I have been stunned by the lack of consumer protections from insurance companies. They can just deny claims improperly and as long as they eventually approve things after a big fight, they face no consequences. They have every incentive to make things exceedingly difficult for providers, patients and their families. We thankfully have a plan that reimburses for providers that don't accept insurance. I truly cannot blame them for not accepting insurance. I'd rather they focus their energies on providing services instead of dealing with paperwork and their rates are perfectly reasonable. I actually have less sympathy for providers that take insurance and then charge people paying OOP 2-3x times the amount they take from insurance. And I have absolutely dealt with providers that are at fault for insurance issues. Like billing me because "insurance didn't pay enough" when in fact insurance paid their contracted rate, and it takes a minimum of 30 minutes of my time to convince them they screwed up. Or another provider that sent the claim to the wrong address, but I have to call them 3 times to convince them that (1) my insurance is in effect and (2) they need to resubmit the claim. It is exhausting.

Anonymous wrote:a whole book was written about this deny, delay, etc.

its the business process of all the insurance companies.

they count on you to give up or stay in network which saves them money

I keep a spreadsheet; see the doctors who I want; get the superbly and submit ASAP. There have been many hiccups (I report them to the healthcare ombudsman who sends a letter that is required by law to be responded to). For the routine weekly visits, I get reimbursed in two weeks.

yup. reading this while on hold with united healthcare. i am fortunate to have a PPO and be able to be reimbursed for out of network, but they sure do NOT make it easy. and its frustrating how many doctors in this area do not accept insurance.

This is why so many people cheered Luigi.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:take 'em to court OP. It could be a groundbreaking case that gets media attention, picks up steam, and gets real reform and results.

I used to do this for a living. No one cares. Media are not covering it. And the reason OP has to do it is because she has elected to pay her bill with insurance instead of cash. Either way it’s on her to make sure it gets paid.

Honestly though the only issue I’ve ever had with my carrier in more than 20 years was whether certain care was reasonable and necessary.

The New York Times has done several articles on patients coping with catastrophically large surprise medical bills, patient's inability to get billing info from hospitals, patients mistakenly getting out of network treatment that costs them a fortune rather than the in-network treatment they thought they were getting. There are many media articles about insurance billing horror stories.

But nothing changes, and we pay the most in the world yet have unexpectedly limited health outcomes as a population given the $$$$$ we pay because Republicans scream "socialized medicine" every time anyone tries to change these practices in the favor of patients.

The healthcare industry are much bigger donors to the Dems than the GOP. I think both Bernie and Elizabeth Warren are among the largest beneficiaries of donations from the industry.

Things got a whole lot more complicated and expensive when Obamacare was launched....

You have to understand health insurance is a bureaucracy, and rule number 1 of a bureaucracy is NOT to help the people it ostensibly serves. Helping people in theory is still a rule but it's not even in the top 10 rules. Rule 1 is to protect the bureaucracy at all costs.

That is why it's so difficult to even to speak to anyone in the first place. Why all the names are buried behind the generic "Shanta B" or "Tierra G" with no last names. That's why no email addresses are given, only phone numbers to answering machines. That's why the paperwork is so vague and if you write a grievance letter (which must be mailed, never emailed or uploaded online) to a distant office, they will never answer any of your reasonable questions but some kind of autobot generic response that clarifies nothing and invites you to call this number, which once again is an answering machine that no one answers. That's why six different people will tell you the exact same thing when you're trying to find a different answer. That's why it takes six weeks or a few months to get anywhere.

It's not 1990 any more. Everyone in healthcare is first and foremost a bureaucrat. Their occupation, whether doctor or administrative, is secondary. Once you understand this, then you understand why they behave the way they do. I know I am a number to them, I know I am instantly forgotten the next second. As a result I no longer attempt to be nice or considerate whenever I have to deal with any healthcare situation (thankfully not very often). I'm sure I'm rude and brusque, but that is exactly how I'm treated by them behind that fake facade of niceness.

a whole book was written about this deny, delay, etc.

its the business process of all the insurance companies.

they count on you to give up or stay in network which saves them money

I keep a spreadsheet; see the doctors who I want; get the superbly and submit ASAP. There have been many hiccups (I report them to the healthcare ombudsman who sends a letter that is required by law to be responded to). For the routine weekly visits, I get reimbursed in two weeks.

