Posted on 11/23/2023 12:03:32 AM PST by texas booster
Plus if anyone actually thinks someone reviews insurance claims they are nuts. Some get reviewed if they cannot be automatically adjudicated by a computer system. The number of claims processed in a funds transfer system are hugh and serial. /s
And then if you follow the money. What entities are building huge facilities. Hospitals.
Years ago I took my daughter to the ER because she was coughing uncontrollably. This had gone on for several hours. ER couldn’t diagnose it so they admitted her. She spent a day or two in the hospital. It did turn out to be relatively minor.
the 8th grade dropout sitting at a desk at CIGNA denied the claim declaring that it wasn’t an emergency.
The probably didn’t like that I called their guy an 8th grade dropout either. When we appealed, CIGNA called to tell me they scheduled a “hearing” with about eight of their people and me. I said “sure, I’ll schedule a conference room at my office for you to come over.”
They told me it would be at their office at which point I reminded them that it was their problem and that I wasn’t lifting a finger in my defense.
They followed up with a call to my wife threatening to garnish my wages. At that point, I went to my company HR and told them to stuff it because they can’t garnish what doesn’t exist. “I quit.”
Long story short, they didn’t let me quit and the company dealt with CIGNA from then on. Somehow they worked it out.
When I changed jobs, not having CIGNA was a criteria.
Yeah,I liked that one.
I took my daughter to the ER at 2 am when she started peeing bright red blood and passed out. Insurance tried to deny because it was “just” a UTI and not a true emergency. Like I could tell that at 2 am.
Waiting for the denials on chest pain and difficulty breathing to start. You should have known it was just heartburn, just mild pneumonia, should have waited until 8 am and urgent care was open. Of course urgent care is just calling ambulance if they get a suspicious chest pain walking in.
This explains these weird ads I have been seeing where a guy pops into place and tells the woman where to get her scrip filled...
And I once needed a very hard-to-find prescription: CVS wanted to charge me 4× what we ended up getting it for.
The insurance companies think they will save money but the chain stores will just raise their prices...
I always encourage Freepers to clearly identify in their posts which “Medicare” they are talking about—I think you are talking about Medicare Part B, correct?
So about a year after the incident with my daughter, we had a CIGNA rep at the office explaining the policy. About 50 colleagues in the room.
At one point she said “If you think it’s an emergency, then it’s an emergency.”
I raised my hand and said “So if you’re 3 year old daughter is coughing uncontrollably for several hours, you take her to urgent care, who transfers her to ER, who admits her to the hospital because they can’t figure it out, would that be an emergency?”
“Well of course it is” she replied
“Really? Cause you’re stupid company sure didn’t think so, they denied my claim and tried to garnish my wages.”
Lots of stony silence after than one
What other criteria did you have? Or was that the only insurance-related criterion you had?
Regards,
Do the math-—Over 6 ‘claims a minute processed”.
OBAMA has done the most damage to the USA with what he did to our healthcare system.
“We literally click and submit,” one former Cigna doctor said. “It takes all of 10 seconds to do 50 at a time.”
+++++++++
Looks like the same caliber people / systems doing the signature verification for the Arizona elections that shafted Kari Lake.
> Is that choice permanent? <
I’m afraid I don’t know the answer to that question. All I can say is that my Medicare supplement plan gave me a discount for signing up at 65. That discount would not have been available had I gone with them later.
There’s a guy on YouTube who explains this mess rather well. And he seems unbiased (although you never can be sure). It might be a good place to start. Check out the comments there, too.
https://youtu.be/Iv8Wzey-rII?si=dDpgalAkqzhvmAod
> I think you are talking about Medicare Part B, correct? <
No. Sorry for the confusion. I’m talking about the whole package:
Original Medicare Parts A and B + a supplement plan
vs.
An umbrella Advantage plan
As I noted on another post, there’s a guy on YouTube who explains things rather well. And he seems unbiased (although you never can be sure). It might be a good place to start. Check out the comments there, too.
https://youtu.be/Iv8Wzey-rII?si=dDpgalAkqzhvmAod
“350 for a Vit D test is about 5 times the normal cost”
My insurance would pay the average cost of this test for your area, like maybe $50.00 if that and the difference you don’t have to pay.
If the provider accepts your insurance, including medicare and they billed the insurance $382.00 for an office visit, your insurance will say that $254.95 of that charge is not payable as it exceeds what Federal law allows and you are not responsible for it, only $ 127.05.
Some providers will try to get you to pay their full billed amount, that is called “Balance billing” and is against the law. This includes both “in network and out of network”.
My wife’s hospital system stopped accepting CIGNA because dealing with them was difficult and their payments were so bad it was costing them money.
I wonder how many national health systems need to dump them before they learn?
Also, check which insurance company you can get, it can make a big difference in what you pay out of pocket.
For example: A large Hospital in Florida for CPT code 93460 will charge $ 12,360.00, if you have Aetna ins. the cost will be $7,043.20. If you have Cigna ins. the cost is $8,775.60. Humana is $10,506.00.
If you have met your deductible and your copay is 20% then you would pay $1,408.64 with Aetna, $1,755.12 with Cigna and $2,101.20 with Humana.
Understand and know your rights, Balance billing and No surprises billing are against Federal and most State laws.
Your first year on Medicare has a built in grace period. Within that year you can switch back to traditional Medicare easily (from Medicare Advantage).
After that period is over, switching back to traditional Medicare can require underwriting and can be denied. I highly recommend you see the Boomer Benefits videos on YouTube:
https://www.youtube.com/@BoomerBenefits/videos
and contact BB directly to navigate this... 817 249-8600. They are great folks to work with and very honest!
All and I mean if the commercial health ins company’s do this same denial of claims. If they get fined by a state they consider it yhe cost of doing business
Ping
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