http://www.firstgiving.com/teephortwo
Ugggg, Sometimes medical insurance drives me up a WALL. Medical insurance comes out of my paycheck each week for my family. I don't mind paying the premium... pretty high imo.
So I need to have an MRI done and my doctor suggested I call my insurance company to verify the hospital they are sending me to is in network. I looked online to no avail. I am never able to find a doctor or hospital online that is in network. (I do now)
So I call the 800 number on my card and ask for assistance to see if the hospital is in network. The customer service assured me they were in network. I go have my MRI done, get the bill well guess what Nope. Not in network. They paid at 60% instead of 80% I sent in the appeal paperwork, got notice back from them that they are standing by their original decision to pay at the lower amount. They said it was my fault that I did not verify that the hospital was in network?!?! Wth. They have it in their records that they told me they were in network. Well in between the time I was seen and receiving my bill, dh had to go to the emergency room. We were actually on a weekend getaway when he needed to go. I told him to hold on, lets try to make it back to the hospital I went to as I knew they were in network. This is the first time we have had to use the ER with this insurance company and we were not quite sure what the guide lines were for going out of network. Plus we really did not have time to call around. We made it back to the local hospital he was treated and sent home. So guess what, they only paid a portion of it.
I have called my hr department to see if they could help me get this straightened out. She has not returned my calls. I now need to send in the second appeal. Hopefully this gets settled as the hospital is now threaten to send me to collections if I don’t pay off in full. I asked about payments they said I would have to have it paid off in full. They don’t do payments that I would have to work that through the collections dept.
Sorry for the long vent. Any suggestions?
Lisa
1|1|You need to contact HR again...ASAP|zydeco|kimr@alador.com|03:27:44|09/23/2009|
For some reason-I think...if you pay the remaining balance of the scan bill that shows that you do agree you owe that amount.
If you are not getting any response from your employer. All the info is in you insurance handbook. BUT it takes forever to figure out on your own!
The last people you should listen to are the people from the insurance company! They will stall until they don't have to pay it. (Been there-done that) They have a record of you calling and why you called...to find a participating hospital. They probably even a recording of that conversation. The help of your employer should make this issue move more quickly. HTH and GOOD LUCK!