Medical insurance...

[leebee]

I am so frustrated. I need an MRI on my knee. Doctor recommended it, insurance denied it. Doctor went to battle for me and the insurance approved it, sent the approval to the doctor's office. Office set up the appointment at the Imaging Center and I should be good to go, appointment is for 12:30 today. The doc's office called yesterday to say that the insurance approved the MRI to be done at the Center for Diagnostic Imaging, not the IC, and I needed to call the insurance and get that changed. Nope, not gonna happen, I have to go to CDI or pay out of pocket. Called the doc's office yesterday as they said they'd go to battle with the insurance company to get the location changed. Called just now and although the info was sent to the doc, she hasn't called the insurance company yet, but the lady with whom I just spoke recommended I cancel the appointment so I don't get charged a no-show fee.

Here is the really frustrating thing: Both CDI and IC are through the same healthcare system! Both are Northern Lights/Eastern Maine Medical, but CDI is at the hospital and IC is at their "healthcare mall" on the other side of town. Everyone uses the two interchangeably, pretty much. You can get bloodwork done at the hospital lab or at the healthcare mall lab. You can go to the ED at the hospital or walk-in care at the healthcare mall. Some of the system physicians have offices at the hospital (like my surgeon), some at the health care mall (DH's surgeon). We've had all these scenarios occur, and the insurance covers. Not this time. Looks like the appointment that took 6 weeks to get isn't going to happen. Remind me again about the "great" healthcare system we have in the USA...

 

[Pea-n-Me]

There could be a reason why the insurance company doesn’t want to use a certain place. Like, say that particular place hasn’t met their quality indicators or something like that, so they don’t want to pay for care there until they up their standards. There’s a lot that goes on behind the scenes that most people don’t know about. You want to have a good reading of your knee. These issues come up from time to time for all of us. I don’t think that translates necessarily, though, into healthcare sucks in the USA. I know it can feel that way when we’re frustrated. I hope you can get it all sorted out!

 

[Skippy918]

I’m sorry, that’s so frustrating!
Healthcare does suck in the USA. Dh went to the emergency room a few weeks ago cause he was in excruciating pain. Turned out to be a kidney stone. The hospital billed insurance 16k!! He had a ct scan and pain meds. I have no idea what we’re going to owe.

 

[Pea-n-Me]

I’m sorry, that’s so frustrating!
Healthcare does suck in the USA. Dh went to the emergency room a few weeks ago cause he was in excruciating pain. Turned out to be a kidney stone. The hospital billed insurance 16k!! He had a ct scan and pain meds. I have no idea what we’re going to owe.

Have you been to the grocery store or gas station lately? Everything’s gone up!

 

[cedricandsophie]

If the results go into your online file and your dr can view it, what does it matter? If the dr group has an interest in the imaging center the other place could provide the same exact test at a lower cost. I’d just get it done. The quality of an mri doesn’t vary much but the cost can.

 

[SirDuff]

If they are interchangable, why is your doctor insisting that you go to IC?

 

[mamamary]

I’m annoyed with my dr./insurance this morning. Last August I went for my yearly physical which should have been free. Because my dr. Asked me many different questions and we talked about different things my dr. Said it was no longer a physical but a regular drs. Visit which will now cost me just under $200.

I thought the purpose of the yearly physical was to go over everything. For my next physical in a few months I will be very careful what I say.

 

[Skippy918]

I’m annoyed with my dr./insurance this morning. Last August I went for my yearly physical which should have been free. Because my dr. Asked me many different questions and we talked about different things my dr. Said it was no longer a physical but a regular drs. Visit which will now cost me just under $200.

I thought the purpose of the yearly physical was to go over everything. For my next physical in a few months I will be very careful what I say.

I find this to be such a bs policy.

 

[Skippy918]

Have you been to the grocery store or gas station lately? Everything’s gone up!

I know. But how do they justify 16k for an ER visit? Plus at least with groceries or other stuff you buy, you know the price up front so you can choose whether to purchase it or not or shop around. Can’t do that with the ER cause they can’t tell you how much it’s gonna cost.

 

[Kennywood]

Medical insurance, whether through a private company or through the government is based upon one premise: They that pay the bills make the policies and the decisions.

 

[Dan Murphy]

Have you been to the grocery store or gas station lately? Everything’s gone up!

My recent heart ablation (and did not last, no refunds), $138,000, not including doctor bills yet.

 

[Dan Murphy]

I am so frustrated.

Hoping it gets resolved, leebee.

 

[leebee]

If they are interchangable, why is your doctor insisting that you go to IC?

