If you like your doctor, you can keep your doctor! AND save money while
doing it!
Strong work. So, an hour or two of effort saved you thousands of
dollars. While you should not have had to do this, you did it and got a
high payback.
--FT
On 11/30/16 11:05 AM, Dan Penoff via Mercedes wrote:
Local hospital has big disclaimer in their admitting area that says something
to the effect that no care provider in the hospital (i.e., doctor) is a
hospital employee.
They also have a reputation for third party billing.
We avoid them like the plague after the wife took one of the kids to the
emergency room there some years ago. We got billed by so many out of network
providers it was ridiculous. We spent three years fighting every one of them
with our insurance company, and after the dust settled paid almost nothing
beyond our copay. I can’t count the number of times we got calls from
collection companies, etc. It was so scammy it wasn’t funny.
If you work hard and advocate enough you can beat the system, but it takes a
fair amount of effort.
Wife has been dealing with a major medical issue this year. Part of the
treatment involves additional surgery, which is optional but mandated by
Federal law to be covered by insurers if the patient wants it. So she goes to
a surgeon who specializes in this area, only to find that they’re out of
network. She goes to her provider’s information to see who is in network, only
to find that there are no surgeons with this specialty within a 150 mile radius
of the Tampa area. Now how can that be?
She talks to surgeon, who laments that they play a constant game of applying to
insurers to be an in-network provider, stuff sits around for months until they
finally turn them down for no reason. Then the process repeats itself.
So wife decides to use this surgeon anyway. Then she calls her insurance
company patient advocate and asks her to find an in-network surgeon with this
specialty in Tampa. She can’t. I would add that the specialty is a common
one, something you would find in any metropolitan area many times over.
So then wife insists on a review with her PA, her company’s benefits manager,
and a consulting nurse with the insurance company who does claim reviews. The
meeting starts off with the wife asking why her surgeon can’t be in-network
despite applying to be many times over.
Hmm. Don’t know.
Then she asks the consulting nurse to identify an in-network provider in the
Tampa metropolitan area. After almost 10 minutes of searching her records, she
comes up with someone. However, the specialty is several lines down their
shingle. In other words, unless you went through every one of the surgeons
they listed in their provider list line by line looking at their capabilities,
you would never have found them. And it’s not the surgeon’s primary specialty.
That gives one a vote of confidence, doesn’t it? She asked the nurse if she
would choose this provider if faced with the same condition. She wouldn’t
respond.
Strike two.
Because there was some urgency for the start of treatment, all of this took
place several weeks after the wife committed to this surgeon and one surgery
had already taken place. So she suggested that it would be in the insurance
company’s best interest to go ahead and honor this surgeon’s work and consider
them in-network from this point on, since there would have been no way for her
to identify an in-network surgeon without direct interaction on the insurance
company’s part since their documentation had nothing.
Her benefits director concurred and made a few suggestions regarding the
insurer’s lack of transparency in this regard.
Her surgeon is now an in-network provider for this company for all of his
patients who use the insurer. As a show of gratitude for her efforts he has
waived her copay for all of her surgeries. Nice.
Dan
On Nov 30, 2016, at 10:24 AM, Mitch Haley via Mercedes <mercedes@okiebenz.com>
wrote:
https://www.fatwallet.com/forums/finance/1539048
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--
--FT
Winston Churchill:
“Never give in--never, never, never, never, in nothing great or small, large or
petty,
never give in except to convictions of honor and good sense.
Never yield to force; never yield to the apparently overwhelming might of the
enemy.”
_______________________________________
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