Insurance related what to do...UPDATE

jcsntms06

Okay most of you know that DH lost his job in December and took a buy out. With that buy out we got health insurance for an additional six months. I applied for health benefits last Thursday, July 1 through my employer. Well A has her 9 month appointment on Friday. I called the insurance company yesterday to see if they could give me the group #, policy# and a phone number where the pedi could call in to verify. Well as of yesterday my enrollment had not processed. I was pissed, and then was told it could take 7-14 days. I was told I could still keep my appointment but I would most likely have to pay out of pocket, and then have the doctor's office re-bill my insurance company. Here's the issue I'm having, I called the pedi office to try and reschedule and the next available appointment is August 17th. Um A will be over 10 months old. I know she's due for shots at her 9 month appointment and then again at 12 months. The reception reassured me that she could wait until 10.5 months to be seen. And it would be quite fine to be seen again 6 weeks later for her 12 month appointment.

Would you pay out of pocket and just go to the Friday appointment? Should I just cancel and wait until August 17th? Should I reschedule her 12 month appointment for a few weeks later? 

I'm beyond pissed that my employer and Insurance company is making this out to be my fault, like it's my fault that DH lost our coverage and they will take their good old time. 

I kind of feel bad for venting  

This morning I called the insurance company and got all the info I needed. And then was told my cards were mailed to me on 7/6/10. Hopefully I will get them today. If not, I have the info I need, so no matter what I won't have to pay a dime. 

Thanks for listening to be vent. 

Lisa and Mickey

I guess it would depend on a couple things. First, financially, can you do it? The appointment, shots, etc, will probably wind up being several hundred dollars. Of course, it is important, but if it is going to make things tough and they said she can wait, I would probably wait. Also, will it mess you up if you were to never get paid back? The things ins companies say are never guaranteed and while you would probably get paid back, there is a chance you wouldn't.

KathrynMD

I would just go now and pay out of pocket and get reimbursed.

I don't think this is anybody's fault - it just takes awhile for paperwork to process - you wil still be covered.

daisybaby09

I really do not know about your employer/insurance.  Maybe someone from an HR background will respond, but...

When I came back to work we wanted to get on my insurance.  The paperwork took a few weeks but the insurance was good as of my start date (a month prior).  Everything was accepted from that date.  Just like when LO was born it took a few weeks but the insurance paid his bills backdated.

If you can ask the DR office to bill you.  This way you can submit it when the paper work is complete and you never have to pay?

Good luck.  About canceling the appt if your dr said its ok and you are Ok with it that is an option.  I would be a little put off by my Ped if appts took that long to rebook.  That is just me though.

UGH  

jcsntms06

Lisa and Mickey:

I guess it would depend on a couple things. First, financially, can you do it? The appointment, shots, etc, will probably wind up being several hundred dollars. Of course, it is important, but if it is going to make things tough and they said she can wait, I would probably wait. Also, will it mess you up if you were to never get paid back? The things ins companies say are never guaranteed and while you would probably get paid back, there is a chance you wouldn't.

I am worried that I may not get my money back. I asked the pedi how much the appointment would cost and they couldn't give me an amount. I'm sure a few hundred dollars. So much to think about. 

jcsntms06

daisybaby09:

I really do not know about your employer/insurance.  Maybe someone from an HR background will respond, but...

When I came back to work we wanted to get on my insurance.  The paperwork took a few weeks but the insurance was good as of my start date (a month prior).  Everything was accepted from that date.  Just like when LO was born it took a few weeks but the insurance paid his bills backdated.

If you can ask the DR office to bill you.  This way you can submit it when the paper work is complete and you never have to pay?

Good luck.  About canceling the appt if your dr said its ok and you are Ok with it that is an option.  I would be a little put off by my Ped if appts took that long to rebook.  That is just me though.

UGH  

I was a little turned off that they didn't have anything available until August. 

I figured once I applied I would be covered. So in case something came up and I had to be seen by a hospital etc I would be covered. 

I just hope when I call back on Thursday they will have the information I need. 

KathrynMD

you doctor's office should be able to just bill your insurance company - nothing out of pocket for you. 

