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Man do I despise my insurance company somedays.

As some of you know, I got a colonoscopy the other day because I felt like it. I am 41, so I checked with my insurance company to make sure it was covered as my parents have both had benign polyps removed. It was supposed to be covered 100% because it was considered preventative.

Well, I got my Explanation of Benefits and saw where I was going to owe my provider $200 as part of my deductible. So I called the insurance company and they told me the provider coded it as a diagnostic colonoscopy and not a screening. Diagnostic means I had something wrong and needed to find out, whereas screening means I just wanted them to look and see.

After talking to my provider and then having to recall the insurance company, I finally asked if the two could resolve the situation and stop making me the middle man.

Got a call from the provider later and they told me they had resolved the issue and it was the insurance that was incorrectly working my claim. On top of that, every effing time I spoke with one of the client service reps with the insurance company, they asked me if I had any supplemental insurance.

You know they wanted supplemental to help pay for the colonoscopy. I do not have supplemental.

Good thing I am somewhat familiar with insurance and how the claims work, but can only imagine how many Americans pay their bills when it is either the provider or the insurance company making a mistake in their favor.

Way to be diligent.

Another example of why we don't need for-profit insurance.

kalm wrote:Another example of why we don't need for-profit insurance.

I don't agree with that, but I do think we need easier to read statements that explain what you were billed for and how your insurance plan paid out.

Like I said, I caught the insurance fuck up and actually have caught them once before and once caught the hospital not doing their job and trying to pass on a $500 charge to me. Got the hospital to resubmit the bill with the proper claim and the insurance paid the $500 like they were supposed to.

I catch this shit because I work in the lab industry and constantly get calls from doctors who need me to resolve billing issues with their patients and their insurance. While 90% of the time the reason is because the patient doesn't understand the copay and deductible portion of their bill, insurance companies surely don't help with their explanation of benefits.

It should almost be that the hospital and insurance company need to prove what they are billing and paying two times over, but differently.

SeattleGriz wrote:

kalm wrote:Another example of why we don't need for-profit insurance.

I don't agree with that, but I do think we need easier to read statements that explain what you were billed for and how your insurance plan paid out.

Like I said, I caught the insurance **** up and actually have caught them once before and once caught the hospital not doing their job and trying to pass on a $500 charge to me. Got the hospital to resubmit the bill with the proper claim and the insurance paid the $500 like they were supposed to.

I catch this **** because I work in the lab industry and constantly get calls from doctors who need me to resolve billing issues with their patients and their insurance. While 90% of the time the reason is because the patient doesn't understand the copay and deductible portion of their bill, insurance companies surely don't help with their explanation of benefits.

It should almost be that the hospital and insurance company need to prove what they are billing and paying two times over, but differently.

Off the top of my head, we spend something like $300 billion a year on insurance paperwork alone. Talk about bureacracy.

That's the reason there are as many people at the check-in to a doctor's office as there are trained healthcare providers.

We can do better.

kalm wrote:

SeattleGriz wrote:
I don't agree with that, but I do think we need easier to read statements that explain what you were billed for and how your insurance plan paid out.

Like I said, I caught the insurance **** up and actually have caught them once before and once caught the hospital not doing their job and trying to pass on a $500 charge to me. Got the hospital to resubmit the bill with the proper claim and the insurance paid the $500 like they were supposed to.

I catch this **** because I work in the lab industry and constantly get calls from doctors who need me to resolve billing issues with their patients and their insurance. While 90% of the time the reason is because the patient doesn't understand the copay and deductible portion of their bill, insurance companies surely don't help with their explanation of benefits.

It should almost be that the hospital and insurance company need to prove what they are billing and paying two times over, but differently.

Off the top of my head, we spend something like $300 billion a year on insurance paperwork alone. Talk about bureacracy.

That's the reason there are as many people at the check-in to a doctor's office as there are trained healthcare providers.

We can do better.

Except for the rare occasions we saw a doctor, my dad took us kids to the vet.

Cheap, not much paperwork, and terramiacin (sp?) works just as good as human antibiotics.