General Your Health Care Headache

Huntn

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Ever since we moved to Texas, we have been running into doctor offices who try to charge up front for their services. Here is the issue, about 40% of the time they either don't know what their actual cut will be after insurance makes it's adjustment, or they have inaccurate data (not to mention thousands of different varying levels of coverage), or they are trying to get money out of their patients upfront. I understand the reason. In Texas there is a high % of uninsured, and I imagine quite often they end up eating their bill. But Insurance should be different, yes? Unfortunately the in-network contracts these offices sign, allow them to collect up front. But it's the patient's right, and pain in their butts to verify what is being asked up front is accurate. :mad:

Here is an example. My wife's colonoscopy is scheduled for Monday morning. We get a call from XXX Colonoscopy Center saying we owe $1049 upfront. I call UHC and they say it’s covered. I call XXX back and they say the code the Dr sent is not covered as preventative. I call Dr ZZZ's office and they say it’s a disagnostic code, not a preventative code because she had polyps last time, which is not covered. I call UHC who tells me it does not matter what the code is, colonoscopies are covered, 1 per year at 100%. Tomorrow morning, Friday, we have to do a conference code with Dr ZZZ’s office. This represented 5 phone calls with me on the phone for over an hour and more time tomorrow. 🤬

Here is the inconvenience. If they submitted a claim up front, I would not worry about it because I can check with the Insurance Company at my leisure and get the right amount to pay. If they expect payment as you walk in, and I tell them no I'm not going to give you $1049, then they will not do the procedure.
 
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SuperMatt

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Ever since we moved to Texas, we have been running into doctor offices who try to charge up front for their services. Here is the issue, about 40% they don't know what their actual cut will be after insurance makes it's adjustment. I understand the reason. In Texas there is a high % of uninsured, and I imagine quite often they end up eating their bill. But Insurance should be different, yes? Unfortunately the in-network contracts these offices sign, allow them to collect up front. But it's the patient's right, and pain in their butts to verify what is being asked up front is accurate. :mad:

Here is an example. My wife's colonoscopy is scheduled for Monday morning. We get a call from XXX Colonoscopy Center saying we owe $1049 upfront. I call UHC and they say it’s covered. I call XXX back and they say the code the Dr sent is not covered as preventative. I call Dr ZZZ's office and they say it’s a disagnostic code, not a preventative code because she had polyps last time, which is not covered. I call UHC who tells me it does not matter what the code is, colonoscopies are covered, 1 per year at 100%. Tomorrow morning, Friday, we have to do a conference code with Dr ZZZ’s office. This represented 5 phone calls with me on the phone for over an hour and more time tomorrow. 🤬

Here is the inconvenience if they submitted a claim up front, I would not worry about it because I can check with the Insurance Company at my leisure and get the right amount to pay. If they expect payment as you walk in, and I tell them no I'm not going to give you $1049, then they will not do the procedure.
This is complete BS. We have an entire political party united to keep this system going no matter what. I think that can only be explained by donations to that party from those profiting off it.

The insurance company seems to do everything they can to avoid paying out, so the doctors and hospitals are pressuring patients to pay up front. What a f-ing great system we have in America.
 
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Ever since we moved to Texas, we have been running into doctor offices who try to charge up front for their services. Here is the issue, about 40% they don't know what their actual cut will be after insurance makes it's adjustment. I understand the reason. In Texas there is a high % of uninsured, and I imagine quite often they end up eating their bill. But Insurance should be different, yes? Unfortunately the in-network contracts these offices sign, allow them to collect up front. But it's the patient's right, and pain in their butts to verify what is being asked up front is accurate. :mad:

Here is an example. My wife's colonoscopy is scheduled for Monday morning. We get a call from XXX Colonoscopy Center saying we owe $1049 upfront. I call UHC and they say it’s covered. I call XXX back and they say the code the Dr sent is not covered as preventative. I call Dr ZZZ's office and they say it’s a disagnostic code, not a preventative code because she had polyps last time, which is not covered. I call UHC who tells me it does not matter what the code is, colonoscopies are covered, 1 per year at 100%. Tomorrow morning, Friday, we have to do a conference code with Dr ZZZ’s office. This represented 5 phone calls with me on the phone for over an hour and more time tomorrow. 🤬

Here is the inconvenience if they submitted a claim up front, I would not worry about it because I can check with the Insurance Company at my leisure and get the right amount to pay. If they expect payment as you walk in, and I tell them no I'm not going to give you $1049, then they will not do the procedure.
This sounds fishy... I've never seen or heard of anything like this...
 

