One week after the hospital visit, we went to the doctor's office. The cast was cut off, the arm x-rayed and a new cast was put on.
This is the same thing that happened at the next three visits.
My husband's company decided to switch insurance policies. Accidents were 100% covered, now they aren't. So, the accident and the first follow-up visit were completely paid for by the insurance company. However, the last thee visits weren't. We have the $20 co-pay and a deductible for "surgery" which is how they code the recasting.
I'm more than mildly annoyed with this, but thems the breaks.
However, we got the bill for the first two visits to the doctor.
Things done during visit one included: cut cast off take z-ray put new cast on
Total charge, billed to the insurance company, $75. Insurance company pays all of it.
Things done during visit two included: cut cast off take x-ray put new cast on
Total charge, billed to the insurance company, $300. Insurance company says we have to pay $20 co-pay and $117.40 deductible for "surgery." (And that is only the allowable portion for the original charge of $145.)
Now, we called the insurance company. See, in this new policy, they pay 100% of the first $300 for x-rays. Cool. The office visit, we pay a $20 co-pay. Cool. Some random charge the insurance company disallows. Cool. The recasting, billed as surgery, isn't part of the $20 co-pay, but part of the deductible. Annoying.
We also wondered, since if we had joined the group with the broken arm and it would have been a pre-existing condition and they wouldn't have paid for any of it, why all the follow-up visits weren't covered under the old policy, since it was all the same accident. They said that it was up to the doctor whether or not to charge for follow-up visits. Like he got stitches, the follow-up for getting them out was included in the original price of getting them put in. Oh, and they said, too bad, so sad about the other part. (And the thing that really annoys me is that this change came when it did. Our old benefit period ran February to February and we paid the deductible on it and now have to start all over again because none of the deductible was paid in the last 90 days!)
Now, I understand all of this. I'm pissed, but I understand.
What I don't understand is why during the first visit, which was under the old policy and the insurance company was paying 100%, the doctor charge was $75 and now that we are paying for the "surgical casting" he is suddenly charging $300 a visit.
Is something funny going on here? My husband, after being totally not helped by customer service people at the insurance company (I just enter the claims, I don't know anything about that), was transferred over to the fraud department, which was "out of the office" today. (A whole department, out of the office?) He also tried to deal with "Josh" the dork in the billing department at the doctor's office. He had his little code book out and was quite snotty with my husband, who quickly lost his temper and left. The fraud department is supposed to call him on Monday. His question to them is going to be, isn't it odd to be charged two different prices for the same service?
Anyone know anything about this?
Posts: 9871 | Registered: Aug 2001
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The recasting, billed as surgery, isn't part of the $20 co-pay, but part of the deductible. Annoying.
It sounds like the doctor's office is mis-coding that. There is no way it is surger. HCFA puts out a standardized list of procedure codes. This should not be surgery (IMHO).
We also wondered, since if we had joined the group with the broken arm and it would have been a pre-existing condition and they wouldn't have paid for any of it
Actually, because of HIPA (Health Insurance Portabiltiy Act), there is no such thing as a pre-existing condition if you switch from one group plan to another.
why all the follow-up visits weren't covered under the old policy, since it was all the same accident.
I'd get with your prior insurance company and check on this. It may be that they will cover the follow-up visits, because the accident happened on their watch.
They said that it was up to the doctor whether or not to charge for follow-up visits.
Ask him/her for a discount. $300 for a follow up is pretty much ridiculous.
the deductible was paid in the last 90 days!)
Have your employers' HR rep contact the new insurance company and see if they'll credit you with the deductibles, since it was a mid-year switch.
doctor charge was $75 and now that we are paying for the "surgical casting" he is suddenly charging $300 a visit.
Check with the doctor's office. That just doesn't sound right. They might have made a billing error. Or perhaps bill #2 has a portion that should have been charged on bill #1, and therefore should be submitted to the other (better paying) insurance company.
My husband, after being totally not helped by customer service people at the insurance company
You've got to keep going up the food chain. Most of these people don't have a clue. Just keep asking for "your supervisor" until you get to a point where you feel the answer is non-bogus.
