insurance BS

taboullio84

Soooo My insurance called and said something about a glitch.. Might take 90 days to fix.. I don't have 90 days. Office canceled for my sugar test tomorrow.. Uggghhhh can we not... Can we F#$&N not ? or I can pay full price out of pocket.

taboullio84

Figured I'd give it 30 days and just pay for the test and checkup...

rrcameron21

You need to call and make them fix this asap!! You cannot wait 90 days!

Katerina&Baby

Call your insurance and keep calling until you get a woman on the phone (am i being wildly sexist? You bet - but maybe she'll have kids of her own) and try to see if you can get her to look into the problem personally and expedite whatever the solution is. Explain that you don't have the extra money lying around to front the cost of these really important diagnostic tests and that your due date is X and that you absolutely, positively cannot have your insurance tied up when you know you're going to be in the hospital. Basically I would call in an upset panic and plead for the insurance agent to see what they can do to help get this sorted out ASAP.

klkonwi

Insurance is such a bitch sometimes!!!! Sorry

klkonwi

You never answered my question yesterday if your doc checked you or you had any other preterm labor scares ?!

Frogger5

At least can you be assured that they'll reimburse you after it gets sorted? That is really not cool, though. I hope you can convince them to work with you!

KaLikeAWind

What a load of bs. I like the suggestion to call and get a woman on the phone who could sympathize and try to advocate on your behalf. Other than that - raging bitch mode, engaged! (Just enough of RBM to propel your cause forward, not so much it hampers and throws up roadblocks) If its a 'glitch' then that means its on them - they have no right to make you wait and your health, your babies health suffer because they messed up

taboullio84

klkonwi said:

You never answered my question yesterday if your doc checked you or you had any other preterm labor scares ?!

I had an appointment for tomorrow. She was suppose to check me then. but i was feeling fine.. Just braxon Hicks nothing serious. Today after getting the call they feel stronger . but I am sure it will calm down when I do.

I called them back.. They said I can still go to the hospital.. Or get a new Dr. She is no longer in their system by mistake... That's what they are fixing... So I can wait and see or get a new Dr. I guess I will have to look for A new Dr. BC I need the glucose test and check on my cervix. I been with her for 3/4 of my babies.. I love her.. She is amazing.. And she even notices small changes like hair cuts.. I'm not sure if I ever told y'all but I have severe social anxiety.. I was medicated for years.. I'm not on medication BC of the pregnancy and I rarely leave the house.. So finding a new Dr is a big deal for me.

klkonwi

@taboullio84 ahh! Sounds overwhelming esp with the anxiety. wishing you luck. I also have anxiety and can't take anything due to the pregnancy except Wellbutrin.... Hang in there!

taboullio84

@klkonwi I'm just happy I can at least look for another Dr. At first I thought I was going to deliver at home Lol

enigmaticjj

If you haven't yet, I'd suggest asking for a supervisor/manager when calling the insurance company.  Something this serious and time sensitive I wouldn't trust a regular representative.

47923ang

Is the issue that the doctor is out of network?

What kind of insurance do you have? Is it an HMO or a PPO?

With an HMO, you need to use an in network doctor or the claim will be denied. (You would be responsible for the whole bill if treated, except in emergencies).

With a PPO, you can go to any doctor you want. In network is almost always cheaper, but out of network the insurance still pays. You may have to pay a higher copay if you go out of network, but not the entire bill.

KonaCoffeeBean

I would be crazy pissed. Normally, I hate the idea of paying OOP, because I think getting an insurance reimbursement is always such a long shot, but in this case... you really need the test. Is it very expensive?

KaLikeAWind

taboullio84 said:

klkonwi said:

You never answered my question yesterday if your doc checked you or you had any other preterm labor scares ?!

I called them back.. They said I can still go to the hospital.. Or get a new Dr. She is no longer in their system by mistake... That's what they are fixing... So I can wait and see or get a new Dr.

