Hellobee Boards

Insurance is evil. DH is still battling a claim from years ago! I'm sorry, good luck!

I continue to be shocked by the amount of our bills, yet no one is intelligent enough to answer my questions when I call to ask about them.

I've actually had really good service when I've called, and I have been calling a lot while I figure out this speech therapy thing.

@jedeve: Cost-sharing for vaccines is not illegal.

@jedeve: Insurance makes me insane. I'm to the point where I know our plan inside and out, better than the CSRs, and can tell the provider "No, we have a co-pay/co-insurance, please recheck!"

I won't bore you with details unless you'd like me to, but here's the magic words:
- "I'd like to speak to a supervisor"
- "This is impacting my quality of care"
- "I'll need a reference number for my records"

The quality of care one really sets a fire under their asses. Make sure you speak to a supervisor, NOT a CSR, and request that the call be recorded. Don't hesitate to get your state attorney general involved if necessary -- we've had to get ours involved three times now, and each time they found in our favor. It's kind of helpful when the calls are recorded & it's cut and dry!!

@jedeve: My advice would be to contact the insurance company. It sounds like the claim isn't being processed by them for some reason. The hospital simply wants paid for services rendered, and you're responsible for the payment if insurance doesn't cover. The billing company has their hands tied because the insurance isn't processing the claim.

So, I'd start with them. I'd demand to speak with a Supervisor, have them conference call you into the billing department or hospital, get the claim taken care of and throw in some "impacting our quality of care" (because who wants to go to the doctor if insurance isn't going to cover their costs?!) and tell them you want the call recorded AND a reference number.

@jedeve: There are a few key words and phrases in there that indicate cost-sharing is not expressly prohibited (an example would be *enrolled in new group . . .* and *eligible* . . . that serve as qualifiers). Also, when preventive care items or services are provided as part of an office visit, it may be difficult to determine whether the office visit itself may be subject to normal cost-sharing requirements.

@MsLipGloss: My biggest issue with that terminology is that it's open to interpretation. Our plan definitely has some grey-area terms, and depending on who you talk to it's interpreted differently.

For us, personally, we've reviewed our health plan in great detail then called to confirm coverage. One of our huge problems a few years ago was that we were given wrong information -- terminology was interpreted incorrectly by the CSR we spoke with -- and we ended up with massive bills!

Other than going up the food chain, I don't know what to do about it. I really shouldn't have to spend 2903482309483 hours on the phone to have my health benefits explained to me. I should be able to open my benefits book and understand clearly what is covered and what isn't. In other words, I shouldn't have to call and ask questions.

I feel for you, insurance companies are evil. I spent all morning arguing with a CSR because each time I call I get a different response...so frustrating!! good luck!

@MsLipGloss: My aunt writes policies for Highmark and the stories she tells me... oh my god. Let's just say she is *told* what words to use.