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.
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