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  Playing the Waiting Game
Posts: 2304
 
| Obammacare BEWARE!!! I had to resort to obammcare.. I thought I had a pretty good plan... $32.68 a month and only $500 total out of pocket other than copays. I get the plan check my Dr.s all my Dr.s are IN-network... YAY yeah right..I went to my Heart Dr who is IN-network, he has a few test done at the Shawnee office and I also have an appointment with him there. Well I get a letter from my insurance telling me that my tests were done OUT of network... So I double check.. Yep Dr is IN-network. So I call the billing office at my Dr. and am told that the OFFICE he works out of is owned by OHH (oklahoma heart hospital) who by the way is OUT-of network???? WTF??? How can this be and HOW the HELL would I know this. SO my Dr bill is paid but the tests he ran and the OFFICE staff is NOT..... My warning to you all is be sure where your Dr is practicing is IN-Network... I really like my Heart Dr. but what happens if I need a real procedure done LIKE in a hospital I obviously can't have it done at OHH?? I don't want to have to find a new heart Dr. too... UGH |
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 Undercover Amish Mafia Member
Posts: 9991
  
Location: Kansas | Wow....I am covered under the state of kansas employee health program which is through blue cross and blue shield....I'm thankful for it |
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 I Prefer to Live in Fantasy Land
Posts: 64864
Location: In the Hills of Texas | All the premiums are also going up for 2015.
Hate to think that I'm old enough for Medicare but I am and I love all the free insurance...Yeah right..$109.00 taken out of your Social Security check, $55.00 for the value plan Drug Plan and $169.00 for a supplement plan to cover what Medicare doesn't but only if it is a charge Medicare approves. Times this by 2 for both of us.. |
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 Coyote Country Queen
Posts: 5666
| Our insurance is going up $80 per month! I know you can't afford to not have insurance, but I'm beginning to wonder if I can actually afford to pay for it. And I'm not just mad about the insurance. I'm also mad at how much the doctors and hospitals are charging for procedures compared to what we actually pay after the insurance determines what the service is worth based on their agreement. I wouldn't need such high insurance costs if the hospitals would charge me what they agree to charge the insurance company. When they take a $5,000+ bill and write off all of it but about $1,500 it sure makes me wonder why I couldn't get that rate without insurance.
Sorry fortune rant. Im just frustrated about this whole insurance deal. |
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Playing the Waiting Game
Posts: 2304
| hoofs_in_motion - 2014-11-25 4:34 PM Wow....I am covered under the state of kansas employee health program which is through blue cross and blue shield....I'm thankful for it
Yeah exactly what I thought!! Mine is blue cross blue sheild... But did you know that Blue cross blue sheild has 8 different plans??? Yeah me niether... but I'm learning. |
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Playing the Waiting Game
Posts: 2304
| Jenbabe - 2014-11-25 4:53 PM Our insurance is going up $80 per month! I know you can't afford to not have insurance, but I'm beginning to wonder if I can actually afford to pay for it. And I'm not just mad about the insurance. I'm also mad at how much the doctors and hospitals are charging for procedures compared to what we actually pay after the insurance determines what the service is worth based on their agreement. I wouldn't need such high insurance costs if the hospitals would charge me what they agree to charge the insurance company. When they take a $5,000+ bill and write off all of it but about $1,500 it sure makes me wonder why I couldn't get that rate without insurance. Sorry fortune rant. Im just frustrated about this whole insurance deal.
NO PRoblem SPEAK your mind... Tell us what you really think... NOT sarcastic I mean it... go on and tell us all the bad stuff.. |
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 "Hottie"
Posts: 1373
Location: Okemah,OK | I recently ran into same problem.....my doc is in network but the lab that ran blood tests is not. I got a HUGE bill, called the doc, called the lab and found out they don't penalize you for being out of network. Basically took what would've went to deductible or been paid if they're in network and billed me that. Dropped bill from $1500 to $180! Long story short, call the lab. Granted you shouldn't have to and it's shady that some are in and some are out but you may be surprised at what they're willing to do. |
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Coyote Country Queen
Posts: 5666
| Isn't it crazy the price difference? I've heard multiple stories about how if you don't have insurance they will give you a greatly reduced rate. Or if you're actually going to pay they will drop the cost dramatically. That tells me they are playing games with insurance, and with taxes or whoever they're reporting to for non-payment losses.