Huntn

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This sounds fishy... I've never seen or heard of anything like this...
I had not heard of this until I moved to... Texas. And it is allowed in the contracts health providers write up for their in-network providers. In Minnesota, everything was billed after it ran through insurance.
 

Alli

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I had not heard of this until I moved to... Texas. And it is allowed in the contracts health providers write up for their in-network providers. In Minnesota, everything was billed after it ran through insurance.
That’s even how they do it in Alabackwards. Texas has really hit rock bottom.
 

ronntaylor

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Something similar happened to us a few years ago. My primary doc suggested I get a colonoscopy early due to family history. Set up the appointment, got his authorization letter settled and show up for a prescreening to be told that we had to pay $1K+ before the actual colonoscopy and that if we didn't follow through, the prescreening would not be covered. Totally ridiculous and enraging. Took several calls, including a couple three-ways and we finally gave in and paid in advance.

Took several months to sort it all out later and to get fully reimbursed. We were more worried about the damn bill and how it nearly screwed up our coverage year for regular doc visits and procedures. Got a clean bill of health and everything sorted out for a 2nd colonoscopy years later.

Hearing from family members and good friends, it appears that there's a 50/50 chance you'll be screwed if you need a colonoscopy. A cousin skipped his because of all the BS involved.
 

Huntn

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Given everything else going on in the state, I’d bet the hospitals and insurers have the Texas legislature wrapped around their little finger—even more so than in most states. I sure wouldn’t bet on regulatory relief anytime soon.
Here is the thing as I understand it, we’ve had UHC for several decades including when we lived in Minnesota full time. There was a 2 year period where we were splitting our time between Texas and Minnesota and that was when they, when I first ran into this collect up front, that United Health Care told me that was in their rights, written into the contracts which I assume applies to all of their in-network providers, not just Texas, but I’ve not verified that. The real issue is that a significant portion of the time they are wrong and they over collect because whatever they are looking at is not accurate or they are lazy or are trying to scam us. 🤬

This case with the colonoscopy is the most egregious. I’m getting ready to do a conference call between me, the insurance company and the Dr. Office.
 

tobefirst

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My biggest healthcare headache was around 15 years ago now. I worked for a hospital at the time and had to have surgery on my knee. I found out later that the anesthesiologist working that day – at the hospital where I was employed, mind you – was out of network and I received a, I think, $1500 bill from the anesthesiologist. After calling his office, and my insurance, and writing a letter explaining that I did not have the option to *choose* an anesthesiologist that was in network, eventually the bill was waived or covered or something.

While working there, it was a constant concern of whether anything I had done would be covered? Hey, doc, where are you sending those labs? Can I take the paperwork for all of this with me instead of you submitting it?
 

ronntaylor

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The real issue is that a significant portion of the time they are wrong and they over collect because whatever they are looking at is not accurate or they are lazy or are trying to scam us.
I absolutely hated UHC the last few years we had them. Never had an issue, then it changed almost overnight. We had separate accounts and then combined into a family account once we got married. And then the BS started. Was so glad when the University switched carriers and we didn't have to deal with the extortionate practices. I truly believe their aim is to dissuade people from certain procedures as a way to save costs. Of course, it may cost lives given early detection is best and forcing people to pay upfront is devilish.
 

Herdfan

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I absolutely hated UHC the last few years we had them.

