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In the spirit of Sac's health ins. ques....


rocknrobn26
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As many of you know I spent ~2.5 days in the hospital w/ heart attack symptoms. 2 days ago I recieved a letter from my insurance co. that said that they will NOT cover procedures done on the 3rd day due to an 'ADMINISTRATIVE ERROR"! Long story short, they claim I should have been sent home and have had the test scheduled as an out patient. How was I supposed to know that? It took a 30 min. phone call and 5 different people to get this info. That day was worth about $4000! The 5th person said, after major prodding, that I was NOT to be held responsible for the 3rd day's bill, because the hospital is on they're 'A' list and they should have known better. :D

 

I'll stop there, 'cause the story gets very involved. I see a major fight coming in the next month. The bit-ch even said "We would have paid a person extra to come in on monday (as it was a holiday) and you should have known that!" How the fluck was I supposed to know that? :D I looked after the fact at my policy and didn't see dick about that!

 

FWIW..........the final bill is ~$16,000!!! :D My daily prevacid was $13 A PILL!!!! WHAT THE HELL IS GOING ON HERE?????????? What happened to the days when the Docs told the Ins. Co's what to do? Now they tell the docs what to do! :D

 

Chargerz......what's your take on this? HMO in my area is not an option.

 

Thanks for the rant!

RR26

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Insurance Low-Balling + Malpractice Litigation + Indigent Care = RR Taking it in the  :D

 

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It's the death knell of the US health care system. Every other country in the world has gone to socialized medicine and it works. Sooner or later we're going to realize it's us that's out of step, not them.

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FWIW..........the final bill is ~$16,000!!! :D My daily prevacid was $13 A PILL!!!!  WHAT THE HELL IS GOING ON HERE??????????  What happened to the days when the Docs told the Ins. Co's what to do?  Now they tell the docs what to do! :D

 

Chargerz......what's your take on this?  HMO in my area is not an option.

 

Thanks for the rant!

RR26

 

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The days of doctors telling insurance companies what to do passed a long time ago. I saw it coming and opted not to go into private practice. It's the best decision I ever made.

 

If you get stuck with a $16,000 bill, then you will be the victim of a gross injustice. :D You are the patient, not an expert on what tests to order or pills to take. (We have discharge planners in our hospital that communicate with us and help us coordinate a patient's total care, both in the hospital and out, so patients get exactly what they need without sending out bills later to patients.)

 

There should be an appeals process that you can pursue to contest the charges being levied against you. Hopefully the insurance company will end up reversing those charges.

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RR, that sucks. If you followed the HMO's rules for preapprovals to get into the hospital, etc., then I can't see how they can hold you responsible for the hospital's decision to keep you there. Once you arrive, a case manager at the hospital and a case manager at the ins. co. need to talk to go over what treatments you'll need, etc. The hospital is on the hook to get the preapprovals it needs, not you. You can appeal this decision with the HMO.

 

If you ultimately get hosed on this, you can set up a payment plan with the hospital and pay them $1 a month. :D After all, you're retired and on a fixed income, no? Hospitals are traditionally pretty good about letting you set what you feel you can afford toward paying down your bill. So long as you're paying 'something' it's OK. Since they screwed up, they surely don't even deserve the buck a month, but hey.

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It's the death knell of the US health care system.  Every other country in the world has gone to socialized medicine and it works.  Sooner or later we're going to realize it's us that's out of step, not them.

 

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yup but dont tell that to the dato heads

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RR, that is a bunch of bull, give em he ll!

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Screw them RR! I would definitely fight through every adminstrative hearing process that they have. I would fight it at both the insurance and hospital level. If that isnt working, threaten to call the local investigative reporters. The hospital definitely want want any bad publicity where they and the insurance company's screw up is hurting an old retired man. That might back them up a little. If not I would start sending all of my correspondence with them by cert mail. This could get very ugly...

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Screw them RR!  I would definitely fight through every adminstrative hearing process that they have.  I would fight it at both the insurance and hospital level.  If that isnt working, threaten to call the local investigative reporters.  The hospital definitely want want any bad publicity where they and the insurance company's screw up is hurting an old decrepit retired man.  That might back them up a little.  If not I would start sending all of my correspondence with them by cert mail.  This could get very ugly...

 

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fixed

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Thanks for the replies. I'll update this when I start to :D w/ them.

 

 

RR - settle down.  Take some deep breaths.  Go to your happy place.

 

I think they are trying to push you over the edge so that they don't have to pay anymore of your bills. :D

 

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:loadingshotgunwith00buckshot:

 

 

The days of doctors telling insurance companies what to do passed a long time ago. I saw it coming and opted not to go into private practice. It's the best decision I ever made.

 

If you get stuck with a $16,000 bill, then you will be the victim of a gross injustice.  :D  You are the patient, not an expert on what tests to order or pills to take. (We have discharge planners in our hospital that communicate with us and help us coordinate a patient's total care, both in the hospital and out, so patients get exactly what they need without sending out bills later to patients.)

 

There should be an appeals process that you can pursue to contest the charges being levied against you. Hopefully the insurance company will end up reversing those charges.

 

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It's actually $4K-$5K of the bill.

