Use the following chart to deal with your insurance company. This chart compares what they say to what they really mean
What they say What they mean
In Network Pay up
Out of Network Pay up
Co-Insurance Pay up
We’ll look into that Pay up
We have to check Pay up
You get the idea. They make it supremely complex and impossible for the normal person to understand.
Last December, my son was disgnozed with a chronic disease. He spent four days in the hospital and has an $11,000 treatment every two months. We figured we hit our deductible by January. In February, he broke his elbow and we figured the surgery would be 100% covered. Using whatever corny math these people have, I think we finally hit our out of pocket deductible in October.
My wife, with an accounting degree and about 100 hours of research has discovered thousands of dollars in errors, surprisingly all in their favor.
I even asked my company why they don’t have an ombudsman to help employees navigate this morass.
Plus, every time we catch a mistake, they credit us and then recalculate every bill since the mistake was made, resulting in even more errors.
Good luck. Never give up. Question and fight every dollar.
http://www.medicalclaimshelp.org/home1.aspx
from above link:
“Sometimes getting a medical claim paid correctly can be a real battle. It starts when a charge that should be covered is denied. You call customer service, and they tell you that it will be reprocessed. Then, in a few days, another denial arrives with a brand new denial code. You call again. It’s denied again. And it may stay that way if it’s stuck now in this health insurance claims adjudication netherworld where nothing is paid easily, if at all. “
Recently a clinic manager told me; “Resolving wrongly denied medical claims used to be a simple process. A biller working in our office would stamp “APPEAL” in big red letters on a photocopy of the claim, and mail it back to the insurance company. These days, you’d be wise to put the cost of that postage in the bank, and throw away both the APPEAL stamp and its red ink stamp pad because it won’t even make it past the insurance company’s initial computer screening. They’ll toss it into the trash and you’ll never hear anything back from them. Today, you need to get your ‘A-game’ on. Otherwise, you won’t see a penny.”