what good is our health insrance

[mommytoe]

I just got a letter from our health insurance company. They are not paying anything toward my dd's medical bills.

I took her to a participating dr. What more could I do? She needed a dr.

Now I need to come up with $300 that I don't have.

I am still trying to get the regular bills paid.

 

[Irin997]

Do you have an HSA plan or a deductible? That could be why you have to pay...although it is less than usual fees. I broke my thumb right after my health insurance switch to an HSA. $875 in doctor's bills later, which were discounted by the insurance company from $1100, and then later discounted to me another 20% for payment by a certain date. I will NEVER have a high deductible or HSA plan agin. I now have a $0 deductible and normal co-pays.

 

[goodcook5]

Often it is 20% or more. Certainly worth a phone call. Insurance IS very frustrating. I commiserate with you.

 

[dodukes]

I feel your pain, i just now qualified for my own policy after losing my jon in june and of course thats when i had to go to urgent care for somthing dumb. I now have close to $3000 to pay from that (altho i am applying for financial aid fromt he hospital) and now my regular insurance premium (which i got a few days after ) and its still a crappy plan, i am actually afraid im gonna actuallly have to USE it..lol..i feel your pain!!!

 

[girli565]

I'm so sorry to hear that!

I know HSA's are difficult to understand but maybe a phone call to the Ins. company could sort out why you have to pay the bill and not them.

 

[Pumbaa_]

What is the reason they are not paying the bill? Was it copay or deductible? Denied?

If it was copay or deductible, usually you would be responsible for the negotiated rate rather than the billed rate, usually lower.

If it was denied, what was the reason? Some things are common submission errors, some things are appealable.

If it is a bill from the provider, do nothing until you get something from the insurance company.

(I used to work for an insurance company in the call center. We would get lots of calls from people who got a bill from the provider with zero due, indicating your insurance company has been billed. Some of these things are automated)

Let us know,

 

[Green Tea]

What is the reason they are not paying the bill? Was it copay or deductible? Denied?

If it was copay or deductible, usually you would be responsible for the negotiated rate rather than the billed rate, usually lower.

If it was denied, what was the reason? Some things are common submission errors, some things are appealable.

If it is a bill from the provider, do nothing until you get something from the insurance company.

(I used to work for an insurance company in the call center. We would get lots of calls from people who got a bill from the provider with zero due, indicating your insurance company has been billed. Some of these things are automated)

Let us know,

Absolutely! So often things get stuck in paper work mistakes and people just pay them. Read your policy! If the expense should have been covered, then cite the policy.

 

[Colinsmom]

What's the reason they denied the claim? If it isn't consistent with your policy declarations, then call the insurance company. Errors are pretty common (either by the claims dept or by your dr's insurance submission).

 

[jsmla]

Hubby had major surgery in June and we experienced several snafus with Blue Cross from a complete denial to several refusals on smaller things. With a bit of patience and a lot of time on the phone we were able to straighten it out. It only takes one number in the wrong place to mess things up. Hubby's anesthesia bill was refused at first because we weren't covered for treatment for drug dependencies. He had a hip replacement. It turned out to be a typo by the billing office. Good luck!

 

[bigbabyblues]

Why aren't they paying? It could be something as simple as they need COB (coordination of benefits) info...they want to know if there is other insurance.

Have you called the insurance? I work in a hospital billing office, we run into this all the time, especially with a new policy.

 

[WendyisDarling]

ITA with others about giving your ins. co. a call if you haven't already. I have so many problems with insurance and most of the time it just takes a couple of phone calls to sort it out.
Most recently, ins denied the claim from an allergist and all the allergy testing . They said she was not in network. The dr. office told me the doctor is a participating provider. This one actually took about half a dozen calls to sort out. She was listed in an unusual way in their system, I guess. Oddly enough, she was rated as one of their preferred doctors . Other times a code has been entered incorrectly. It really happens to us quite frequently. I wonder how many ppl just pay the bill with questioning it.

Good luck to you. I hope you get it resolved and can give us an update.

 

[bnorm27]

Perhaps the OP was supposed to get a referral before going to a participating Dr. Or, maybe this doctor is not listed as her primary physician. Most health plans will even pay a certain amount towards doctors out of your network, so I would venture to say the $300 is not the total bill.

 

[mommytoe]

Dh called the insurance company when he got home.

They told him the dr lied to us about being with our insurance company. There was also some other stuff that dh didn't explain to me on why they are not paying anything period. Tomorrow dh is calling the dr to find out how they made such a mistake and see what they are willing to do about their mistake.

