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Health Insurance


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So last setptember/october I had health issues that required several office visits and some outpatient stuff.

The way our insurance works we have to start with our primary doctor who can then refer us to specialists. We have different levels of copay.

So my primary sends me to a surgeon. I pay $40 copay. He sends me for a CT SCAN. The test is covered, all is good. He in turn suggests I see a GI specialist. I get a referal from my primary and approval from the insurance. The GI doc wants me to get scoped from both ends. That gets approved. I go to the hospital. The copay is a few hundred dollars but they say they will knock about $80 off if I pay on the spot rather than get billed. I do that. Insurance did not cover the $100 drink required for the tests.

After all is said and done I begin receiving a bill for $280 from the surgeon meaning the office visit has now cost me $320. The hospital is billing me for a little over $100. Both the surgeon and the hospital state that the insurance did not cover the entire amount. Insurance company blames the hospital and surgeon for not accepting what they paid to cover 100%. The surgeon and hospital state the insurance company did not cover as much as agreed.

Three months of battling both threaten me with collection. I cave and pay the bills.

This pisses off.

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Sucks. My Sweetie was a billing specialist for quite a while, and if the Dr. has a contract with the insurance co., the Dr. has to take what the insurance co. offers. At least in Ohio.

I am fighting one now with a chiropractor. They did a test that wasn't covered, they didn't call the ins. company ahead of time to get it approved, the didn't tell me it wasn't pre-approved, and billed me $900, almost a year later. I suggested they urinate up a hemp line, they dropped the "charge" to $300, I told them to piss higher. Received a letter from a collection outfit in December. Fun is just starting. Good luck with yours.

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I had my first heart by-pass when I was still on active duty in the Air Force and it was done in a civilian hospital since I was to unstable to move to Walter Reed. Well the Air Force took their sweet time to get around to paying the 32,000 dollar bill and I started getting bills from the hospital. Luckily, my commander who was a friend, was the nephew of a member of the House of Representative, he found out what was going on called his uncle and the bill suddenly got paid.

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