Our family physician is going to a format where he no longer accepts any insurance. I haven't gotten the details, but it sounds like you pay a small fee to be his patient with greatly reduced rates. It sounds great because he is limiting his patients and guaranteeing same day appointments. I've heard others considering doing this as it cuts out insurance. The only drawback I see is that we cannot drop/change our insurance because of a medical condition that requires several CTs a year. So we still have our large insurance bill on top of the fee to be his patient.
I wanted to add this - When we had our first child we thought we were covered as far as insurance. Turns out they covered basically nothing. The hospital worked out a deal with us where they cut our bill in half.
Edited by Jenbabe 2014-11-25 6:09 PM
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 No Tune in a Bucket
Posts: 2935
Location: Texas | This out of network billing stuff happens all the time and it has nothing to do with Obamacare. I have insurance thru the Teacher's Retirement System and encountered the same problem. They even had a thing on TV recently talking about it and warning people to ask if the providers (x-ray, blood, etc) are in-network. I went to an in-network hospital for x-rays but the tech reading the x-rays was NOT in-network. How stupid is that? |
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Elite Veteran
Posts: 1064
Location: Idaho | Sorry if this is OT, but I would really like to know how people that do not have insurance through their work place afford to pay for it every month?! I just added my husband and and our new son and our plan is almost $800 per month! Our employer refunds our every month thankfully, but really how do others do it? We also do not qualifie for any tax rebates. |
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Veteran
Posts: 264
| My husband and I don't receive insurance through our jobs. We looked into obamacare and were told we would be paying close to $1200 a month. There is no possible way we could afford an extra $1200 so we decided to go uninsured. Im curious to see our "fee" during tax time for being broke. |
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Elite Veteran
Posts: 1064
Location: Idaho | turnedout - 2014-11-25 8:08 PM
My husband and I don't receive insurance through our jobs. We looked into obamacare and were told we would be paying close to $1200 a month. There is no possible way we could afford an extra $1200 so we decided to go uninsured. Im curious to see our "fee" during tax time for being broke.
See that is just crazy to me....that's my house payment.... |
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 Neat Freak
Posts: 11216
Location: Wonderful Wyoming | cowpony45 - 2014-11-25 7:03 PM Sorry if this is OT, but I would really like to know how people that do not have insurance through their work place afford to pay for it every month?! I just added my husband and and our new son and our plan is almost $800 per month! Our employer refunds our every month thankfully, but really how do others do it? We also do not qualifie for any tax rebates.
We were paying $560 for a family of 4 and it is an HSA and a very high deductable. Got a letter that it is going up over $100 in Jan. We just keep busting our backs to make it work. This year I had $323 applied towards my $5,000 deductable...
We would have been better off paying the $323 vs the $6,720 |
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Expert
Posts: 1255
| I just applied for it two weeks ago and they told me I'm not making enough money and suggested I apply through the state of new Mexico which I did but haven't heard back yet. |
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Too busy outside!
Posts: 5417
| myhre - 2014-11-25 8:06 PM I just applied for it two weeks ago and they told me I'm not making enough money and suggested I apply through the state of new Mexico which I did but haven't heard back yet.
Not making enough for obamacare?? |
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Too busy outside!
Posts: 5417
| turnedout - 2014-11-25 7:08 PM My husband and I don't receive insurance through our jobs. We looked into obamacare and were told we would be paying close to $1200 a month. There is no possible way we could afford an extra $1200 so we decided to go uninsured. Im curious to see our "fee" during tax time for being broke.
