Monday, August 20, 2007

At least I got a Fancy New Pen

Ok, this is different from my normal posts, but I have an issue I thought I'd air out, see if I can lend any wisdom to anyone else. Maybe that'd make all this frustration worth it!

It seems that anytime we have anything medical done, we get "surprises" when it's over, where we owe more than we expected.

If you have health insurance, you'll quickly learn certain terms. Such as "in or out of network." And "copay, deductible, and limit." And of course, "HMO or PPO and EOB (explanation of benefits)." I think you need a law degree to really understand it all.

~Once we checked Chuck into an ER because his heart was beating way too fast and out of rhythm, and it was truly a life or death situation. Unfortunately they had to shock him twice (while he was awake!!), but praise God, that reset his heart, and things were back to normal. Then the cardiologist tells us we need to do a surgery as soon as possible so it doesn't happen again, and he's available to do it the next morning. The only catch is the hospital didn't have room so we would have to go to another. But the hospital said that in order for our health insurance to cover it, he'd have to be transferred by ambulance. What we didn't know is that the health insurance wouldn't cover the ambulance it cost us an extra $400 to go 10 miles. All so our insurance would cover the other stuff!?

~I found an oral surgeon in my network who did my wisdom teeth, and then I returned to him to have my jaw surgery. Since everything went fine billing wise the first time, I had no idea I'd have problems this time. A week before surgery, his billing person tells me that the insurance is saying he's not in network, but not to worry, because they have a contract to prove they're in network, and even if that doesn't work, they'd take what insurance pays out of network, because it was actually more anyway, and just treat me as in network in what I'd owe personally. They required I pay the full amount ($1250) that would be owed to them beforehand, then if my insurance decided that amount should go to the hospital and anesthesiologist instead, then they'd refund the money to me afterwards.

After surgery I got a totally different story. Come to find out, they weren't in network, because it was considered medical, not dental (they were in dental network but not the medical network). And then they went back on the agreement, and decided that I now owed thousands of dollars, even though my insurance had actually paid more than they would've gotten in network. Finally I found a letter they'd written that said I'd only owe that full amount that I paid before, and they decided to write off the extra...but then my insurance did decide that full amount should go to the hospital and anesthesiologist. Do you think they refunded me the money? No way. My surgery cost double what I'd expected.

~Recently Chuck and I decided to try out a dentist. I asked if they were with my insurance, and they said yes. So I went through my visit: cleaning, consultation, even lots of x-rays. They said I owed nothing, as per my insurance. But then when Chuck went in, they waited until he'd gone thru everything to inform him that they weren't in network, and we owed $400 for the services. When I asked why they said they were with my insurance, they said "but you didn't ask if we were 'in network', just if we were with them. We take them, we bill them as out of network." Sneaky, sneaky...

~And on to my latest issue. Charlie's dentist. I had red flags that I should have heeded earlier. With the first visit, I got a fancy new pen with his name on it. I should've wondered how he pays for things like that! ;) Before the second visit, they said they like to take the full amount that will be owed (including what insurance will pay) from me, and then reimburse me when insurance pays. When I told them I couldn't afford that, they offered me a credit card application!! But then they told me they could do a "predetermination" with my insurance, which then showed the amount I'd owe, instead of a couple thousand dollars for Charlie's fillings. We went in for that visit, but it didn't work, so they didn't collect any money from me.

So once again, they wanted thousands before trying the fillings in the hospital. Again, I asked for a predetermination. What wasn't noticed is that my insurance only covers silver fillings, not white fillings. And what I didn't know is this dentist only does white. And in the predetermination they checked to see if they could do only 2 fillings, and 2 root canals, and insurance said it'd pay $1600 and my cost would be $250 (plus $300 to hospital). The dentist told me that while Charlie was under anesthesia, if they found more that they deemed necessary to do, they'd do it, which meant my bill would be more. What I didn't know is that he did EIGHT fillings instead of two that weren't covered by insurance at all!! So a few weeks afterwards, I get some big bills. I called my insurance to see why they only paid $800 instead of $1600 (on top of figuring out they don't cover white fillings). The reason for only paying $800 is because that was all that was left in Charlie's limit for the year...which they don't mention in the predetermination! So not only did the dentist have surprises for me, so did insurance. So instead of a $550 bill, we're paying close to $2 grand! And since the services are already done, there's no negotiating. And just like my oral surgeon, they want their money asap and they're not going to budge on what is owed. The ironic thing is, we just sunk $2,000 in teeth that will fall out in a few years.

