Insurance...seriously? Vent UPDATE

Flamingo86

So before I did acupuncture I called my insurance company and talked with them in-depth. They clearly stated that my acupuncture benefits were covered and unlimited with a $15 co-pay per session, as long as my provider was in-network. I made sure he was in-network. Now my insurance is saying I owe $70-$100 per session. Wtf? They are saying they are going to send me a bill for over $700. I'm annoyed.

How do you usually sort these things out?

UPDATE: I spoke with the insurance company and the acupuncturist (and took record of it this time). It looks like the way my visits have been coded is messing things up. My acu said that he would submit a corrected claim and that should take care of it, but he would let me know if it looked like it wouldn't before I pay for more visits. So it looks like things are okay.

PinkinProvence

Ughhh - that sucks and makes me want to cry when it happens!

First, I would get your Explanation of Benefits (EOB).  Sometimes they are available online or sometimes they are mailed to your house.  From the EOB, you will see the reason you are paying (i.e. the service is covered but you have a deductible you haven't met yet, the service is covered but you have co-insurance or the insurance company outright denied the claim.)

With that information, I would call both the acupuncturist and insurance.

Did you write down when you called and asked about the acupuncture?  If you have a date, time, name and inquiry number, you can prove that someone told you it was covered and you relied on that information.  I have a notebook that I keep all IF telephone calls I make to the insurance and doctors because you get such conflicting info.

IT IS SO FRUSTRATING!  I'm sorry

Flamingo86

PinkinProvence said:

Did you write down when you called and asked about the acupuncture?  If you have a date, time, name and inquiry number, you can prove that someone told you it was covered and you relied on that information.  I have a notebook that I keep all IF telephone calls I make to the insurance and doctors because you get such conflicting info.

I didn't do that, but that's a great idea and I will be sure to do it from now on.

I am trying to read the EOB but that part of the website is down I have to leave for work soon . When I look at the claim in detail it says the "acupuncture" part of the claim is covered but the "medical visits" part is not (the $70). Wtf. Every time I do acupuncture he talks to me for less than 5 minutes and then sticks the needles in me so I have no idea what "medical visits" is.

Either way if this is legit the person I spoke to was very unclear. We are trying to save for potentially adopting and my H and I agreed a while ago that we would not pursue fertility treatments that were not covered by insurance. This is so irritating. I'm going to call the insurance company on my lunch break and try to see what is going on.

ILoveRedVino

I know my insurance covers acupuncture for some things and not others.  Fertility is not covered.  The receptionist asked me 50 million times if I was having pain and I kept saying no -- later to find out that she was trying to give me a hint because pain is covered.

Flamingo86

ILoveRedVino said:

I know my insurance covers acupuncture for some things and not others.  Fertility is not covered.  The receptionist asked me 50 million times if I was having pain and I kept saying no -- later to find out that she was trying to give me a hint because pain is covered.

I thought of this too, but I'm a little confused b/c my acupuncturist only does fertility and he is a preferred provider.

Uptowngirl2009

I really hate insurance. I'm sorry Hope you get it sorted out!

ecinereb

Hope you can get this all sorted out!

seahorse01

I am glad things are working out!

ecinereb

Glad they are getting things sorted out for you!

LuckyAngel07

So glad it got sorted out! I hate that there are so many ways to code things, making it all too easy to have something submitted under the wrong code for you and causing these kinds of headaches.