Let us know what your Tax fee is- I'm curious too- |
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Troll Buster
Posts: 6045
| RocketPilot - 2014-11-25 7:50 PM
This out of network billing stuff happens all the time and it has nothing to do with Obamacare. I have insurance thru the Teacher's Retirement System and encountered the same problem. They even had a thing on TV recently talking about it and warning people to ask if the providers (x-ray, blood, etc) are in-network. I went to an in-network hospital for x-rays but the tech reading the x-rays was NOT in-network. How stupid is that?
^^^^ this is spot on!! I sell health insurance and the customer has some responsibilities too. I'll always ask what doctors they use and where they go so I can make sure they are In network before they get the plan. Or they can call customer service and find out before the appt. sorry but people who don't do their own homework and get screwed always have to blame someone else....I hate "Obamacare" as much as the next person but surprisingly you can't blame it for everything.  |
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 Hugs to You
Posts: 7550
Location: In The Land of Cotton | Wait until you have insurance. You are in a car wreck. Unconscious. And, because you didn't ask the emergency Dr treating you if he is in your next work, you owe a huge bill. The hospital is in the network, but not the Dr's that they hire for the ER. Yep, it is happening everywhere. I hate it when I get calls from my employees with this type of thing. Makes me sick to my stomach. |
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Troll Buster
Posts: 6045
| 3canstorun - 2014-11-26 7:58 AM Wait until you have insurance. You are in a car wreck. Unconscious. And, because you didn't ask the emergency Dr treating you if he is in your next work, you owe a huge bill. The hospital is in the network, but not the Dr's that they hire for the ER. Yep, it is happening everywhere. I hate it when I get calls from my employees with this type of thing. Makes me sick to my stomach.
I dont know what ins company would do that, every company I work with all er claims are always in network regardless |
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Coyote Country Queen
Posts: 5666
| cowpony45 - 2014-11-25 8:03 PM
Sorry if this is OT, but I would really like to know how people that do not have insurance through their work place afford to pay for it every month?! I just added my husband and and our new son and our plan is almost $800 per month! Our employer refunds our every month thankfully, but really how do others do it? We also do not qualifie for any tax rebates.
We make it work because we have to. Our new rate is a little over $700 per month for our family of 4. We have a $2,000 deductible and another $2,000 80/20 co-pay. So with our monthly rate and deductible/co-pay we have to pay $12,400 before we are fully covered. If the hospitals would charge us the same rates they have contracted with our insurance company we could reduce our insurance coverage and just pay out of pocket. But without that the bills for the CTs alone would be over $10,000.
I can think of a lot of other things that I could put that money towards, but we don't really have an other option. |
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Undercover Amish Mafia Member
Posts: 9991
Location: Kansas | suzy2qtee - 2014-11-25 5:21 PM hoofs_in_motion - 2014-11-25 4:34 PM Wow....I am covered under the state of kansas employee health program which is through blue cross and blue shield....I'm thankful for it Yeah exactly what I thought!! Mine is blue cross blue sheild... But did you know that Blue cross blue sheild has 8 different plans??? Yeah me niether... but I'm learning.
my employer offers several different plans, BCBS KS has 3 with the employer (plans A, B, C) I chose plan A for myself and my daughter.
I pay $100 a paycheck |
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Hugs to You
Posts: 7550
Location: In The Land of Cotton | RacinPeggy06 - 2014-11-26 9:42 AM 3canstorun - 2014-11-26 7:58 AM Wait until you have insurance. You are in a car wreck. Unconscious. And, because you didn't ask the emergency Dr treating you if he is in your next work, you owe a huge bill. The hospital is in the network, but not the Dr's that they hire for the ER. Yep, it is happening everywhere. I hate it when I get calls from my employees with this type of thing. Makes me sick to my stomach. I dont know what ins company would do that, every company I work with all er claims are always in network regardless
First Health Care. Also, when I personally went in for a mammogram, they found a spot. Well, it just became a diagnostic test and wasn't free like Nobama said it would be. Same with a colonscopy. If they found polyups, isn't free any more. Became a ddiagnostic test. You the patient pay the $900 for that. Even if you go to a group of Dr's, dont just assume the whole group of Dr's is in the net work - sometimes they are not. You as the consumer must ask about each one, and you don't know who you might see that day. One might be out, at the hospital etc.
