bettyann29]

I work for a health insurance company and answer phone calls from members and providers regarding benefits and claims.. Yes they can make you pay before your surgery for the deductible.. if the provider calls the insurance company and verifies your benefits and asks if your deductible is showing as met and are told no than they have the right to request that money before doing surgery.. it sounds like your husband had the surgery already and now you are getting the bill so it doesnt even appear they are asking for the money beforehand.. and just to mention.. hospitals especially know up front exactly how much the insurance company is going to pay because there are networks generally involved (not so though if the hosptl is not participating) and they know their discounts up front because they sign the contract and they know how much percentage will be written off .. so once they call and verify your benefits they take that from the discounted amt and they know exactly your portion.. most dont ask for it up front though because deductible is taken from claims in the order they are recvd and processed with the insurance company so if you pay your deductible to the hosptl and the surgeons bill gets to the insurance company first and the insurance company takes the deductible from that bill then when the hospt bill comes in the deductible is met and you only owe your coinsurance.. so now you may have paid too much money.. then the patient has to deal with the provider on getting any overpayments back.. Alot of providers dont want to do this, so they just send in the bill and see what happens.. the only problem with that is that sometimes when they dont collect any money up front then they get stiffed for payment from the patient.. so some of them are stricter on it.. They actually have that right..

 

[delilah]

My son had 2 teeth removed in January. The oral surgeon tried to do the procedure in his office under conscious sedation. It didn't work. My son was kicking and thrashing, so we had to return two days later to have the teeth removed under general anesthesia. The total bill was about $3300. For two baby teeth (actually, impacted supernumary teeth that were keeping the adult teeth from erupting). Am I glad I did it? You bet. The adult teeth are now almost totally grown in, and his beautiful new smile looks great.

 

[mssocks]

bettyann you poor thing! I always feel so bad for the person answering my calls when I have problems. I'm sure people treat them badly all the time. I try to get the business done as if I were talking to a friend who is sitting with me. At least there is one friendly moment in their days! Of course I am a little annoyed at the girl who was going to resubmit a claim and didn't. But that;s how it goes - and why I check on line to see how things are progressing.

 

[mickeyfan1]

I don't mind paying my share, and I have NEVER had a problem with my insurance carrier. I was just peeved at the doctors office wanting money for something they hadn' done. The deductible I understand but to say they want the rest when they don't even know what they were going to end up doing.

I hope it all works out for the OP, we are waiting for the surgeon, the anesth, and the hospital portin bills now. I don't expect them, to be too much, they are all participating in the plan, and the negotiated rates are darn good.

 

[AllyandJack]

I always pay my co-payment up front for office visits, planned procedures, etc. My parents are both medical billers and that's just what we did.

However, I DID have a huge problem with the twit who came into my ER bay when I was having my miscarriage. She shows up asking me for my $100. ER co-payment. I turned all Linda Blair on her and she went away quickly.

Make sure you check your contract to be sure you're paying the right amounts. I swear these places bill amounts just to see who will pay and who will check to see if it's correct.

 

[The Mystery Machine]

To answer your question, prepaying for surgery is "standard operating procedure" now when you have to meet a deductible.

The key is that you have to iron everything out with insurance company to make sure you are not overpaying!!!!
We stay on top of things and you will 'overpay' if you are not careful.

 

[bettyann29]

bettyann you poor thing! I always feel so bad for the person answering my calls when I have problems. I'm sure people treat them badly all the time. I try to get the business done as if I were talking to a friend who is sitting with me. At least there is one friendly moment in their days! Of course I am a little annoyed at the girl who was going to resubmit a claim and didn't. But that;s how it goes - and why I check on line to see how things are progressing.

Some days its harder than others.. Sometimes I get cussed at and called all kinds of names.. I feel bad when insureds call in and end up crying.. I have a sick child who has medical problems so I do understand what others are going thru and I do empathize with them.. The job really isnt all that bad but some days I just want to be on vacation..

I did apply for another job in the company recently and Im hoping I get it.. but until then Im just glad to have a job..

 

[bettyann29]

Make sure you check your contract to be sure you're paying the right amounts. I swear these places bill amounts just to see who will pay and who will check to see if it's correct.

Actually that is more correct than what alot of people think.. You wouldnt believe how many claims are disputed and come to find out the hospital is billing for services they didnt even do..

Whenever you have surgery or a hospital stay you should ALWAYS request an itemized bill from the hospital and see what they are billing and make sure they really did it.. in the long run it will save you money because you wont be paying your % coins.. also the policies we have and a past major health insurance company I worked for had a benefit in the policies that if you find a mistake that the provider billed for and you contact them and they correct their bill (and they will if you bring it to their attn), then you get money from the insurance company.. because you are saving them money..

 

[bettyann29]

To answer your question, prepaying for surgery is "standard operating procedure" now when you have to meet a deductible.

The key is that you have to iron everything out with insurance company to make sure you are not overpaying!!!!
We stay on top of things and you will 'overpay' if you are not careful.

Yep.. you have to read your explanation of benefits and verify everything.. I think alot of times people get the bills and just pay them not paying attention and its something that maybe they shouldnt have paid or end up overpaying..