So, the moral of the story: ASK questions! Pay attention to every little detail, because you never know when it'll come back to bite you. Keep good records. Check with your insurance, don't just believe what the doctor says. If you can, get everything in writing.

Another little thing the dentist did with both the first visit and the hospital visit, is that they conveniently forgot to write off the discount they give for being in network. If I hadn't cross referenced with my explanation of benefits, I might've paid even more than I owed.

Also, my mistake was that I didn't notice where the insurance said in the predetermination that they don't cover white fillings, and I didn't ask if they do silver. I assumed that because they were in network, things would go smoothly.

And one thing I've found is that doctors just want to do their jobs and don't want to talk money. And kinda like "good cop, bad cop," their billing office might not have the bedside manner after the service, that the doctor has. So while you may trust your doctor, be careful with the billing people.

That's all I have to say about that. ;)


Angie said...

Comment from Melony:

I'm sorry, but that's sad!!! I am one of those ppl who doesn't pay attn to things like that, but I WILL NOW!!!! I'm sorry again! There is so much out there that we need to be aware of, it's sad that some places do take advantage of us too! :(

Angie said...

Comment from The Thiers &- Blog Archive &- Exciting Times:

[...] Another exciting thing about this is the new health insurance company. As you may recall from a post a couple of months ago, I've had terrible experiences with Humana for the last 8 years. The interesting thing is the timing. Chuck came home yesterday telling me he thought he'd accept the offer. I then checked the mail and got a letter from Humana saying they were rejecting my appeal for how they handled Charlie's recent dental work. So, hearing that we'd be with a new health insurance company definitely softened the blow and gave me hope for the future! [...]

Angie said...

Comment from The Thiers &- Blog Archive &- I'm not Super Woman after all:

[...] ~I know this is a super-long blog, but there's more to catch up on. Remember how I told you about the big dentist bill we never anticipated? Charlie had to be put under anesthesia to get 2 root canals, and it ended up a financial nightmare that my health insurance didn't hardly cover. The dentist said he needed my authorization to do whatever else he thought necessary while this was happening...what I didn't know is he found 8 cavities to fill!! So my bill to him went from $250 to nearly $2 grand!! Anyhow, the second half of this story...the hospital and anesthesiologist was supposed to be covered under the medical (versus dental) side of the insurance. But for the last 4 months, Humana kept rejecting the claims. I even filed an appeal, telling them they needed to cover this. Finally, Chuck mentioned it to the HR dept. at Rackspace, and they offered to help me with it. While Humana is still refusing to pay (which makes no sense, it should be covered!), Rackspace has decided to cover it anyway! This was a potential $3500 bill on top of what we've already paid, which had given me a few nights of no sleep and more than a few tears shed in the last month. I had truly agonized over the fact that I couldn't seem to fix this problem. Once again, I'm not Super Woman. [...]

Angie said...

Comment from The Thiers &- Blog Archive &- An Excess of Abscess:

[...] No, I haven't had baby3 yet! But the last couple of days have felt like it. My oldest baby has an abscessed tooth. If you remember from back in June, the first time I took Charlie to the dentist we were told his teeth were in bad shape. Considering he'd only had them three years of less, it was hard to believe. His two front teeth were near-abscessing so we cut out nearly all sugar until he had the root canals in July. So here we are, 5 months later, and he's never complained about his teeth hurting until this past Tuesday. At first I thought he just had a popcorn seed stuck in them or something. But his complaints became more frequent, and Wednesday night he woke up crying about them. So we went to the dentist Thursday, who said that he could find absolutely nothing wrong with them. But, he said, waking up in the night is a symptom of an abscess that obviously hasn't come to the surface, so start him on antibiotics now. This was the dentist who performed all the work in July, and who I had decided we would not use again due to the financial nightmare of it all. Anyhow, all day yesterday Charlie cried in pain, and even ran a fever while on full doses of both tylenol and ibuprofen. On into the night it went, and by this morning, the entire left side of his face was swollen! So we went to another dentist today, since the infection is showing itself now, and he showed me which tooth is indeed abscessed. He reassured me that the antibiotics will work soon, so not to worry (easy for you to say). So now we play the waiting game, and I try to keep up with his pain management. Charlie's not only feeling the pain, but also disappointed that he doesn't get to eat the strawberries I had just gotten him, among other sugary things. [...]