A few months ago J had an endoscopy done by an in-network provider, at an out of network facility with an out of network anesthesiologist. We got a bill from the anesthesiologist because our deductible was applied to his bill.
Last night I called UHC to complain, we used an in-network doctor, we had no choice regarding the anesthesiologist. Last night I got the run around and was told the only thing to do is file a written appeal (this didn't get me very far when I wanted the CPM covered).
I was advised by a fellow hip friend (thanks Maria) to ask for 'rapid resolution'. So I called again today and explained to the rep that I was unhappy with the outcome of my call yesterday, she voluntarily (without me asking) transferred me to rapid resolution. The rep at rapid resolution (again) explained that because the facility was out of network, they will not pay for the anesthesiologist at the in network rate. I didn't back down when she told me (again) to file a written appeal. Since I again, kindly asked that UHC pay for the anesthesiologist, she decided to look into my plan. She then told me that I have the "fully insured plan" (not sure what that means) and that she can forward this to the appeals department. I should have an answer in 15 days.
What is the point of my story? Had I just accepted what was told to me on the phone yesterday, I would probably be screwed. I still may end getting screwed, but I feel like something was accomplished today because I was persistent with them.
3 comments:
Dear Suzie. Good going. I also had the run around from my insurance company as well. I literally spent three hours today alone on trying to find out my benefits. It is so mentally exhausting. Nothing is black and white anymore. It seems to me that my friends that have no insurance seem to have a much smoother journey with this. I have been following your blog and just wanted to say thanks for writing about your recovery process.
Sloan, thanks for reading and for mentioning it on hipscope, glad you like it. I hope it can eb helpful to you and others!!
swauz,
Something very similar happen to me. I just received a bill from a dr i saw for my hip 16 months ago!!!! for like $250. I called to see what happened at the dr and they gave me a retarded answer, so being the smart ass i am and with the advice of your father(mine too) told them i ould be paying them $5 a month until i could pay it off. She did not like this and said i had to pay to which I replied "i'll pay the same way you bill, and you'll get my $ net 400 days" Again she did not like this answer and told me i was refusing to pay and she would send me to collections. I told her to go fuck herself and that i never refused payment, rather she was refusing to accept my $5/month. Long story short, I called UHC where i spoke to a very nice rep who basically told me Dr Herreras staff suffers from a slight form of mental retardation, and should have never billed me out-of-network and had they not been lazy asses, this would not be a problem and my $10 co-pay would have been fine and once the dispute is resolved thats all that I'll have to pay. Sometimes it pays to call the insurance company cause they might just help.
(Some parts of this story have been fictionalized to make it sound better)
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