Is there anything more frustrating than insurance?

legallyginger · September 2013

Disclaimer: I know this is probably at least somewhat my fault because I didn't call and check coverage with my insurer beforehand.

I get excellent health insurance through school, and I've double and triple checked my coverage online, and it says that prenatal care and "other maternity services" are covered at no cost to me. HOWEVER, I just got an explanation of benefits letter from my insurer saying that I'm going to be billed $423 for the blood work done during my NT scan. That is almost as much as I'm going to be paying to deliver the baby, so I thought that was completely outrageous. I went online to look at my claims, and there is a separate claim processing for the ultrasound that was done at the same hospital on the same day. That was completely covered, no cost to me.

The letter lists three charges (two for bacteriology and one for cytology, whatever that means), I'm assuming for the vials of blood they took (or maybe the claim numbers were put in wrong?). My insurance should only be billed for one of those vials in the first place, because the second was given for a study that the hospital was doing in conjunction with the medical school. I just don't understand how the NT scan itself would be covered but simple blood work wouldn't be. The letter notes that not a dime was covered for these claims, because "benefits are not available for routine services." I don't even know how to interpret that. Ugh. And of course I can't call them until tomorrow because they're only in the office til 6.

Aaaand that's my vent for the night.

rachmckenna · September 2013

A few of my friends at my job had the same thing happen. Some of their bloodwork was sent to a lab out of state and they got huge bills. I checked with my dr to see how they did mine and they said it was local. Could this have happened to you?

Yenemous · September 2013

No! Nothing is more frustrating to me right now either! I have a HSA plan with a $3K deductible so I'm basically paying for everything out of pocket right now. I'm high risk so I have an appt with my regular OB and an appt with the peri every month. Plus I had an NT scan and I've had blood drawn four times already. I have paid for ALL of this. I'd like to think it would all be ok once I meet my deductible (which I will do very soon at this rate) but it starts over again in January. That's right! I get to pay $3K again in January! I picked the wroooooooong time of year to get KU I guess. It also wouldn't be so bad if my premiums were low but to cover me and DH on this plan I pay around $450/month. Stupid HSA plan. I hate it!!!!!!!

legallyginger · September 2013

@rachmckenna that could be. I'm anticipating spending all day on the phone tomorrow between Blue Cross and the hospital. Ugh.

@Yenemous- that sucks! I'm sorry. High deductible plans are the worst. My MIL has one that is 10k, and she had to have surgery last year. She's going to be paying it forever.

ntdane · September 2013

Insurance is such a pain. They make the policies way more confusing than they need to be, then when you call with questions no one can answer them. It's great.

I got lucky at my NT scan because the nurse actually paid close attention to my insurance card and noticed a logo on it for a local lab. She looked into it and discovered that it meant they only covered labs/blood draws from that particular lab. Anything else would be out of pocket. She then found the lab, called and got the paperwork set up, and printed me directions. What a great nurse! If she wouldn't have caught it we would be out $300.

boymom312 · September 2013

Ugh! Insurance is the Bain of my existence these days. My insurance isn't local. Translation: there are 0 providers in my area. I have to jump through so many hoops and the best one is that I have to inform them of every procedure code that will be done in advance for them to approve a special "gap exception" For my visits/doctor. So if we go off script, I then need to appeal every bill because it will be denied. I've talked (and bawled! ....hormones) to so many ins people, nurses, billing depts, and coding offices that I've started a notebook, yes i said a friggin notebook, of all conversations just so I can remember! I'd rather set my hair on fire than deal with this crap.

twinlove314 · September 2013

Yenemous said:
No! Nothing is more frustrating to me right now either! I have a HSA plan with a $3K deductible so I'm basically paying for everything out of pocket right now. I'm high risk so I have an appt with my regular OB and an appt with the peri every month. Plus I had an NT scan and I've had blood drawn four times already. I have paid for ALL of this. I'd like to think it would all be ok once I meet my deductible (which I will do very soon at this rate) but it starts over again in January. That's right! I get to pay $3K again in January! I picked the wroooooooong time of year to get KU I guess. It also wouldn't be so bad if my premiums were low but to cover me and DH on this plan I pay around $450/month. Stupid HSA plan. I hate it!!!!!!!

I'm in the same boat....DH and I were thinking about switching to a lower deductible, but, that would make our premiums go up. I've already talked to our insurance several times to verify coverage, and at this rate, will probably know everyone at the ins company by name soon :-/

benevolentforce · September 2013

I hate this shit with a passion. I have insurance stories that boil my blood just contemplating them. Good for you for getting to the bottom of it (despite how irritating it is)!

codec · September 2013

Yenemous said:

No! Nothing is more frustrating to me right now either! I have a HSA plan with a $3K deductible so I'm basically paying for everything out of pocket right now. I'm high risk so I have an appt with my regular OB and an appt with the peri every month. Plus I had an NT scan and I've had blood drawn four times already. I have paid for ALL of this. I'd like to think it would all be ok once I meet my deductible (which I will do very soon at this rate) but it starts over again in January. That's right! I get to pay $3K again in January! I picked the wroooooooong time of year to get KU I guess. It also wouldn't be so bad if my premiums were low but to cover me and DH on this plan I pay around $450/month. Stupid HSA plan. I hate it!!!!!!!

This is us right now. We have to meet a $3000 family deductible, with only $1700 in our HSA account and after deductible our max out of pocket is only $2000. So really only $3300 total for everything. I went in to L&D fo a couple of hours and there went all the money in our HSA account. So we have to start paying with our own cash sooner than we thought.

