Advice on in network out of network dispute(health Insurance)

[italianquaker]

I have a question for anyone who might have been through this and what their experiences were? My wife had to go for a thyroid scan. On the insurers website they stated and still do that the company was an in network provider. They also stated that you have to call the company to confirm. I called the company and was told that they were in network( I did not note the name) The bill comes and they are out of network but the insurance company still has them as in network(website). I called the billing office to see if any arrangements could be made and they said no I called the insurance company and they said I should of called them but their is no mention that that it is a requirement. Any suggestions or am I out of luck Thnx in advance

[Buckeye McFrog]

In my experience, just about the only thing that seems to work with these rockheads is public humiliation.

I would take my story to a local reporter or talk radio host. If doing so would not infringe on your wife’s privacy too much.

[Alberta's Child]

I've never dealt with this situation before, but I would suggest that you print copies of the materials from the insurance company's website where they list the place as an in-network provider. Also, put together a set of notes to document the time and date of the phone call you made to them.

This information might come in handy in the event of a billing dispute. If the insurance company continues to give you a hard time, you should look to pursue this through your state insurance commission.

[italianquaker]

Thnx I did that

[NEMDF]

Print the screen of it showing the provider in network. Write to the insurance company and cc to the state insurance commissioner.

Tell them that you (or the insured) called to verify and was told it was in network. Tell them you expect to have the charges covered as “in network”, in accordance with the terms of the insurance policy. Wait a few weeks....

[italianquaker]

I appreciate the advice

[NEMDF]

PS Maybe send the letters by registered mail to both the insurance co and the state insurance commissioner.

Tell them in the letter that you also expect a call from a service rep of the insurer, to verify that the charges are covered in network.

[italianquaker]

Thnk you I did print the screen

[goodnesswins]

Put all communications in writing. Saves headaches later and $$$

[TomGuy]

Keep calling. Also, jot down the date/time/name of CS agents you talk with.

If the current CS agent can’t give you an answer, ask to speak to the supervisor. Take it up the chain of command.

If their website says they are in the network, make a screencap for reference later.

If necessary, contact your state Insurance board.

[GOPJ]

When bad goes to worse the best path might be to hire a specialist. Start with ‘free information’...

Claims specialists tend to charge between $50 and $100 an hour... Consultation is usually free.

free information: www.medicalclaimshelp.org

Alliance of Claims Assistance Professionals - www.claims.org

Above links from Kiplinger Retirement Report

[eyeamok]

Take SCREEN SHOTS of EVERYTHING and PRINT All of it, then go down to the US Post Office and FILE a Formal Criminal Complaint of MAIL FRAUD, documenting the FRAUDULENT use of the US Post Office to willfully and knowingly send FRAUDULENT BILLING NOTICES, it is a FELONY to do so.

Get a hold of your STATE dept of Consumer Affairs and File another FORMAL CRIMINAL COMPLAINT for Deceptive and Fraudulent Advertising and Fraudulent or Deceptive Billing Practices.

THIS WILL GET THEIR ATTENTION.

[AppyPappy]

Having the name of the person at the company will not help you. If the company says you are wrong, you are wrong even if they said previously you were right.
They are like the government. You have to pound them into submission. You call until you get someone who agrees with you and then escalate from there.

[cyclotic]

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.

[call meVeronica]

There are several good suggestions but to be formal and uphold your appeal rights it does have to be in writing and via certified mail for your appeal.

Depending on your state the insurance commissioners are coming down hard on the plans for bad data on the provider websites and directories.

The plan can pay an out of network provider as in network so you can request that.

You can also contact your legislators for help. The insurance companies hate legislative complaints.

There is a difference here to make everyone aware so you know to ask the questions in the future.

The people who perform tests/x-rays etc and the people who read and interpret them can and often are separate. Both contract separately and charge separately.

[texas booster]

The same basic scenario happened to me on a root canal. By a reputable dentist in Dallas, who claims not to be in network.

Looks like more and more doctors are playing both sides of the aisle, and since the insurance companies are only looking out for themselves, the consumer gets burned.

i will follow the advice above and keep pushing.

[italianquaker]

Thank you

[Baldwin]

I have over 20 years in the medical claims end. Call up and ask to speak to a manager/supervisor. Explain the situation. They should be able to just override and pay as an in network claim. If not tell them that you will contact your state’s banking and insurance department. No one is going to want to deal with a doi complaint over such a small issue.

[Zarro]

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 had a similar experience, except that I don't have an accounting degree. I felt like I had another full-time job, I spent so much time watching over the billing and the "errors", also all in the insurance company's favor.

I even asked my company why they don’t have an ombudsman to help employees navigate this morass.

Would be nice.

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.

Hmmm, my company actually LEFT the original, errored, billing on their web site and just added the new, corrected, version. It was very annoying.

Good luck. Never give up. Question and fight every dollar.

I agree 1,000%. I also made complaints to my employer, so they knew how bad this company (oh, UHC is their initials BTW) is. We have a new insurer this year. They almost HAVE to be better.

[cyclotic]

I told the insurance company In writing that the good by rate for forensic accountants was $200 an hour and if they keep it up, I’ll start billing them.