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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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Folks on-line