The thing that confuses me is does it count if we make payments to the hospital, or do I have to actually pay all at once. The very sad part of all of this is that at one time I used to actually do hospital billing, lol

So confused.

map94612 · September 2013

I hate insurance stuff too! I am on an independent plan because my husband's company does not offer insurance and my company wants to charge $300 per month just for myself. I am lucky and some of my services are covered thanks to the new health care law. But my ultrasounds are not covered except for "complications of pregnancy." Well, I've had 2 ultrasounds due to bleeding and they are saying that's not a complication. I am still trying to figure it out to see if I can get it covered. I totally feel your pain!

bumpuser9058414 · September 2013

legallyginger said:

Disclaimer: I know this is probably at least somewhat my fault because I didn't call and check coverage with my insurer beforehand.

I get excellent health insurance through school, and I've double and triple checked my coverage online, and it says that prenatal care and "other maternity services" are covered at no cost to me. HOWEVER, I just got an explanation of benefits letter from my insurer saying that I'm going to be billed $423 for the blood work done during my NT scan. That is almost as much as I'm going to be paying to deliver the baby, so I thought that was completely outrageous. I went online to look at my claims, and there is a separate claim processing for the ultrasound that was done at the same hospital on the same day. That was completely covered, no cost to me.

The letter lists three charges (two for bacteriology and one for cytology, whatever that means), I'm assuming for the vials of blood they took (or maybe the claim numbers were put in wrong?). My insurance should only be billed for one of those vials in the first place, because the second was given for a study that the hospital was doing in conjunction with the medical school. I just don't understand how the NT scan itself would be covered but simple blood work wouldn't be. The letter notes that not a dime was covered for these claims, because "benefits are not available for routine services." I don't even know how to interpret that. Ugh. And of course I can't call them until tomorrow because they're only in the office til 6.

Aaaand that's my vent for the night.

I think we may have gone to the same place for testing. Women and Infants? They told me that I would not be charged for that either, and I haven't been. I say just call the insurance. Sometimes they submit things with the wrong codes. Sorry, insurance is frustrating.

TradeMama · September 2013

I have great insurance but I still got billed for the lab work for my NT.

legallyginger · September 2013

@Berry30- yep! So weird, I didn't know you were that close, haha.

I got an email response from BCBS this morning saying that the hospital submitted the claim as routine services when the type of tests are not considered routine services. So I have to wait until the hospital bills me, and if/when they do I have to call them and have them resubmit the claim with a medical diagnosis, whatever that means. At this point I don't even know who I would call at the hospital, so I guess it's a waiting game. So frustrating! I swear, at least one out of every three times I go to the doctor there is some stupid billing issue.

bumpuser9058414 · September 2013

@legallyginger, I am near New Bedford. I went to their center in Dartmouth. I've had similar insurance issues, hopefully it gets cleared up.

erind0213 · September 2013

Last pregnancy I paid $50.00 toward the NT scan/bloodwork, but I won't know for sure till I am billed.

laurendom · September 2013

It's super frustrating. I found out with DD1 that my CF screen was not covered! It cost me $600, completely ridiculous, it was standard test and my insurance felt otherwise. what a joke.

craftiemommie · September 2013

When they took my blood for the nt scan they talked specifically about how they had to use certain labs for certain insurances and it was great I had ghi because that made it easy, but I have had blood work charges in the past so I fully expect to be hit with a charge!

crystaljoanna · September 2013

Your insurance company will have a preferred lab company. Your doc and facility should have known this. Instead, most facilities have a lab they like to use. For example, I had my bloodwork done at the NT appt and the facility had a paclab employee who worked in the facility so the bloodwork would have gone there if I didn't insist on sending it to quest. My insurance only covers quest.

At my first ob appt they sent the lab work to paclab and I got a bill for $110 from the lab. I called the ob explained that my insurance isn't covering the bill and the office agreed to pay the lab bill without a problem.

Chances are your provider may have just sent the blood where they wanted without giving a thought to what your insurance company's preferred lab is.

BethSt · September 2013

Yenemous said:

No! Nothing is more frustrating to me right now either! I have a HSA plan with a $3K deductible so I'm basically paying for everything out of pocket right now. I'm high risk so I have an appt with my regular OB and an appt with the peri every month. Plus I had an NT scan and I've had blood drawn four times already. I have paid for ALL of this. I'd like to think it would all be ok once I meet my deductible (which I will do very soon at this rate) but it starts over again in January. That's right! I get to pay $3K again in January! I picked the wroooooooong time of year to get KU I guess. It also wouldn't be so bad if my premiums were low but to cover me and DH on this plan I pay around $450/month. Stupid HSA plan. I hate it!!!!!!!

I'm right there with you, it's nice that I've met my deductible for the year, but it all resets in January and I'm back at square one with the deductible. So frustrating!

Pinecone21 · September 2013

legallyginger said:
@Berry30- yep! So weird, I didn't know you were that close, haha.

I got an email response from BCBS this morning saying that the hospital submitted the claim as routine services when the type of tests are not considered routine services. So I have to wait until the hospital bills me, and if/when they do I have to call them and have them resubmit the claim with a medical diagnosis, whatever that means. At this point I don't even know who I would call at the hospital, so I guess it's a waiting game. So frustrating! I swear, at least one out of every three times I go to the doctor there is some stupid billing issue.

Most places, these tests are not routine yet, at least not in the way that other blood work is routine. Since you're not over 35, and if you have no family history of the issues they are testing for, your insurance might not cover it because they see it as medically unnecessary. Sorry.

MarineWife6713 · September 2013

We have military ins & i got a letter from the obgyn saying everything is covered 100% including a vaginal delivery, with no deductible needing to be met. Cool right? Theres gotta be a catch that i missed...
However ive also received a bill from the normal dr i went to to get the referall (military must do's >:-/) to the obgyn. They say ins rejected the claim because they do not recognize the id#.
Whaaa? Bugh. Monday will be spent on the phone.

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