Health care did need revamping. But mainly on the insurance side. Who has the most money in the world - banks and insurance companies - who screws the consumer the most - banks and insurance companies.
We all got screwed even more with nobama care. |
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 Twin Sister to Queen Boobie
Posts: 13315
Location: East Tennessee but who knows?! | SIGH......this is exactly what I do for a living.
This went on BEFORE Obamacare even existed. This is not an Obamacare issue.
This is an issue with insurance companies not being able to keep their complicated computer systems in order and accurate so they can give correct information when people call. Their systems are often not locked down so that anyone can change a provider record.
I would appeal based on you made a choice based on what you were told by the insurance. They should have a record of that call.
For future reference always call the provider to find out if they are in network and ask about labs, etc.
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 Expert
Posts: 3782
Location: Gainesville, TX | This happened to me recently. I called the lab. They told me to call the insurance company. Evidently the insurance company has to pay if you were served at an in network hospital that only uses an out of network service. Called the insurance company and got everything squared away. No big deal, just a little research and phone time. |
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 A very grounded girl
Posts: 5052
Location: Moving soon..... | I know that this will not make any of you feel better because your rates are going up, but we all pay high prices for those who go to the hospital ER and have no insurance, are here illegally or just do not pay their bills. We all pay for the charges of the illegals and anyone else that does not have insurance and refuses to pay their bills. This is just the way it is. I do know that if you pay cash, here in Texas, they will give you a 50% discount most times. My husband had to go to ER 2 weeks before his insurance was in effect and his bill just for the hospital was $20,000. They lowered it to $9,800 and I am paying them $50 per week.
I do not understand why anyone would think it is okay to just not pay for services rendered. |
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Twin Sister to Queen Boobie
Posts: 13315
Location: East Tennessee but who knows?! | Karol - 2014-11-26 1:46 PM I know that this will not make any of you feel better because your rates are going up, but we all pay high prices for those who go to the hospital ER and have no insurance, are here illegally or just do not pay their bills. We all pay for the charges of the illegals and anyone else that does not have insurance and refuses to pay their bills. This is just the way it is. I do know that if you pay cash, here in Texas, they will give you a 50% discount most times. My husband had to go to ER 2 weeks before his insurance was in effect and his bill just for the hospital was $20,000. They lowered it to $9,800 and I am paying them $50 per week.
I do not understand why anyone would think it is okay to just not pay for services rendered. It's easier to collect from a patient than it is an insurance company with all the hoops providers are having to jump through. Providers hands are tied tight with all the rules and regulations and requirements and heaven forbid you should have to appeal-- then we're lucky to get paid within 6 months and that's without interest and still at the discounted contracted rate.
Yes it's a system designed to cost share-- if it didn't, the system would be absolutely bankrupt and even emergencies would be out of luck.
Edited by Fairweather 2014-11-26 1:55 PM
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Playing the Waiting Game
Posts: 2304
| RacinPeggy06 - 2014-11-26 7:48 AM RocketPilot - 2014-11-25 7:50 PM This out of network billing stuff happens all the time and it has nothing to do with Obamacare. I have insurance thru the Teacher's Retirement System and encountered the same problem. They even had a thing on TV recently talking about it and warning people to ask if the providers (x-ray, blood, etc) are in-network. I went to an in-network hospital for x-rays but the tech reading the x-rays was NOT in-network. How stupid is that? ^^^^ this is spot on!! I sell health insurance and the customer has some responsibilities too. I'll always ask what doctors they use and where they go so I can make sure they are In network before they get the plan. Or they can call customer service and find out before the appt. sorry but people who don't do their own homework and get screwed always have to blame someone else....I hate "Obamacare" as much as the next person but surprisingly you can't blame it for everything.
