Since I have been so sick I have become a bit of a medical insurance expert over the years. Nobody else is going to figure it out for me, so I really had no choice. It all started back in college when I got my first US health insurance. I ended up having knee surgery my first semester, and got a crash course in how things work. Very different from what I was used to in old Sweden!
We now have excellent coverage from United Healthcare, I have been very pleased so far. I have my own plan and Ken and Sarah shares one. Since we are self employed it is very expensive, we pay lots of money every month (but it should be cheaper and cheaper now when Ken is getting more and more employees). If anyone asks I am Director of Marketing in his company, by the way ;-)! After reaching my annual deductible of $2,850 I am not suppose to pay anything more for the year, but you never know...
Now after having had such a big, highly unusual surgery I have been keeping an eye on all claims as they have been processed by the insurance company. Many times they make mistakes, and when I call I tend to be more knowledgeable than the customer service representatives answer my calls! Not a good thing, but I can usually clear up their mistakes by being persistent. It can be hard sometimes!
Well, the cost for the surgery and the time in the hospital has so far reach close to $100,000... I noticed today that several claims had been denied, so I started digging around looking at the codes. It just didn't make sense to me at all. I tried to talk to the insurance company, but "their computers were down". Funny enough they were back up again when I called back immediately after hanging up! It turns out I was correct. One claim of almost $3,000 had incorrectly been coded as if I was suppose to pay it, when it was in fact suppose to be coded as a network discount... And a whole bunch of lab claims had been denied, because they were processed as medical visits, not lab tests! So they are all back in processing, we will see how that ends!
But to my relief they biggest bill, the one for the specialist's services, was paid with no problem in the whopping amount of $85,000... Whew!
5 comments:
Jösses det är verkligen ett heltidsjobb att vara patient. Beundrar dig för den koll du har men jag förstår att det är nödvändigt. Jobbigt att behöva ligga på som en hök och dubbelkolla ALLT. Fult av försäkringsbolagen att försöka lura folk genom att registera saker fel med fel koder. De hoppas väl på att ingen ska upptäcka. Jag känner fortfarande att sjukförsäkringssytemet är som en gigantisk djungel för mig.
Jag instämmer i Desirees kommentar, det är verkligen ett heltidsjobb vara patient. Jag har heller ingen vidare koll på allt som rör sjukförsäkringssystemer, jag får säga som Desiree igen att sjukförsäkringssystemet är en gigantisk djungel för mig också.
Skriv gärna mer allmänt om det, ifall du vill.
Good grief!
I'd want to keep the surgeon for that!!!
OJ, vilken tur att du är vaken och upptäcker sådant här. Jag kan inte låta bli att tänka på alla som inte törs/kan/orkar kontakta sina försäkringsbolag och därför betalar sådant de inte ska betala. För att orka tjafsa med förs.bolag ska man tydligen vara tillräckligt frisk för att vara sjuk... Snurrigt
Yes, it is a pain, but not too bad when you get used to it. I know people who just don't know better than to give up. I know they could easily win a fight against the insurance company, but they just don't know where to start. I offered to help, but they opted to pay and not speak up. I could never do that!
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