It's not the doctor, it's all one system. Docs in the system put in the request, the schedulers schedule the appointments. Outpatient MRIs are seen at the Imaging Center, in-patient are seen and the CDI, which is AT the hospital. For some reason the insurance will only cover CDI. I've been to both before, and the facility at the IC is newer, cleaner, runs on appointments and pretty much on schedule. At the CDI, it seems like you roll the dice to be seen. When I was inpatient for an eye issue, I laid on a gurney in the hall for over 2 hours, waiting for CDI to bring me in for the scan.

My recent heart ablation (and did not last, no refunds), $138,000, not including doctor bills yet.

I've been wondering how that went, @Dan Murphy. Sorry to hear that it didn't work. My MIL also had an ablation, and it worked for about 3 days. Hopefully you are feeling OK and there'll be other options.

 

[Colleen27]

Ugh, good luck. I've started paying OOP for treatment relating to the one condition I have that requires ongoing care, because my ophthalmologist retired and it has been a run around with my insurance ever since. The other doctor I see - and who I have seen, often, because my primary used to travel for several months of the year with the international aid agency that he's retired to join full-time - was somehow covered as part of the primary doctor's practice, but now that he's the lead, they've classed him as out of network and want me to find a new ophthalmologist. Except I live in a rural area, they're the only practice in my county, and I really don't relish the thought of 30-40 mile drives home with my eyes dilatated or having to find someone to drive me to and from every routine monitoring appointment (which can be once a year or can be every three months, depending on results). So for now I'm paying cash for the doctor 6 miles from home instead.

 

[NWOhiogal]

Everybody else in the world thinks Americans are crazy for not DEMANDING universal healthcare. They can't believe the hoops we have to jump through just so we don't go bankrupt being living, breathing human beings. And a lot of times we do anyway.

Unfortunately the medical profession has such a powerful lobby I don't think it's ever going to change. The rich don't care if the poor suffer and die; and they'll always get the best of everything. They don't see what the problem is!

 

[tvguy]

Well, my two current issues with the healthcare system are not with the insurance companies, they are:

1) LONG waits to see specialists. The first opening to see a Nephrologist was 4 MONTHS.

2) Doctors ordering more tests than are needed and/or not looking at my medical record to see I have already had that test done my another Doctor. My insurance did say a PET scan was not "medically necessary", and when I asked the specialist who ordered it, he said he really didn't need the test, he just wanted it.

 

[SandyinMonterey]

I hate dealing with medical insurance companies. The back & forth is ridiculous. It's made too complicated and I'm sure the insurance companies do that on purpose. Been thru the CT Scan, MRI ,etc. Usually, out patient facilities (those not within a hospital) are usually less expensive and, of course, being within network. A LOT has to do with how it's billed and diagnosis AND procedure codes. Though I have had some instances when an out patient facility called my insurance to find out what my out of pocket would be and was told this very high amount and stuff about meeting my deductible but I know that when using an out patient facility, deductibles don't apply, they only apply when using in hospital facilities. When you speak to a representative from your insurance company, make sure you take notes: their name, date, time and you can ask for the reference number ( that's the number pertaining to your call, they keep a record of it). I'll be going in for some tests next month, orginially told my out of pocket was a little over $800. after MANY calls and knowing most of what they were telling me (the facility and insurance), I got it down to $45. And this happens A LOT to me. My husband needed an MRI done years ago, it was denied. Was told to do PT, which would be more expensive. But, like doctor said, we didn't know what was wrong and doing PT first could make things worse. Ended up finding an out patient MRI that gave SIGNIFICANT savings (even more than if we went thru with insurance) if we paid out of pocket and they would also do a payment plan if needed. But that was about 10 years ago but it cost $300 out of pocket.

 

[Kitty 34]

Sorry, you're dealing with this Leebee. Been there a few times especially when I was first starting my infusions. It can be so frustrating.

 

[Dan Murphy]

My recent heart ablation (and did not last, no refunds), $138,000, not including doctor bills yet.

I've been wondering how that went, @Dan Murphy. Sorry to hear that it didn't work. My MIL also had an ablation, and it worked for about 3 days. Hopefully you are feeling OK and there'll be other options.

Feeling exhausted with almost no physical exertion. Otherwise, pretty well, leebee. Did your MIL do something else? They are looking at using a drug to 'assist' the ablation over the coming coup[le months.

Oh, and with the ablation, 1 cardiac MRI, 1 TEE and 2 cardioversions, total is so far about $173,000 (no refunds, no returns)

 

[cvjw]

Go to the other location and keep your appointment. I would drive a little bit to actually get an MRI and not have to go thru the whole approval process again.

My neighbor is from Canada. Her whole family is still in Canada. Talking to her about how long her family has to wait for MRI’s, cat scans and other procedures will make your 6 week wait seem really quick. Her sister has a serious medical condition and has been waiting many months for treatment.