When we added Ella to our insurance when she was born it took several weeks to get all teh paperwork sorted out, but in the meantime, I think I just paid them whatever my regular co-pay was and after the fact we got the account squared away - and I think I owed them an additional $20 co-pay for something.

bethybeach

I don't know about paying out of pocket.  The same issue happened with my SS.  He needed to go to the dentist and my co. hadn't gotten the paperwork in on time.  And this was the first time he or DH was on my insurance.  The dentist office said I had to pay the full amount and try to get reimbursed.  The issue is when you look on your insurance statements when they write down the cost of the visit we were going to be out that money.  So say the bill from the Dr. is $100. your insurance co. writes it down to $60 and you have to pay the $20 co pay.  You would be out $40 still.  I don't know if this would be your case but I would find out if it expects to be a costly visit.

Cooper81

I would also suggest actually talked to the Dr. or a NP to make sure postponing the shots would be ok.  I've learned from experience that receptionists are not always the most informed about these things, but will tell you it's ok based on their past experience, and that's not always right.  Personally I would keep calling every day until the appointment to see how things are moving along and pay out of pocket.  Everytime you talk to someone about the insurance make sure you get their name, time you called, and exactly what they said so that if they try and claim they didn't tell you to keep the appointment you have it well documented.  We had a few insurance issues after John was born switching from DH's to a gov't plan and had kind of the same issues, we worked it out in the end, but it was so frustrating during at the time.  I feel your pain

jcsntms06

KathrynMD:

you doctor's office should be able to just bill your insurance company - nothing out of pocket for you. 

When we added Ella to our insurance when she was born it took several weeks to get all teh paperwork sorted out, but in the meantime, I think I just paid them whatever my regular co-pay was and after the fact we got the account squared away - and I think I owed them an additional $20 co-pay for something.

My only issue is that none of us, have an insurance card. We are changing Insurance companies all together. Unlike when A was first born, we already had a card, and the doctors just used our policy and waited to bill. Does that make sense? 

daisybaby09

I would suggest calling your HR and confirming what your Coverage date is. That would be the date your company authorized you to be covered.  As long as that is before the appt you "should" be fine.  

My Dr office just kept trying to put it through with just his name and my info and insurance company name.  We did not have a policy number.  I would be shocked if your DR wouldn't bill you for it.  They can try putting it through and then if it doesn't get approved charge you for it later.  

The important thing is coverage date.  Just as Kathryn said when our LOs were born the coverage took a few weeks to get sorted out but their Coverage date was their DOB.  

 

bethybeach

If you don't have an insurance card most likely the dr is going to charge you the full amount up front.  I agree w/ pp keep calling and talk to the dr as well.

jnealet

I'd call and what shots your lo is supposed to get on friday.  If they are time dependant, I wouldn't wait.  If they aren't, then I would go for an August appt. 

Talk to HR also, they may be able to give you a temp card.

Lisa and Mickey

bethybeach:

I don't know about paying out of pocket.  The same issue happened with my SS.  He needed to go to the dentist and my co. hadn't gotten the paperwork in on time.  And this was the first time he or DH was on my insurance.  The dentist office said I had to pay the full amount and try to get reimbursed.  The issue is when you look on your insurance statements when they write down the cost of the visit we were going to be out that money.  So say the bill from the Dr. is $100. your insurance co. writes it down to $60 and you have to pay the $20 co pay.  You would be out $40 still.  I don't know if this would be your case but I would find out if it expects to be a costly visit.

FWIW- assuming insurance paid the dr, the dr would send you a credit, you wouldn't lose the money totally.

jcsntms06

UPDATE:

Spoke with the doctor and we've been told that DD only needs the Hep B shot, so we could wait if we wanted too. We also spoke with them about coming in w/out cards. They said they would bill me (all I owe is the co-pay which I know) and then once I get insurance card they would bill the insurance company) So it looks like we won't have to pay anything above our co-pay. I hope to get some info from the Insurance company tomorrow of Friday morning.

Thanks for ladies for the advice. I just keep calling the doctor and got some answers. 

ucgrad

I'm glad to hear you got it worked out. What a load off!