Insurance ugh!

Discussion in 'Random Ramblings' started by rancher hicks, Dec 27, 2010.

  1. rancher hicks

    rancher hicks Chicken Obsessed

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    Feb 28, 2009
    Syracuse, NY
    So I have a dentist of course and two insurances. Now one is primary and one is secondary. The thing is they send me a bill when all insurances haven't paid. Or they submit to the secondary first and not to the primary or just screw things up. Man! Now I always watch for my EOB from the insurance company and/or companies to make sure they've paid or decline the claim.

    I have in the past paid a bill only to have the insurance company pay and then have the dentist office say, "well you have a balance of blah, blah, blah." Like I'm rich and can have the dentist hold my money. NOT!

    So watch your insurance with the Doctor or Dentist and if something seems suspicious call your insurance company to see if the claim has been submitted right or at all. Make sure you don't pay until the insurance company has sent you your EOB. Explanation of Benefits, telling you what if anything was paid.

    DW works in insurance at the hospital and here they have a certain number of days to submit to your insurance company and if they don't the hospital has to write it off as their loss. Make sure you call your insurance company to see if there is a "pre-approval" on your treatment, or you could get stuck. Even if it's the providers responsibility. DW says they get stuck for lots. Insurance companies can be tricky.

    In the case that ticked me off now the bill was submitted to the secondary first, so i called and said no I have a primary insurance. Now when it was submitted to the secondary it was without the EOB from the primary and both times I got the bill!!!!

    Don't pay a bill till your sure all insurances have paid their claim and you have proof of what and why. Take no ones word for it, get that EOB in your hand or you could be stuck holding the bag for a lot of money.

    Just needed to tell someone before they got stung like I did once.

    Rancher
     
  2. gritsar

    gritsar Cows, Chooks & Impys - OH MY!

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    Insurance is a big hassle. I have two insurances - Medicare is my primary and DH's insurance through work is my secondary. The two companies argue all the time over who is going to pay my bills.

    The biggest problem we are having right now is with DH's workmans comp. claims. After these doctors and hospitals have gotten all they are going to get out of WC, they are trying to bill us for the remainder. Umm, no. You get what WC agrees to pay you and that's it. That's the law.

    Bloodsuckers. [​IMG]
     
  3. rancher hicks

    rancher hicks Chicken Obsessed

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    Quote:Don't even get me started on WC. If it's not the Federal government get a lawyer for sure.
     
  4. Dunkopf

    Dunkopf Chillin' With My Peeps

    Sep 24, 2010
    Kiowa, Colorado
    We got burned by trusting our doctors office to get a surgery pre certified. DW had a surgery 12-22-09. Her deductible and all copays had been paid. So we figured free surgery except for the surg tech. They are never on the preferred provider list. 8 months later the hospital send us a bill for 500.00 for the surgery. I call them and they say that BCBS didn't pay for 500.00. So I call BCBS and they tell me it wasn't pre certified so they kept back 500.00. I sent them an appeal and just got the denial back a few weeks ago. Now we're paying the hospital an extra 166.00 for 3 months.

    Learned a lesson though. Always be sure you are pre certified. I won't complain too much. It was my fault. I know better than to count on people to do something I'm responsible for. Besides, BCBS paid out about 70k over the past 2 years on my policy.
     
  5. rancher hicks

    rancher hicks Chicken Obsessed

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    Quote:Did you check to see who was responsible to get the surgery "precertified"? Check your paperwork. DW says the hosp. gets stuck lots cuz the billing office billed it wrong. They may be trying to pass the buck.
     
  6. Dunkopf

    Dunkopf Chillin' With My Peeps

    Sep 24, 2010
    Kiowa, Colorado
    Yes. It states clearly on my ID card that I am responsible for pre certification of any surgical procedures. This was discussed with the Dr and he assured us that it would be handled by his administrator. We received a letter stating that the surgery was approved and we thought it meant we were pre certified. Between the 2 of us we have had about 11 surgeries in the last 8 years. It has always been handled by the doctors office. It just turns out his administrator who has since been fired was a dimwit.

    It was really the hospital that caused the surcharge. They didn't submit their billing until 6 months after the procedure and the insurance company was upset about it. I tried to get the hospital to accept responsibility, but that was like pulling teeth since it was based on me not getting the surgery pre certified.
     
  7. herfrds

    herfrds Chillin' With My Peeps

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    The craziest one I ever saw was the hospital billed my FIL's insurance for our DS.
    Talk about a huge mess trying to explain that yes they both have the same first and last name, but different middle names and birth dates.
     
  8. TennesseeTruly

    TennesseeTruly Chillin' With My Peeps

    Mar 5, 2009
    Church Hill, TN
    In 2006 I had a really bad accident. I spent 27 days in the hospital, first 9 in ICU. Imagine the bills??

    Well silly hospital billed the secondary insurance first and guess who didn't get paid for over $277,000???? Yup. I bet heads rolled over that one.

    Laurie
     
  9. booker81

    booker81 Redneck Tech Girl

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    Of course, you could have an oopsie with Social Security who decides to "kill" you, and find out when you are getting your prescriptions refilled that you don't have insurance - because according to the insurance company, you died!

    Happened to my mom. Apparently it's great fun trying to convince the Social Security office that you are, in fact, alive. They had closed her Social Security number and everything.

    We only have one insurance, DH's, and it's often a doozy. I refuse to pay anything other than copays until I get my EOB, and even with some specialists, won't pay the copay until I get an EOB. I can't keep track of my copays, they seem to change, for a while it was $20, then $29, now $20 again. Hosptial didn't bill for one of my surgeries, until I called and told them no EOB, no payment. That was 100% covered.

    I did manage to get some of my hospital copays ($100 each) wiped when the hospital made an oopsie and discharged me instead of booking me for emergency surgery. They would rather eat the $100x2 copays (one for each admission), than get sued (though honestly, I wouldn't bother suing, too much time, energy, and money).

    Insurance isn't fun.
     
  10. rancher hicks

    rancher hicks Chicken Obsessed

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    Feb 28, 2009
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    Quote:In this state there is an agency to handle appeals like this and if you've got paperwork to prove the hospital was supposed to submit in a timely fashion and didnt' you may be off the hook and them on it. Here the hosp. would be stuck. Check for a state agency to handle this and appeal to them.

    Sounds like they're trying to stick you.

    Case in point, I had a company that only sent me half of what I was entitled to. What they didn't tell me and I found out quite by accident was that I had to "call them" and tell them it was an ER visit to get the other half. I don't know why, the "code" should have told them it was an ER visit but they were crooks.

    Try the state for see what they can do. Write you congressman and he may be able to help.

    Hope for the best

    Rancher
     

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