Post # 1
I’m just really upset and hoped some bees could give me some advice/comfort.
I had to get a procedure done last month as I normally do every year since I was like 13. My old insurance always covered it in full but once I moved out of my parents house and got my own job I got insurance through work. The new insurance sucks beyond belief compared to my old one but at least it is there in case something major happens.
Anyway, the insurance I have now claims that it covers preventive care in full. I’m not the normal age for getting the procedure done so they won’t cover it because on the bill it wasn’t billed as routine. I called the billing department at the hospital and they have to bill the way the Dr. reffered me as, and the Dr. has to reffer it as my diagnosis from when I was a kid. Insurance only covered my medicine and pregnancy test that was given to me that day and it wasn’t even in full. They won’t cover my procedure at all and I just want to cry. They didnt even cover 25% of the costs from that day. Its a routine procedure to me! I plan on appealing but am afraid I’ll be stuck with the bill. I’m just overwhelmed and needed someone to listen. Thanks to those that have read, I’ll try to get back to my day now.
Post # 3
I’m sorry, it sounds like your insurance is just like mine. It sucks. 🙁
Post # 4
Awww HUG! I’m frustrated with insurance too! My parents were teachers so they always have had great insurance and now that I’m on my own my insurance really stinks! I work for a good company but in comparison to what they have nothing compares. Also, my poor Fiance due to being laid off 1.5 years ago has had to pay all his own health bills. He’s been working since then but because he’s a contracted worker he doesn’t get benefits and because we’re not married yet he can’t be on my insurance. SIGH. He has more medical issues than me too so out of the 2 of us it’s probably better for me not to have insurance then him.
Post # 5
Ask your doctor if he can either change the diagnostic code or add a second one. The worst thing he could say is ‘no’…
Post # 6
I don’t have anything helpful to add other than I’ve lived in Canada and in comparison, the American health care system is UNBELIEVABLE. I cannot believe the way things work here! Canada also has a similar system to many parts of Europe and even MEXICOs system seems to work better and be more affordable!
I was so shocked coming to a place that thinks it can justify tens of thousands of dollars if you break your damn arm!
Sorry, I think I just added to your rant but I would appeal!
Post # 6
Wow that sucks, for the future are you able to change your insurance premium so that you pay a little more towards it each month and that way they will cover more procedures for you.
Post # 7
As a previous poster said, definately call and talk with one of the staff in the doctor’s office directly. The billing department can’t change a billing code, but the staff can contact your insurance help you work it out. I had to do this all the time when I worked in a clinic.
Post # 8
I would definitely start with the doctors office, and if they won’t change the code, tell them you need ALL your records dating back to the diagnosis for that procedure, so you can appeal the insurance denial. It will suck if you have to do that, but hopefully having to copy all those pages will get their asses in gear!
Post # 9
Most health policies also will not cover pre-existing conditions for the first year of coverage. That could be part of your problem.
Post # 10
Thanks for the replys so far
@DaneLady: I called my family doctor and she said she had to code it that way but if there can be more than 1 code than maybe I can get her to do that.
@ViaMinorViator: I hate the way the US does medical. I would love it we had a national health care system.
Post # 10
I agree to start with the doctor. Hopefully they can find a different way to have it billed so that it is covered by this insurance. I had Lupron shots for 6 months and I got a 3 month shot one time and they insurance denied it because they called it experimental but the 1 month shot was covered by the insurance.
Post # 11
What kind of procedure was it?
I make sure not to have anything done without asking if it’s covered first. Especially when I’m at the dentist office. Want to give me flouride? Is it covered? lol
Post # 12
@strawbabies: I gave them proof of credible coverage since I had insurance all my life so then pre-existing conditions would be covered. I was worried about them avoiding paying.
Post # 13
@JustMarriedinDC: It was a colonoscopy. When I called the insurance company the guy said that it would have been covered in full if it was coded routine. I do the same thing at appointments as well, if its not covered then I don’t want it. I didn’t really have a choice on getting this done or not since if I don’t get treatment by having polyps removed cancer will develop.
Post # 14
Definitely check with the doctors. They can also appeal on your behalf and tell the insurance company that the procedure is medically necessary. Next time, make sure you double and triple check that everything is covered before doing anything!