I understand what you are saying but My problem is "WHY would this even be a consideration?? It just doesn't make sense too me.
And before this I didn't even KNOW to ask this question.. That is the main reason I made this post to forwarn others of this situation..... AND it's just easy to blame obamma care...  |
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Playing the Waiting Game
Posts: 2304
| AND I would like to thank EVERYONE on here for your input... I am learing lots of stuff. |
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Twin Sister to Queen Boobie
Posts: 13315
Location: East Tennessee but who knows?! | suzy2qtee - 2014-11-26 2:16 PM RacinPeggy06 - 2014-11-26 7:48 AM RocketPilot - 2014-11-25 7:50 PM This out of network billing stuff happens all the time and it has nothing to do with Obamacare. I have insurance thru the Teacher's Retirement System and encountered the same problem. They even had a thing on TV recently talking about it and warning people to ask if the providers (x-ray, blood, etc) are in-network. I went to an in-network hospital for x-rays but the tech reading the x-rays was NOT in-network. How stupid is that? ^^^^ this is spot on!! I sell health insurance and the customer has some responsibilities too. I'll always ask what doctors they use and where they go so I can make sure they are In network before they get the plan. Or they can call customer service and find out before the appt. sorry but people who don't do their own homework and get screwed always have to blame someone else....I hate "Obamacare" as much as the next person but surprisingly you can't blame it for everything.
And before this I didn't even KNOW to ask this question.. That is the main reason I made this post to forwarn others of this situation..... AND it's just easy to blame obamma care...
It's because the insurance companies contract by group not by location .
They may contract with the physician group but the lab or xray tech may be contract workers employed by someone totally different....They all work at the same place but they have different employers and the insurance contracts with the employer. |
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Twin Sister to Queen Boobie
Posts: 13315
Location: East Tennessee but who knows?! | suzy2qtee - 2014-11-26 2:20 PM AND I would like to thank EVERYONE on here for your input... I am learing lots of stuff.
I do contract appeals for a large orthopedic practice and am very familiar with the set ups and navigating the systems. Feel free to PM if you think I can help. |
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 I Don't Brag
Posts: 6960
| Jenbabe - 2014-11-26 8:50 AM
cowpony45 - 2014-11-25 8:03 PM
Sorry if this is OT, but I would really like to know how people that do not have insurance through their work place afford to pay for it every month?! I just added my husband and and our new son and our plan is almost $800 per month! Our employer refunds our every month thankfully, but really how do others do it? We also do not qualifie for any tax rebates.
We make it work because we have to. Our new rate is a little over $700 per month for our family of 4. We have a $2,000 deductible and another $2,000 80/20 co-pay. So with our monthly rate and deductible/co-pay we have to pay $12,400 before we are fully covered. If the hospitals would charge us the same rates they have contracted with our insurance company we could reduce our insurance coverage and just pay out of pocket. But without that the bills for the CTs alone would be over $10,000.
I can think of a lot of other things that I could put that money towards, but we don't really have an other option.
Google " low cost CTs" and/or "low cost MRIs" I found a network of labs by doing that, that charges a fraction of the amount billed by the hospital. An MRI at the hospital was close to 5K and something like $450-900 through the low cost network. I have a 5K deductible and there was no way I was going to pay 5K for an MRI just to see if something is torn in my butt! |
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I Prefer to Live in Fantasy Land
Posts: 64864
Location: In the Hills of Texas | I signed up for Medicare Part D that is for prescriptions. You need a lawyer to decipher all the BS. At the end of it they had to read me more BS about my policy and it went on to explain that we might end up owing more if our annual salariea are above a certain amount. I asked what the amount was and at this time they don't know.  |
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Ot but want to warn all ya'll