We have 2 options in the ACA network, BCBS and CareSource. But recently billboards have been showing up touting UHC being a different "Blue". So I looked when I was renewing my coverage. What they were offering was a joke. It was written by their Golden Rule subsidiary and it even states that some policies don't meet the ACA minimum coverages. Not sure why they are even bothering.
 

Huntn

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I absolutely hated UHC the last few years we had them. Never had an issue, then it changed almost overnight. We had separate accounts and then combined into a family account once we got married. And then the BS started. Was so glad when the University switched carriers and we didn't have to deal with the extortionate practices. I truly believe their aim is to dissuade people from certain procedures as a way to save costs. Of course, it may cost lives given early detection is best and forcing people to pay upfront is devilish.
I’m good with UHC as they are the most competent element of the health system I deal with regularly. That said I’m looking forward to my wife hitting 65 and Medicare+ my Secondary coverage will be a substantial cost savings Over the $600 a month she pays just to have coverage with a $5500 annual deductible. 👀
 

Huntn

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Ever since we moved to Texas, we have been running into doctor offices who try to charge up front for their services. Here is the issue, about 40% of the time they either don't know what their actual cut will be after insurance makes it's adjustment, or they have inaccurate data (not to mention thousands of different varying levels of coverage), or they are trying to get money out of their patients upfront. I understand the reason. In Texas there is a high % of uninsured, and I imagine quite often they end up eating their bill. But Insurance should be different, yes? Unfortunately the in-network contracts these offices sign, allow them to collect up front. But it's the patient's right, and pain in their butts to verify what is being asked up front is accurate. :mad:

Here is an example. My wife's colonoscopy is scheduled for Monday morning. We get a call from XXX Colonoscopy Center saying we owe $1049 upfront. I call UHC and they say it’s covered. I call XXX back and they say the code the Dr sent is not covered as preventative. I call Dr ZZZ's office and they say it’s a disagnostic code, not a preventative code because she had polyps last time, which is not covered. I call UHC who tells me it does not matter what the code is, colonoscopies are covered, 1 per year at 100%. Tomorrow morning, Friday, we have to do a conference code with Dr ZZZ’s office. This represented 5 phone calls with me on the phone for over an hour and more time tomorrow. 🤬

Here is the inconvenience. If they submitted a claim up front, I would not worry about it because I can check with the Insurance Company at my leisure and get the right amount to pay. If they expect payment as you walk in, and I tell them no I'm not going to give you $1049, then they will not do the procedure.
Four more calls today, left 4 messages because no one picked up, and no return calls from the Clinic. I ended up calling the Clinic and asked to talk to who was in charge. I spoke with the business office manager. I told her that the person handling billing had gotten at least 3 phone calls and yet I had not heard back from her and that if it was not resolved by today I would be canceling the procedure for Monday morning.

How hard can it frick’n be? The insurance company says it’s covered. How many times exactly do they have to say it?? Based on past experience I assume some level of incompetence or dishonesty.

The business officer manger called me back in 40 min, resolved. :unsure:
 

Huntn

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We have 2 options in the ACA network, BCBS and CareSource. But recently billboards have been showing up touting UHC being a different "Blue". So I looked when I was renewing my coverage. What they were offering was a joke. It was written by their Golden Rule subsidiary and it even states that some policies don't meet the ACA minimum coverages. Not sure why they are even bothering.
I can only speak for the UHC plans I have seen.
 

Thomas Veil

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Years ago before Rachel Maddow, Keith Olbermann (who had her time slot) used to regularly go after United Health Care. The stories he told of denied coverage and byzantine red tape sounded much like the stories you guys are telling. So this surprises me not.
 
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Years ago before Rachel Maddow, Keith Olbermann (who had her time slot) used to regularly go after United Health Care. The stories he told of denied coverage and byzantine red tape sounded much like the stories you guys are telling. So this surprises me not.
Most of my headaches came from that company too with their ****** preapproval processes.
 

ronntaylor

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Had a medical appointment today and of course it went south from the very first seconds. Scheduled for 8 a.m., have to arrive at 7:30 a.m. I got there a few minutes early. Go straight to the department and the cretin at the desk practically yelled "Name." No "Hello" "Hiyadoin'?" Nada. Gave my name and before she did anything else she asked for my prescription (still can't wrap my brain around a test needing a 'script, but whatever). Informed her that everything was taken care of as I was solo and didn't want to carry anything. I filled out all forms online, including Pre-check, Check-in, and COVID screening. Even paid deductible. She insisted that I had to have a paper script. I asked her to try looking in her computer as So&So took the info and assured all was set.

