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| Dab |
Uuuuuuurrrrrrghhhhhhhh
I hate getting mail on Saturdays when I can't get ahold of someone on the phone!
$895 worth of medical tests, supposedly I guess I owe $4 so I get a notice from my OB/GYN's group that unless it's paid by 1-20-03, they are cancelling me as a patient.
But of course I get a $10 billing fee in October but nothing in the mail so had no idea I owed a whopping $4 and now another $10 billing fee with this one telling me if I don't pay, I can't be a patient so now it's $24.
I am just looking at this little adjustment page wondering where in the heck this $4.20 comes in. Gotta love how there is no explanation just, credit, adjustment, patient copay.
Sorry, I'm just irYKWted. I was just there a month ago for my follow up so I don't know why they didn't tell me then to pay $19 instead of my $15 copay.
It's not the amount but the fact that I'm just sick and tired of the guessing game on if the insurance is gonna pay like they claim. Seems like there is always an exception to everything. Supposedly according to the booklet, all the tests I had done should have been covered since I went to the prefered doctor and they were ultra sounds, biopsies etc for a test that did come back bad so it wasn't elective type of stuff. I'm just not understanding why my copayment didn't end it and what this $4.20 is from. Even though it's not a large amount, I'd still like some explanation of why I'm paying so that I can determine on next open season if I want to switch insurance companies. Seems to happen all the time....oh yeah, we do pay for mamograms but you talked to that woman so we don't cover that part of it LOL
(just joking there but I'm just frustrated right now). I like my Kaiser better, pay my copayment and walk out, never see a charge or anything. I hate all this garbly gook, adjustments here, credits, there, what Blue Cross/Fed paid, what the doctor won't charge blah blah blah......I just wanna know up front. Thanks for letting me rant. |
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| TrpltJanie |
Please don't say Blue Cross/Blue Shield. They do pay but I have to wade through red tape and constant calls to the reps to get just ONE misunderstanding cleared up. I have four at the moment so here's to hoping that it'll clear up before the end of the year.
Hang in there Dab and don't let them off of the hook! |
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| Lunarlady |
Blue Cross is also a bad name around here in Lansing. We recently avoided a huge problem because Sparrow Health System (Largest health system and hospitals in Lansing) was going to terminate Blue Cross's privilidges as of midnight, December 31. They've extended it for six months so they can continue talks, but it doesn't look good.
From what I can gather on the news, it goes like this:
Sparrow Health System charges more than Blue Cross is agreeing to pay for standard procedures. Sparrow claims they are losing "X" many millions a year due to Blue Cross's antiquated charts on what it should cost to have "X" done.
Blue Cross says Sparrow Health System is overcharging.
Blue Cross covers government workers and GM employees - two of Lansing's largest workforce members. The only other hospital in town is Ingham Regional Medical Center (which has it's OWN bad reputation and may not have been equipped to handle the overload from Sparrow Health System).
From what I'm hearing on the West side of the state (I'm from Kalamazoo and still keep tabs every once in awhile on them), Bronson/Borgess hospital is ALSO in the same pickle with BC/BS (bs = something else according to my friends from that side of the state, BTW) With Bronson/Borgess Health Systems, however, the patient has to pay the overage (must be a different plan than the state workers) so the patients are getting really tired of BC/BS as well.
So based on my info from the news and friends, here's my theory:
BC/BS has been concentrating so much on winning more contracts with employers that they've cut down or capped the prices on their procedures. They've now reached the point where hospitals and health care systems are crying "ENOUGH!!" and demanding higher caps for routine procedures.
If BC/BS has to up their charges for services to employers, BC/BS will lose these contracts to other insurance providers who are a little better at keeping control of internal costs and are able to better serve their customer, not just their customer's employer. BC/BS may be offering better contracts to large employers (like the State and GM) because they get a profit from the large amount of people who DON'T use the insurance and take their chances on the workforce that MAY have to use the insurance.
In general, BC/BS sucks. Best of luck straightening out your problems. :(
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| Tink *~*~* |
Here's a little secret I learned during the cancer years.
Don't ever let a medical bill go to collection, even if you are trying to dispute it and the clock is ticking. A payment of as little as a one dollar per month and they cannot turn you over to collection or take any other legal action against you. It's called "showing good faith".
Back in 1992 when I was diagnosed and had the surgery, I was pretty poor and had no idea about all of this, and the surgery bills went to collection. At the time, I had traditional indemnity insurance, which was a double edged sword. On the one hand, I was able to pick my own doctors and off I went to Memorial Sloan-Kettering for treatment without having to worry that they wouldn't take my insurance. On the other hand, I was stuck with the deductible plus 20% copay plus anything that the insurance company deemed "above and beyond reasonable and customary charges". After all, this is Sloan-Kettering we're talking about, so their charges were higher than anyone else's.
I was disputing "above and beyond reasonable and customary charges" and negotiated a 70% payoff with the collection agent. When we were all done, the woman told me the little secret about the one dollar a month and they can't touch you. The reason she told me is that her mother had just gone through the breast cancer ordeal and she knew I was in for months of expensive chemo and radiation. She was really generous, because I was a potential return victim of the bill collector agency she worked for and she could have booked business against me, but chose to tell me the secret instead.
Of course, please check the laws in your state/country, but this is the way it works in NY to this day.
Tink *~*~* |
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| Robey |
quote:
Dab wrote:
I guess I owe $4 so I get a notice from my OB/GYN's group that unless it's paid by 1-20-03, they are cancelling me as a patient.
This doctor would let a patient go over a sum of $4.00!!!!!
Dump him/her! fast! |
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| Dab |
quote:
Robey wrote:
This doctor would let a patient go over a sum of $4.00!!!!!
