A group for political progressives and warriors for truth and justice. Socialism isn’t a bad word here.
The system is broke
December 13, 2012 at 8:45 pm #174643
A RANT that I need to get off my chest…
Guess I am part of the problem because I DON’T have the answer…
Had to go to the doctor 3 months ago to have a fish hook removed from my thumb
JUST got the 4th insurance statement, this one from BCBS, 63 days after the incident.
And that is ONLY part of the problem..
“the bill” was for an for another Xray, (which I would question why I would needed any of them)
BCBS agreed to pay 1.31 for the xray because Medicare had already paid 5.25
The doctor office had billed Medicare/BCBS for 28.00 (IMO a reasonable price for a single xray)
The first 2 billings was for the actual doctor’s visit for removal of the hook and they included 24.49 for the first Xray.
Somewhat careful review of the 4 billing statements indicate that the doctors office billed Medicare within 3 days of the incident, within 2 weeks BCBS was billed for the difference and then almost 5 weeks later another bill to Medicare went out for the 2nd Xray…and then a week later another bill to BCBS.
got to be signficant amount of overhead considering at least 8 people were involved administratively processing claim paperwork for a 30 minute doctor visit….
2 different insurance programs have different rates for services provided, neither of which are terribly close to the actual billed rates
END of Rant
December 13, 2012 at 9:46 pm #174647
One thing the Affordable Care Act will do is streamline administrative processes with the insurers or they will lose money big time. Many of them are already feeling it because ACA requires a high percentage of premiums to actually go to health care. What a revolutionary idea!
I share your pain though. My husband was rushed by ambulance to the nearest hospital in late June due to extreme pain. After tests, the hospital determined it was a severe heart problem and they had to transport him to the hospital that handles cardiac care. When I received the bill, I was billed for outpatient services at the first hospital. I argues with BC/BS that while my husband did not spend the night at that hospital, he was admitted to a hospital that day. From hospital #1s perspective it was outpatient but not from our insurance coverage perspective. Had the woman and her supervise argue with me for more than a half hour and tell me that this was the way it was and if I was unhappy about it I could appeal their ruling. By some miracle I had a phone message later that same day informing me that I was actually correct and the charges would be adjusted. I guess that is a good story but if I had not carefully analyzed the billing or wasn’t familiar with the differences in payment based on those two determinations, I would have paid more. How many people are cheated and never know it? I understand “buyer beware” but I’d rather decipher my cable or phone bill than a medical claim.
December 15, 2012 at 4:30 am #174645
Wow, glad I’m 100% VA covered (though getting to that status had its downsides).
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