 

 

RR, that sucks. If you followed the HMO's rules for preapprovals to get into the hospital, etc., then I can't see how they can hold you responsible for the hospital's decision to keep you there. Once you arrive, a case manager at the hospital and a case manager at the ins. co. need to talk to go over what treatments you'll need, etc. The hospital is on the hook to get the preapprovals it needs, not you. You can appeal this decision with the HMO.

 

If you ultimately get hosed on this, you can set up a payment plan with the hospital and pay them $1 a month. :D After all, you're retired and on a fixed income, no? Hospitals are traditionally pretty good about letting you set what you feel you can afford toward paying down your bill. So long as you're paying 'something' it's OK. Since they screwed up, they surely don't even deserve the buck a month, but hey.

 

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It's a PPO. HMO's around my area stink.

 

 

Screw them RR!  I would definitely fight through every adminstrative hearing process that they have.  I would fight it at both the insurance and hospital level.  If that isnt working, threaten to call the local investigative reporters.  The hospital definitely want want any bad publicity where they and the insurance company's screw up is hurting an old retired man.  That might back them up a little.  If not I would start sending all of my correspondence with them by cert mail.  This could get very ugly...

 

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Nod! At least I have the time to fight them! :D

 

 

fixed

 

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I'm am send a copy of this post to your Dad! :oldrazz:

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My Mom works in ortho and they charge off more than they can remember for screw-ups like this. Talk to them and tell them you're not responsible and it'll get charged off. That's why they overbill you 100 times for procedures...cause they collect so little :D.

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My Mom works in ortho and they charge off more than they can remember for screw-ups like this.  Talk to them and tell them you're not responsible and it'll get charged off.  That's why they overbill you 100 times for procedures...cause they collect so little :D.

 

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You're probably right. Ironically, I was just getting ready to do some volunteer work for the hospital! Now?????? :D

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My Mom works in ortho and they charge off more than they can remember for screw-ups like this.  Talk to them and tell them you're not responsible and it'll get charged off.  That's why they overbill you 100 times for procedures...cause they collect so little :D.

 

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Agreed.

About 10 years ago I was rushed to the hospital without health insurance for a collapsed lung. Spent 6 days in the hospital, on the 6th day the doctors said that since my lung hadn't healed on it's own, they were going to have to cut me form sternum to scapula and staple my lung. Just then a nurse meakly asked: "why is there tape on the tube going from his lung to the machine he is hooked up to?" turns out that a hole in the tube was causing air to come in and to constatnly recollapse my lung.

They saved my life (by the time I got to the hospital my organs were all shoved to one side due to the airpocket in my chest cavity growing so much). So it seemed like a fair deal that they didn't chrage me, I didn't sue the hell out of them.

Though obviously not as egregious I think if you talk to the right people and let them know that you want the amiable normal, decent human being resolve to the situation that is fine, but let it be known that you are litigiously unhappy (would never recommend suing of course, just saying that you need to let them know that you are willing to escalate if a normal solution is not found)

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HMO, PPO, POS (which in this case technically means Point of Service but we all know the reality)..doesn't matter. Once you're admitted to the hospital, the hospital is responsible for obtaining the appropriate certification to do whatever they're going to do with or for you. If they treated you without proper authorization, they will have to eat that bill.

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HMO, PPO, POS (which in this case technically means Point of Service but we all know the reality)..doesn't matter. Once you're admitted to the hospital, the hospital is responsible for obtaining the appropriate certification to do whatever they're going to do with or for you. If they treated you without proper authorization, they will have to eat that bill.

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Thanks a bunch, Czar! :D The 5th person I spoke with said that in a round about way, but ONLY because it was a 'Member' hospital. The mind starts to wander, but what if I were in podunk wherever, and it wasn't a 'Member' hospital...then what? Just a scary situation that one has no controll over.

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The insurance company is less at fault, in a sense, than the hospital in this case. Particularly since the hospital is a 'member' of the network. This means they're supposed to know what to do ahead of time. It may be the hospital you end up fighting with, as opposed to the insurance co.

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The insurance company is less at fault, in a sense, than the hospital in this case. Particularly since the hospital is a 'member' of the network. This means they're supposed to know what to do ahead of time. It may be the hospital you end up fighting with, as opposed to the insurance co.

 

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Very true, and it's a shame! :D It is a very good hospital and I'm 1 mile away. I've seen it grow, bigtime, over the last 30 years that I have been in the area. It's amongst the top 100 cardiac hospitals in the nation and has one of the leading neo-natal care units in the country. As I said prevoiusly, I'm considering donating my time to them, but I'll put that on the back burner for the time being! What pee'd me off was my insurance co. saying that it was an 'administrative' error that caused the whole thing! In other words they felt that I should have been sent home, but I feel the hospital/doctors wanted to continue monitoring me, and I like that! Maybe they're CTA, but I 'd rather be safe than sorry. Plus, a year ago, I was rejected on a test my Doc wanted, I was rejected by one of their (CIGNA) 'consultant' Docs. That Doc I have a history w/. He's the one that when I went to him (Neurosurgen) complaining about back pain and arm weakness, threw up his hands and said "There's nothing I can do!". Less than a year later I had 4 cervical discs fused! :D

 

CIGNA SUCKS!!!!!!!!!!!

 

Czar, thanks again! It truly is appreciated! I mean that. Dam, what better place to get info on any subject than here! :D And that thanks goes to all of the rest of you also! :D

 

I'll update as the info comes in. I think we'll all benefit from it!

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