Thursday, December 31, 2015

Latest health insurance company game


Yesterday, I phoned the rehab center at our local hospital, where my other DS and I currently receive services, to schedule some PT sessions for unstable knee DS. Long story short, the receptionist advised me that as of Jan 1 2016, although the hospital in an in network provider, as are the therapists, the third party entity that processes OT/PT claims is changing to a new one, and this new company (B) is not in network with my insurance. HUH?

Absolutely zero communication on this. I e-mailed my liaison at our major US health ins. company; I await a reply. I PM'd my union president, who also was unaware, and has forwarded this on to our union lawyer. @@ More games.

THREE of us have appointments on Tues, which could translate into higher out of pocket costs for us. Sigh . . ins. is so frustrating.


Florence said...

Oh it is always something with the insurance companies! My latest wrangle is that while they paid for my mammogram, they turned down the radiologist who read the mammogram. Sheesh!!

Marcia in rural WNY said...

These sorts of games are becoming more and more prevalent. I pity the people who are mentally unable to keep up with them, and are undoubtedly paying more than they should be for their ignorance. I have a questionable charge on my Mastercard bill this month--apparently for some sort of computer service that neither DH nor I subscribed to--this one not medically related, but where does it stop? I practically need a secretary myself, and both my daughter and I have medical billing experience, and some idea of how things should be done.

It's very disheartening. I belong to an online retirees group from my former employer--they are still attempting to take away benefits from the various contracts under which we retired---supposedly unchanging after retirement!! We are fighting (via lawsuit) for medical benefits taken from us once and people due to retire soon have been filing papers like mad the past couple weeks as new contract offers are being voted on next week, and they need to file in order to retire under the current benefits! It's been a steady erosion of benefits, some of which I understand, but overall the company always wins!! They act first and if no one complains, they get away with it. This is particularly successful if there is a back pay issue (and there is ALWAYS a back pay issue) and the newer employees just vote FOR the new contract in order to get the lump sum payment.

In the last contract, our co-pays changed, and I have yet to figure out exactly the basis for determining which drugs are in which tier. Since my co-pay actually dropped on my generic drugs, I'm reluctant to ask too many questions, although I'm pretty sure I could get a straight answer by calling the insurance company. My co-pay is almost embarrassingly low, so I hate to make any fuss. The lady in front of me at the pharmacy yesterday was NOT paying something like $138 for a prescription that had previously been $15 or something like that. She preferred to see if her doctor could order a cheaper drug. And that's what is happening--people aren't getting the optimum drug because it costs too much. Even when I had my cataract surgery recently--doctor told me to pick up an OTC eye drop for swelling---it cost $30 for half an ounce!! I'm saving the rest in case I need to use it again when I have the second one done--postponed due to the illness I had in November.

It just seems like there is no end to the troubles and the need to oversee every doctor's offices' every move!! 4