This makes it sound like she should be in the system but isn't? As in, they know she is a provider with them but there is a glitch in the matrix? Or as in - she should be a provider but its possible that she isn't anymore and its not a glitch but that the system is correct? Because if its the first, you may be able to ask your drs office to delay billing until the insurance have resolved their glitch in the matrix and paperwork can go thru smoothly. Then you can keep your Dr. Just a thought...

laurendutch

I used to work for an insurance company and this sounds like a manager or even higher up problem.

rklinge0

I went through something similar in Feb, ended up switching doctors. But the best part was when they paid for one item on my bill in Jan and then said the dr was out of network for another bill. I called them out on their b.s. and had the office resubmit bills. They eventually considered in-network and are counting it toward my deductible. Just stay on them insurance companies try to do anything to gey out of paying bills.

taboullio84

mellymar said:

taboullio84 said:

klkonwi said:

You never answered my question yesterday if your doc checked you or you had any other preterm labor scares ?!

I called them back.. They said I can still go to the hospital.. Or get a new Dr. She is no longer in their system by mistake... That's what they are fixing... So I can wait and see or get a new Dr.

This makes it sound like she should be in the system but isn't? As in, they know she is a provider with them but there is a glitch in the matrix? Or as in - she should be a provider but its possible that she isn't anymore and its not a glitch but that the system is correct? Because if its the first, you may be able to ask your drs office to delay billing until the insurance have resolved their glitch in the matrix and paperwork can go thru smoothly. Then you can keep your Dr. Just a thought...

This. She actually is still with them.. It's just a glitch and nobody knows why .. They just wanted me to wait up to 90 days or get a new Dr. But if it shows she wasn't in at the time of visit.. I won't get money back.

KaLikeAWind

@taboullio84 well that's just stupid bull$h!t crap. Insurance sucks. :-q

Knottie55308180

You can't control a glitch, that's on the company, not you. That happened to my fiance, something wad wrong with his insurance but he kept the appointment and went and he was obviously billed full price but once the insurance issue was fixed, he sent in his insurance.info and it was taken care of!

taboullio84

Knottie55308180 said:

You can't control a glitch, that's on the company, not you. That happened to my fiance, something wad wrong with his insurance but he kept the appointment and went and he was obviously billed full price but once the insurance issue was fixed, he sent in his insurance.info and it was taken care of!

I was already told I won't be reimbursed. I have an appointment Monday. I'll just pay full price. That's what we work for I guess.

adia1092

Hello.  I've been lurking these posts for quite a while, so I apologize for not posting much but I've learned a lot here.  Just trying to help.  Did the insurance company tell you what the exact "glitch" is?  Sometimes it can be as simple as a different code number.  Last year, many insurance companies and doctors' offices changed codes for things that have had the same codes for 20 something years!  One of my doctors didn't even realize it last year.  She often has to look up the codes for things when I still see her.

In another incident I was sent a $4000 bill from my OB for labor and delivery and the baby isn't even here yet!  I called my OB billing office and gave them my insurance ID which has been the same for two years and it was cleared and now I'mm 100% covered for labor and delivery.  It made no sense!  Sometimes the billing office does not work well with the insurance company.  I hope that helps.

Katerina&Baby

taboullio84 said:

Knottie55308180 said:

You can't control a glitch, that's on the company, not you. That happened to my fiance, something wad wrong with his insurance but he kept the appointment and went and he was obviously billed full price but once the insurance issue was fixed, he sent in his insurance.info and it was taken care of!

I was already told I won't be reimbursed. I have an appointment Monday. I'll just pay full price. That's what we work for I guess.

Honestly, I would see if there is a way that you could email them confirming that your doctor IS actually in network and covered by your insurance but that, due to a system glitch on the insurance company's part, they are unable to currently process charges from your doctor. If you get them to admit that it's THEIR problem and that at no point was your doctor ACTUALLY out of plan, then you can contest the charges later.