He also tried to deal with "Josh" the dork in the billing department at the doctor's office.
Same thing. Go up the food chain. Talk directly to the doctor if you have to.
His question to them is going to be, isn't it odd to be charged two different prices for the same service?
Excellent question. Keep asking it to the next animal up the food chain until you get a decent answer.
When you finally get a good answer, get that person's name and phone number so you can call them directly next time the place screws up.
Get your company's HR and other people involved if you want, because they occasionally have good contacts at the insurance company.
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The company only had like. . .18 employees. There is no HR department.
And the insurance company is the same insurance company. It's just a different plan. The cheap bastards at work decided to get a cheaper insurance group policy. I tried to tell my husband that this was basically the company cutting his pay, but he didn't believe me. Posts: 9871 | Registered: Aug 2001
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"You've got to keep going up the food chain."
This is really the key to it all, Kayla. My husband is Mister "What is Your Name? Let me Talk to Your Supervisor." He uses his wannabe lawyer tactics, and wins every time, out of sheer persistence.
Urgh. I cave in after the first, "I'm sorry, we can't help you."
Keep at it. Eventually, the doctors and the insurance companies will take up the battle.
Posts: 10890 | Registered: May 2003
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Oh, but he is going to keep bugging people higher up the food chain. He just wants to talk to the people at the fraud part of the insurance company first, not to report fraud, but to find out what was normal for a broken arm. If anyone would know what normal charges are, I would think it would be them.
Another thing we were amazed about was the fact that they replaced the cast 3 times. What's up with that?
And you know what? When they are going to do things that are outside your plan co-pay, they should have to tell you about it before doing it and give you a price list! If he'd known about all this, my husband wouldn't have taken him back to the doctor. "I had one cast the whole time my are was broken when I was his age. This is just the doctors trying to get a new car out of the insurance company." What a goofball. But is is annoying. I can see why they changed the cast one time, after the swelling went down, but the other times, it was just unnecessary. But the first time the did it that I didn't think they needed to, they did it before I knew about it and I didn't know anything about broken arms, never having broken one myself. We went through a lot with my husbands wrist, but he had surgery and an open wound, so things were different. If I'd researched broken arms and cast changes, maybe I would have had the guts to speak up that last time.
Posts: 9871 | Registered: Aug 2001
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It's definitely a pay cut, one that all of us will experience in the future for a few reasons.
Companys are paying a boat load of money for family coverage. Right now, some family group plans cost upwards of $900 a month!!!! Yes, a month.
In Utah, and many other states, group plans cost more than individually purchased plans because state legislatures have put on mandated coverages for group plans. For example, every group plan in Utah must cover mental health exactly like physical health. It must include maternity coverage (even if the "group" consists of 2 70-year-old accountants and their wives"). It must also include an adoption benefit (what the heck does that have to do with medical insurance?).
If you are a starting teacher in my school district, you will be paid $28,000 in salary, and the district will pay a whopping $11,000 for health insurance for your and your family.
In that scenario, a single person is really getting the shaft in terms of salary + benefits.
Posts: 524 | Registered: May 2003
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They only get single coverage. We have to pay for my son to be on the plan. It's $60 a week.
That sucks also. The deductible for one is $1,000 per person or $2,000 per family. There are only two in the family on the plan!
Also, in the last 5 years, the cost has gone from $40 a week to $60 and the plan has gone from 100% accident coverage, $100 deductible, $10 for generic drugs and $20 for brand names, to no accident coverage (covered under regual hospitalization,) $1,000 deductible and $15 for generic, $30 for formulatory and $45 for non-formulatory. It's really maddening.
And when I see how they doctor and the hospital charges, it's no wonder! We are up to over $3,000 for a broken arm!
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The only thing I know about health insurance is that more than my entire salary increase went to pay the increase in our health insurance premium this year. How can I be paying over 3 times as much for a basic health insurance plan than I pay in mortgage each month?
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he is suddenly charging $300 a visit.
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