Trouble in Paradise
Damik
member
Dear Community,
Our tech team has launched updates to The Nest today. As a result of these updates, members of the Nest Community will need to change their password in order to continue participating in the community. In addition, The Nest community member's avatars will be replaced with generic default avatars. If you wish to revert to your original avatar, you will need to re-upload it via The Nest.
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Thank you.
Note: This only affects The Nest's community members and will not affect members on The Bump or The Knot.
Our tech team has launched updates to The Nest today. As a result of these updates, members of the Nest Community will need to change their password in order to continue participating in the community. In addition, The Nest community member's avatars will be replaced with generic default avatars. If you wish to revert to your original avatar, you will need to re-upload it via The Nest.
If you have questions about this, please email help@theknot.com.
Thank you.
Note: This only affects The Nest's community members and will not affect members on The Bump or The Knot.
Update on my hateful insurance
Just got a bill in the mail, they are refusing to pay for the last time I went inpatient. We owe $42.388.00.
Wonderful.
Re: Update on my hateful insurance
Well that's fvcking horseshit!
That is grade A stinkin' Horseshyt. I am so sorry. Am I reading that right, 42K?!
Is there anyone lurking that works with insurance that can give her some info for this? Its a load of shyt.
I'm so sorry Damik.
I might be able to help but I'm going to need more information. Can you tell me about your coverage? Did they say anything about why it was denied? I would start with a call to your insurance company.
Damik you can PM me if you don't want to put that kind of info out there.
Married 10/24/09
BFP #1 5/20/11 ... M/C confirmed and D&C 6/28/11
Dx: LPD - 2 TI clomid cyclels & 2 clomid IUI cycles = BFN
BFP #2 6/29/12!!!!... Beta #1 - 70... Beta #2 - 164
They are just saying it wasn't pre-authorized. Which is horse hockey because we called them before I went in. It was an in network hospital. I went to a different hospital then I did with the one they covered last time.
I have no idea what is going on with them. We've been with them for a little over a year and they have paid for less than half the claims. I'm going to call them tomorrow and DH is going to raise a fuss with his HR. In the past it's been a few hundred here or there and I've resignedly paid it, but this is an unfathomable amount.
Call the insurance company, then the hospital. It is possible that something was coded incorrectly. Ask the hospital for help, keep asking for someone higher up in the billing department until you get it.
Married 10/24/09
BFP #1 5/20/11 ... M/C confirmed and D&C 6/28/11
Dx: LPD - 2 TI clomid cyclels & 2 clomid IUI cycles = BFN
BFP #2 6/29/12!!!!... Beta #1 - 70... Beta #2 - 164
Hold the phone here....
Pay NOTHING.
Keep on these people and keep at it; document every conversation you have had with them, the facility and evey other Tom, D!ck and Harry that's involved in this fiasco.
Pay NOTHING.
If you get threats or nonsense or bull, call legal aid and see about getting an attorney.
you might also speak to the social worker at the hospital, along with the patient advocate --- let them know what your story is and what has been happening. A patient advocate is there to go to bat for you, the patient.
Sometimes ginormous bills get through the cracks while insurance and other entities are still processing their paperwork. I got a bill for an ER visit last year and I called; I was not supposed to pay it -- it was a glitch on the insurance carrier's end.
This could be a keypunch error, a misidentified invoice (maybe this bill is for another patient and the bill is not for you and your name somehow got on it due to error) or a mistranscription; maybe you owe nothing, or a lot less. Keep at them. Don't give up.
Oh, Dami. This is the last thing you want to have to deal with right now.
FIGHT FIGHT FIGHT!!
Then whoever told her that it was okay should have told her that in the first place. Before I had DS, I called the insurance company to make sure all of my ducks were in a row, and it was fine.
The insurance company should have said "Hold the phone, we need to talk to a doctor."
FIGHT DAMIK!
Call the hospital. They should have identified that it was not authorized (within a day or two) and have called and gotten it authorized. PAY NOTHING, call the hospital, and let them call the insurance company and argue with them.
If it's a covered benefit and you just didn't get it pre-authorized, usually you just pay a penalty (like $400 or so), you aren't penalized by having to pay the whole thing.
Definitely raise a ruckus with the insurance company and HR. And don't pay anything.
As someone else said, it may just be a delay in processing paperwork. Don't freak out!
((hugs))
Lurker here....
I am Certified Professional Coder and have worked the ins side of healthcare as well. That being said most insurance companies will accept a retro authorization with a letter of medical neccessity from the physician's office. Contrary to popular belief it is not the Drs responsibility to obtain prior auth (even though most will). I would absolutel appeal this and not pay one dime. Especially if it is a covered benefit. GL!
Oh, Danie... that sucks!
Definitely fight that. Send everything from the past year with your H when he goes to his HR meeting.
Hopefully it's just a keying error, a delayed pre-auth or the claim is just delayed in processing.
Your H's HR will be able to help you guys fight this. Don't give up. I really doubt you guys will be responsible for that nonsense.
http://pandce.proboards.com/index.cgi#general
Ditto this!!!
*shakes angry fist at insurance company*
First, take a deep breath.
Next, call the insurance company first thing Monday morning and ask them why exactly this was not covered. You should have received a letter from them if it was truly pre-authorized correctly before the procedure. Do you have one of those? Bear in mind, a pre-authorization does not mean that they will automatically pay for the service, but it could avoid the penalty.
You can always appeal. Talk to your hospital billing office too. See what they say. If worse comes to worse and insurance won't budge, hospitals will often drastically reduce your debt if you come up with a plausible payment plan with them.
Above all, try and stay calm with anyone you're on the phone with. If people at either the hospital or insurance get defensive, they won't WANT to help you. You want someone to WANT to help you.
As a side note, I recently went through four months of trying to get a claim paid. Evidently, the insurance didn't get all the clinicals to preauthorize a procedure, so they denied the whole thing. I got my MD office to resend the clinicals and my insurance to do a retro-review. The claim was paid, but they applied a $200 penalty to my portion for not getting it preauthorized. My MD office ended up waiving the fee as a courtesy. The key was, I was patient and I never got frustrated with anyone. I kept my calm each time I was on the phone with someone. I left the venting for my husband to hear.