Ever buy something without knowing the price?
In August, some kind unknown soul decided to give me a little nudge to make me literally fly off the handle (of my bicycle) and my hand was broken.
After the cast ritual and eventual cast removal, was asked to go to physiotherapy by the hospital.
All we got was a piece of paper with 11 clinics which were supposedly on the same insurance umbrella!
So we selected 2/11 based on proximity, called the insurance company, confirmed that they were both good for our coverage and chose one because they mentioned rates that were slightly lower than the other place.
Now, no actual exact $ commitment was made by either place because they said "we don't know what we will charge you till we evaluate you, etc. etc."
Based on what they actually did, which was a finite time spent, (looking at the others in the room with hand problems)and there was no real variety to the treatment. Just a rotation of toys to play with for all hand folks.
They did do a great job and did all the wax stuff and eventually got my hand to a point where I decided that no more physio sessions were required. So, not faulting the actual physio doctors.
Never paid anything for the visits, because it was supposed to be covered for 30 visits post surgery and went only for 12 or so between October end to December.
Life goes on and the whole thing is forgotten and bang, we got a bill for ~ 600 bucks mid march!
We are still wading through phone calls trying to explain and get explanations from people. San is doing a much better job of getting answers than me simply because I am deflated by this whole episode. My faith in humanity (or the insuring fraction of it) is shaken to the core!
It was not easy to :
a. get the insurance guys to tell me what would be covered before the physio started
b. get the physio folks to tell me what the cost would be
c. find out what I would end up having to pay before starting the sessions (using all my years of mathematics training this would imply the answer to be b-a where both b and a are quoted in US dollars)
That is as crazy as it gets. Imagine walking into a barber shop, sitting down on the chair and you say "haircut", he "nods" and he starts cutting your hair. Then you walk to the counter and he charges you $128.97 when you expect it to be 10 bucks! Heck, he could charge you anything he wants!
Now the insurance company lady is telling me on the phone "Sir, you are responsible for your payment! It is your responsibility to know what you have to pay from your pocket !"
I wanted to strangle her on the phone. How? How does one find out if we keep running in circles between the doctors and the insurance folks with a chicken and egg argument?
Doctor : we don't know what we will charge you till way after we have treated you
Insurance : we wont know what part of the doctors bill will be covered by our insurance till we see the bill
doctor and insurance to patient : You are responsible for covering the balance of what we do not cover on a bill that we cannot determine at the time of treatment!
The best part is the bill we got for 600+ bucks after the original surgery from the anesthesiologist. This dude apparently does not work at the hospital and he came from another hospital in the middle of the night to knock me out.
Really nice of the old chap, except he is not under my umbrella, and it is supposed to be a big umbrella in California!
Now how is a person who is under extreme pain and is hardly conscious expected to ask an anesthesiologist "by the way, are you in my plan? I am at this hospital because this whole building is under the Holy Blue Cross! but are you a Blueman Crossalic?"
Seriously, it would be great as a "responsible person" to know what I am getting into. If an educated person like me who can ask questions and possibly cover this bill over a few months, can be stumped like this, imagine the plight of a lot of people in this country!
Scary!
.
Labels: fraud, gimmick, health insurance, health is wealth, insurance, medical system
posted by Sundar @ 10:33 PM
11 Viewers Thoughts
11 Comments:
Really scary! I wish there would be more transparency on such issues.
How terrible. This is really adding insult to injury:(
I hope you manage to get the physiotherapy costs down to a decent figure. Thank goodness you didn't take 30 sessions:)
Tell me about it! I paid close to $150 bucks a month for 6 months. Now insurance tells me that they decided not to cover me for the last 1 month because the insurance doctors who have never seen me think I didn't need physical therapy anymore. Scary, horrible, insurance world.
I once had to pay $400 because the ambulance that was called (when I was unconscious) was not in my network.
When my daughter was born, she was in the hospital for 10 days (scary time). There were many different doctors came to see while we weren’t there. We got the bill from some of the doctors who are not under our insurance coverage. Insurance company said the something “you should have made sure……) how I wish my new born can talk.
...i am still trying to figure out how my ..."one" doctor visit can result in two bills! According to the agent on the phone... the doctor can bill it as a separate visit depending upon whats discussed during the visit...pagal kollai
Check this out...Six Companies Pushing for Transparency in Healthcare Pricing
Off topic: Zero Charger
Not the way you want it to be...atleast one side is USB ...I hope the other side of the cable is standardized soon.
Universal chargerku kural kudutha engal sundar anna vaazhga...
Really scary. I wonder whats on in the mind of the insurance company. they sure dont want pissed off customers.
What are they thinking ? How much of incompetence can the system take
buzz comments dont get cross posted in blogger..
this was a great comment..
=======
In the interest that this may help atleast the "knock out" part; have you heard of the RAP clause in an insurance plan. If you haven't, you'll be surprised to know about strange ways of the system - Here is from one of several united health care's faq
http://health.usf.edu/NR/rdonlyres/D72DE4AA-1750-445F-AB66-99F35E754FDB/0/CDHP_faq.pdf
In particular the last line of this answer #17 (read below) WILL interest you.
good luck
Sriram
17. What do I do if I have a procedure (inpatient or outpatient) at an
in-network facility and the anesthesiologist, radiologist or other
care providers at the facility are not in the United Healthcare
network?
The RAP (Radiology-Anesthesiology-Pathology) benefits follow the
facility. If you are at an in-network facility, and a
non-contracted provider provides care, and you are not aware of
their contract, eligible fees are paid at in-network levels as
long as United receives the facility bill prior to the RAP
bills. If UNITED receives the RAP bills prior to the facility
bill, the RAP will be processed as out-of-network. However, once
the facility bill is submitted to United for payment, you may ask
United to reprocess the claims so that the RAP are processed as
in- Network
Unfortunately, this might be specific to Univ. of florida..
:)
folks, thanks for sharing your experiences.
a. looks like I am not alone
b. looks like the new healthcare bill may address parts of this but things might be worse for genuine tax payers?
c. Kavi's question has an open ended answer.. looks like it takes as much as the people are willing to take!
San is doing a great job of getting to the bottom of this. will update this comment section if we get a good answer.
That's where a HMO helps..( but it's got its own share of problems ).
My heart stent procedure - 0 dollars bill !
YOu know me..near Vacaville!
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