Dump him/her! fast!
Yep, $4 and 2 $10 billing fees. I've never been charged a billing fee before. Curious how this would work if I go into the doctor's office and while paying my copayment I ask them, is everything covered, do I owe more money? I want it signed that if I owe money, I asked and therefore if YOU mess up since you didn't calculate correctly you will not charge me $10 to bill me. Think it will fly????
We all know that when we walk out of there no one has the absolute correct figure how who's gonna be paying what.
And to the person above (I've forgotten now, sorry) it is BC/BS federal employees. I am on the more expensive plan that supposedly when I go to a prefered doctor who has agreed with BC to accept their charges or whatever it's called, I'm suppose to only pay my copayment and I have no deductable unless hospitalized.
I really don't think my doctor knows Robb as she just moved to this new group in a fancy dancy hospital LOL She's so good though and listens and does testing. Her old group was a pain. Her nurse told me, well it's not life threatening yet (she calls to give me some results of tests). Hello??? we are talking biopsies and such and I'd like to know what you mean by it could be life threatening??? She says, well do you want to make a talking appointment with the doctor? Well, heck yeah!
So I pay to go talk to the doctor to find out what the results meant. Her old group is still fighting with BC cause they screwed up on putting down the wrong code. This isn't funny but it kinda is, the doc's office put down I had tests for excess hair LOL (I never did find out from my gyn or BC, I had my regular doctor's nurse call the gyn's office and ask..never did get a call back from the gyn...called BC back and said, ok I found out they put xxx and she said, ok yes that's what they put) BC said that's elective and they won't pay LOL My yearly exams came back bad : ) So they had to fix it all. I'm so frustrated, I make sure I go to the prefered docs that are suppose to eat the excess. UUUUUUrrrrrggggghhhhhh I swear, they wait until open enrollment is over and then send you all the bad stuff LOL Now I'm stuck until next December. I'm laughing about it all now though! |
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| Robb |
Dab, did you mean Robey, or Robb? |
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| Lunarlady |
I know what you mean, Dab. I got so spoiled with PHP (Physician's Health Plan) that is based out of the Sparrow Health System. Everything (and I mean EVERYTHING) was covered because, like I said, Sparrow is the largest health system here in Lansing.
Sure, BC/BS was offered FREE to me as an employee, but I still elected to pay for PHP. (I think it was something like $20.00 a month) It was worth it to be able to go to the doctor and not have to deal with the insurance company. |
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| Peggo |
Aaaaaah, don't get me started on Insurance Companies.
Why can't we be civilized and have National Health? I mean really, who asks to be sick? Is this some luxary only the super rich can afford? |
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| Livda T. Nirtom |
What burns my butt is when you go to the DR's office and you have to wait an hr to see the DR, they only spend 5 min with you(most of the stuff is done by other office personnel) and they want to tack ont hese extra fees? WEll how about the patients charging them for the long waits with lousy reading material? I guess the 10 billing charge is to pay for their employees now. Why should the Dr have to take money out of their pocket to pay them, when they can tack it onto our bills now? |
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| melissathepooh |
I'm on the opposite side from you LL on the BC/BS story here in Lansing - it seems strange to me that EVERY other hospital in the state of Michigan will accept BC/BS payment arrangements - but Sparrow - the monopoly of Lansing - will not. Instead we started getting letters from Sparrow offering propaganda on their own Physicians Health Plan - which again to me just meant monopoly. We have a great BC/BS plan through MSU and have no intention of supporting Sparrow after this stunt. In all honesty I have heard just as many bad things about Sparrow as I have any other hospital. Just my opinion |
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| d-r |
two things:
1. sparrow is trying to make up money they are loosing because of the difference in what they want to charge and what medicaid/medicare won't pay them by overcharging blue cross. Blue Cross/Shield doesn't want to get hung with being overcharged so that sparrow can make up revenue they loose because medicaid won't pay the full amount.
2. sparrow was trying to strong arm employees of msu, state, and gm to use their own little in house system of php and drop blue cross - sparrow is looking to profit big by spinning off and selling php as a separate business and they are trying to pad the enrollment numbers to make it as an attractive sell as possible. |
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| Ajax |
I've had BC/BS with the State of Michigan for over 25 years, and haven't had any problems that took more than one phone call to resolve. I'm a believer! |
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| TrpltJanie |
quote:
Ajax wrote:
I've had BC/BS with the State of Michigan for over 25 years, and haven't had any problems that took more than one phone call to resolve. I'm a believer!
WHHHHAAAAAT?! That is SO NOT FAIR! I've been butting heads with BC/BS over certain bills for the past six months. What is your secret? |
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| lesa |
most likely your $4 had to do with the insurance companies UCR, or "usual and customary fees". The companies do a survey of all the providers in the area (which can be quite large, or quite small), determine what the median charge is, then base what they will pay on that. If your provider charges more than their UCR, the remainder will be your responsiblity.
We often had charges of $1 or less at our former pediodontist. They also charged a minimum of $5 billing fee monthly, so if you didn't get it taken care of right away it really added up. I just started keeping track, and I knew that for 6 month cleaning appointments, which were covered at 100%, I needed to pay $1.80.
Lesa |
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| Ajax |
Janie-
We're a pretty healthy lot, and haven't had to haggle with them over much. Once the wrong billing codes were submitted by our ophthalmologist, and resulted in a rejection. Another time our daughters coverage lapsed when she went off to college, but that was the fault of a bonehead in our personnel office. Both problems were quickly remedied.
I should add that the State of Michigan, for whom I work, is BC/BS' largest subscriber. We have our own phone number and specialists who are familiar with the programs, and that helps out immeasurably.
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