I am still trying to find a way to get the money together to pay them, but short of not paying other bills I have no idea how to pay this.

 

[pweyl36]

Dh called the insurance company when he got home.

They told him the dr lied to us about being with our insurance company. There was also some other stuff that dh didn't explain to me on why they are not paying anything period. Tomorrow dh is calling the dr to find out how they made such a mistake and see what they are willing to do about their mistake.

I am still trying to find a way to get the money together to pay them, but short of not paying other bills I have no idea how to pay this.

Well first of all it is your responsabilty to make sure the dr is in network,also
if they told you that then they should waive the fee.By the way, what did the dr do that he charged $300?

 

[Laxmom]

Call the Dr.'s office and ask about a payment plan if nothing else works. The office I work in will not send you to collections as long as you are making a monthly payment toward your bill. And they may not charge any interest.

 

[Green Tea]

My insurance sent me a letter that they were denying a claim b/c dr. wasn't in network. I knew he was and called the insurance company back and they admitted he was and resubmitted the claim. I mentioned it to doctor and he said they do that ALL the time. Look at your list of providers, see if the doctor is listed.

 

[Mouse House Mama]

Dh called the insurance company when he got home.

They told him the dr lied to us about being with our insurance company. There was also some other stuff that dh didn't explain to me on why they are not paying anything period. Tomorrow dh is calling the dr to find out how they made such a mistake and see what they are willing to do about their mistake.

I am still trying to find a way to get the money together to pay them, but short of not paying other bills I have no idea how to pay this.

Sometimes the office only has one doctor that actually is under the insurance and they have to bill through his/her name. The office could have billed under the wring doctor's name. This has happened to us. It is usually the head of the practice.

 

[WendyisDarling]

Dh called the insurance company when he got home.

They told him the dr lied to us about being with our insurance company. There was also some other stuff that dh didn't explain to me on why they are not paying anything period. Tomorrow dh is calling the dr to find out how they made such a mistake and see what they are willing to do about their mistake.

I am still trying to find a way to get the money together to pay them, but short of not paying other bills I have no idea how to pay this.

The insurance company could still be mistaken. As I wrote previously, our insurance company told me the allergist was not in network. They searched and searched while I was on the phone with them. Then said "nope, sorry--she is out of network" (our plan pays $0 if you use an out of network doctor). I was furious because the dr. office told me they were participating providers. So, I called in a bit of a tiff. They assured me they are in network and have several patients with the same insurance and no problems. It took several days and calls between the insurance company and the dr. office and several more from me to figure out YES the doctor is a participating provider. My $900 billed dropped to $16.75! Keep trying.

One thing I have learned to be careful about (esp. with dentists for some reason), you must ask if the dr. is a PARTICIPATING provider. If you ask if they are a provider for such and such insurance they often will say yes, but it only means they will submit claims to the insurance company, it doesn't mean they have a contract or are in network.

No idea what your DD's dr. visit was for, but if it was minor w/o testing $300 seems high. By chance, did you go to an urgent care center? I went once and boy that was a huge mess to work out with insurance even though the urgent care was a participating provider (as someone else wrote, it turned out the billing had to be under a particular doctor's name)

Continuing to hope you get this resolved.

As far as payment: Most places will help you set up a payment plan. They want to get paid. I have heard of people paying $20 a week or $50 a month. They should be especially helpful if in fact they misinformed you about being a participating provider. You maybe could even ask for a discount (the contracted amount your insurance would have allowed). Asking for the discount can't hurt, worst that can happen is they say no.

 

[powellrj]

I agree, call back. I went round and round with the insurance once. They said our Dr was out of network and I knew he was in. It took a couple of phone calls and they found out that yes he was in network. Not sure what the problem was, but we got it fixed!

Good luck.

 

[bnorm27]

Most insurance companies will pay a certain % of expenses for doctor's out of the network. I would call your insurance company to find out what they might be willing to pay. I would also ask them what they feel should be the "reasonable and customary" fees for the service the doctor provided for you. (This will normally be less, sometimes much less, then the doctor would bill an individual). Go back to the doctor and tell him you will pay the reasonable and customary fees for his service. If he provided the service to you, he does deserve to get paid. I realize that someone in his office my have "lied" or gave you wrong information. Most doctor's would certainly be willing to work with you to arrange payment.

Make sure you find a doctor "in network" and that if referrals are required that you get them prior to the visits.

Good Luck!