She wouldn't budge. So I just stood there. I was not going to leave and I was not going to go ballistic. Her co-worker came in and saw us just staring at each other. She intervened, asking me to have a seat. Unfortunately for Miss Cheerful, her co-worker said loud enough for me to hear: "Everything was completed. He's right." She came out and told me to sit in the other room and wait for my name to be called.

The procedure took about five minutes, including the time walking to the section and finishing the procedure. Why fill out form after form and pay your deductible beforehand and yet still have to fill out 2-5 pages and wait half an hour (if you're seen on time) for such a quick check over?! This is why I resist 2nd opinions and try to avoid "Let's just see" procedures. 9/10 it's a waste of time and money, and usually aggravating.

So pissed I totally forgot to go to CVS to get a flu shot. Going as early as possible tomorrow. It'll be my luck that they're out or it's crowded.
 
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Had a medical appointment today and of course it went south from the very first seconds. Scheduled for 8 a.m., have to arrive at 7:30 a.m. I got there a few minutes early. Go straight to the department and the cretin at the desk practically yelled "Name." No "Hello" "Hiyadoin'?" Nada. Gave my name and before she did anything else she asked for my prescription (still can't wrap my brain around a test needing a 'script, but whatever). Informed her that everything was taken care of as I was solo and didn't want to carry anything. I filled out all forms online, including Pre-check, Check-in, and COVID screening. Even paid deductible. She insisted that I had to have a paper script. I asked her to try looking in her computer as So&So took the info and assured all was set.

She wouldn't budge. So I just stood there. I was not going to leave and I was not going to go ballistic. Her co-worker came in and saw us just staring at each other. She intervened, asking me to have a seat. Unfortunately for Miss Cheerful, her co-worker said loud enough for me to hear: "Everything was completed. He's right." She came out and told me to sit in the other room and wait for my name to be called.

The procedure took about five minutes, including the time walking to the section and finishing the procedure. Why fill out form after form and pay your deductible beforehand and yet still have to fill out 2-5 pages and wait half an hour (if you're seen on time) for such a quick check over?! This is why I resist 2nd opinions and try to avoid "Let's just see" procedures. 9/10 it's a waste of time and money, and usually aggravating.

So pissed I totally forgot to go to CVS to get a flu shot. Going as early as possible tomorrow. It'll be my luck that they're out or it's crowded.
Nothing's more frustrating than bad front desk. You can be as professional, well-prepared and compassionate as you can be, if front desk pisses patients off before they get to see you, it's almost all for nothing.
 

Huntn

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Years ago before Rachel Maddow, Keith Olbermann (who had her time slot) used to regularly go after United Health Care. The stories he told of denied coverage and byzantine red tape sounded much like the stories you guys are telling. So this surprises me not.

Most of my headaches came from that company too with their ****** preapproval processes.
I’m not defending UHC in your examples. I just know in my example they were the reasonable party, who were proactive and helpful. :) And over the decades I’ve never been mad at them, they have never given me a reason to be angry, go figure, other than my wife’s insurance is $600 a month, where when I was a active employee, it was $600 a month for both of us. :unsure:
 

Herdfan

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Unfortunately, nowadays, everyone wants to earn as much as possible. So now, when you go to the hospital, the doctors will give you as many examinations as possible. Of course, this is good for you, but you will have to pay a lot more because of this. Therefore, it is important to take care of your health yourself to ask for help from doctors as little as possible. To take care of yourself, you need to know what you use and how these substances affect your health.

Is it revenue based on fear of lawsuit based because they missed something that an additional test might have revealed?
 
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