Still dealing with Insurance companies

OntarioVanMan

Retired Expediter
Owner/Operator
After the last couple weeks and still fighting with insurer over paid procedures and billing codes...we don't pay this we don't pay that....

Maybe we DO need some kind of revamping of insurance companies....

maybe something like an ombudsman, impartial arbitrator?

Leaving these insurers on their own doesn't look like a good thing...
 

greg334

Veteran Expediter
I assume you got an EOB?

Take the EOB to the doctor's office and ask them to explain everything to you. If they refuse, tell them to rebill the procedures because you are not going to pay.
 

OntarioVanMan

Retired Expediter
Owner/Operator
I assume you got an EOB?

Take the EOB to the doctor's office and ask them to explain everything to you. If they refuse, tell them to rebill the procedures because you are not going to pay.

I have an itemized bill from the hospital...there is a few questionable things on it...
JuJu is in contact with both hospital and surgeon.
 

OntarioVanMan

Retired Expediter
Owner/Operator
The hospital should have a patient advocate, ask to talk to them.

hopefully all the subsidy programs will have their decisions made and we'll know what we are looking at..AND then we'll make a trip and talk to that advocate about some of the add-on charges....

I am not used to having to do this...I was used to just walking in and walking out..No bill.....*LOL*

BTW..What is an EOB?
 
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greg334

Veteran Expediter
An EOB is an Explanation of Benefits. It explains everything for that specific claim of services. Depending on the insurance company, they are sent with every claim submitted and adjudicated but some insurance companies (and states) don't require the subscriber to have one unless asked.

I would ask for one to see where the problem is. It is like driving blind, not knowing what was submitted and what the insurance company will pay and what the doctors will eat in losses.

See if the hosiptial has a patient advocate, they do pretty good work (if they are any good) in sorting out billing messes. But don't pay until they resubmit the claim.

By the way the one fallacy with this entire health care 'reform' is that the doctors know what's going on with the patients and the insurance companies but that is farthest from the truth. Very few doctors do their own billing, and those who do are very selective about who's insurance they accept. Those who don't, which I think maybe in the neighborhood of 97% hand that off to office staff or outsourced. The one thing that I am really frustrated with any "health care reform" is having the doctors involved with it - they are not the people having the problems.
 
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