Anonymous wrote:Never had any of these issues.

Consider yourself lucky: Cigna drove me nuts last year--they had faced several lawsuits from patients who said they were using AI to process medical claims because they made so many friggin errors. I have no doubt that if any of my family members had serious health issues, I would need to quit my job and do what OP is doing for a big part of my day to avoid bankruptcy.

I would take my two kids to get a flu vaccine, they would cover only one kid, but not the other, because oopsie.
They refused a topical medication claim for a kid's skin rash, calling it a "dietary supplement," because oopsie.
Stopped covering my spouse's maintenance medication they covered for decades, because, oopsie.
Kid was hospitalized for a week--charged me a massive surcharge for "choosing" a private room even though the hospital only had private rooms in the pediatric ward. Did we inconvenience you by making you call in 85 times to correct this?

What insurance company, OP? I have had very bad insurance companies and very good ones. Zero calling and chasing with the good ones.

Anonymous wrote:

Anonymous wrote:take 'em to court OP. It could be a groundbreaking case that gets media attention, picks up steam, and gets real reform and results.

I used to do this for a living. No one cares. Media are not covering it. And the reason OP has to do it is because she has elected to pay her bill with insurance instead of cash. Either way it’s on her to make sure it gets paid.

Honestly though the only issue I’ve ever had with my carrier in more than 20 years was whether certain care was reasonable and necessary.

The New York Times has done several articles on patients coping with catastrophically large surprise medical bills, patient's inability to get billing info from hospitals, patients mistakenly getting out of network treatment that costs them a fortune rather than the in-network treatment they thought they were getting. There are many media articles about insurance billing horror stories.

But nothing changes, and we pay the most in the world yet have unexpectedly limited health outcomes as a population given the $$$$$ we pay because Republicans scream "socialized medicine" every time anyone tries to change these practices in the favor of patients.

American healthcare is at a breaking point. The whole, greedy system will collapse within 5 years.

Never had any of these issues.

Anonymous wrote:take 'em to court OP. It could be a groundbreaking case that gets media attention, picks up steam, and gets real reform and results.

I used to do this for a living. No one cares. Media are not covering it. And the reason OP has to do it is because she has elected to pay her bill with insurance instead of cash. Either way it’s on her to make sure it gets paid.

Honestly though the only issue I’ve ever had with my carrier in more than 20 years was whether certain care was reasonable and necessary.

Anonymous wrote:I'm getting increasingly frustrated with how much time I spend on the phone dealing with medical billing and insurance overages. I have a full-time job, and every time there's an error or a dispute, it somehow falls on me to resolve it.

I end up chasing down doctors’ offices, calling insurance reps, deciphering billing codes, and making sure everything is accurate just so I’m not overcharged. Meanwhile, the doctor gets paid, the insurance company takes their premium, and I’m stuck doing unpaid administrative work to keep it all in check.

I charge $300 an hour in my professional work. Maybe I should start invoicing these companies for the hours I spend fixing their mistakes. Why is my time treated like it has no value just because I’m the patient?

None of this feels like it should be my responsibility, and yet if I don’t deal with it, I get stuck with the bill. Can anyone explain why this burden is now on us? Because I’m tired of doing their jobs for free.

OP, you are receiving a service. You are not a $300/hour consultant in this particular situation. If you are making phone calls and reviewing invoices, you are basically doing the work of a $20/hour billing assistant. Go ahead and send an invoice to any of these companies. They will laugh and laugh. Might actually make the day of the real billing assistant.

Your time isn't valuable to them. I don't know why you assume it would be. This is the way that American corporate medicine works. The burden is on you because you are the one paying for the service. If you find that your doctors are frequently billing incorrectly, find new doctors. I have not had this problem with any of the doctors I've seen.

Anonymous wrote:

Anonymous wrote:It should be on the medical offices not patient I feel like there is a loop hole here and it's not evil insurance in this situation

go and view the videos of doctors trying to get approval through peer review, and offic staff trying to appeal denials. It is absolutely an insurance company problem. It's also why so many doctors are going concierge

Doctors are not innocent. They are greedy and will think nothing of trying to commit a little health care fraud on the side. Upcoding, unbundling, billing for services not rendered. Most do it and it's important to watch your EOBs and push back.

take 'em to court OP. It could be a groundbreaking case that gets media attention, picks up steam, and gets real reform and results.