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.
Stupid insurance :/
Ugh, I hate insurance! I need to vent. I am still trying to sort out all of our bills from last year. Matt is on his own insurance and I am on mine (cheaper for similar coverage).
Before Connor was born I called my insurance to verify how Connor?s hospital charges would be processed, since I didn?t intend to keep him on my plan. My insurance said they would cover him for 31 days, after that I needed to decide if he would stay on my plan or be covered under Matt?s. I had HR verify this and she got to the same conclusion that I did.
Well my insurance ultimately denied all of his hospital charges.
So, Matt?s insurance processed them instead and they questioned why my insurance didn?t pay because of the 31 day coverage. I talked to my sister who works for an insurance company and she also agreed that it was unusual that my insurance didn?t cover Connor?s hospital charges. So lot?s of back and forth, life goes on and Matt and I weren?t thrilled but accepted the fact that we were going to have to pay a $2000 bill for Connor that we weren?t expecting. (His insurance reduced it by about $1000)
Separate from that, I have put together a spreadsheet and timeline of my charges from last year, what my insurance paid, what my HRA fund paid, what my FSA paid, and what we paid out of pocket. I hit my maximum out of pocket and had been billed for and additional $350 beyond that.
I am working with my insurance and providing all of the records I kept to show them that they need to pay more (I am not the first person at my work who this has happened to). Today, I just so happened to go through some of my EOB?s online and I randomly clicked on one. What the heck?!? They reprocessed Connor?s hospital charges last week and apparently sent the hospital a check. So I call the hospital, sure enough. They got the check yesterday. Now we?re overpaid by $800 because 2 insurance companies made payments on the bill.
Yeah, so glad I saw this because I was JUST about to go online and pay $2000 that we thought we owed.
Now I have to get that all sorted out. I hate to question my insurance company and have them come back saying: ?oh yeah, shouldn?t have paid that, we?ll just take our money back now.? I am though. I asked the hospital about it and she said the insurance company could make a request for a refund next week, a year from now, or even two years from now and I DO NOT want to be in limbo wondering if we are going to eventually be responsible for that bill.
Why do insurance companies have to make things so difficult?
Re: Stupid insurance :/
Pain in the butt! Sorry you are having to deal with this.
We went through something like this with the IRS. Back and forth on we owe them, they owe us, etc, etc. I think checks changed hands 5 times over the course of a year before it got straightened out. Annoying!
Blog
I'm guessing this. Working in health care, I hate insurance companys too. I always wonder if if the people who work for them have to jump through the same hoops we all do.
Blog
CRAFTY ME
my read shelf:
What a PITA.
I have a very similar situation. Chris and the babies were on my insurance. Since I changed jobs, it was terminating 8/31. Rather than add them all to her insurance under the change of life due to policy termination (annoying to document) we added them under their birth.
Her birthday is before mine, making her insurance primary. All of their bills (upwards of $150k in billing) were initially processed through my insurance which paid. Then the insurance background process (?) realized she also had insurance and everything was reprocessed with hers as primary. Her insurance denied the birth/hospital because it wasn't precertified. You know, because the policy didn't exist...
The lazy billing lady at the neonatologist tried to get us to pay out of pocket ("I've been doing this for 20 years and you shouldn't have opened the second policy. Now no one will pay. We can put you on a payment plan". UM NO THANKS. That bill is over $17k if paid OOP. The insurance paid out like $5k under their rates. I'll pass,thanks.).
Several phone calls later, it is ALL running through both policies again with a ton of notes on our account. I get new EOBs more or less weekly for various doctors/facilities. I am not holding by breathe for this to be worked out by their birthday.
Oh god, I hope yours gets worked out! Ha, like you are going to pay out of pocket ... you are right, lazy billing lady - that's for sure! 2 policies does not mean they cancel each other out.
Oh and good point about the birthday / primary! The billing lady from the hospital asked me about that this morning. My birth month is before Matt's so mine would be primary. At least for me, the hospital and I are on the same page.
Oh and to add to the confusion with mine: our company was bought out last year. So essentially last year I had 2 employers and two insurance polices. I KNEW it was going to get screwed up so i made sure to keep everything ... I am not always so diligent about that kind of thing ("eh, toss it aside" type of mentality)
It amazes me that there are people think we don't have a problem with our healthcare and insurance system in this country. This is all so ridiculous.
Blog
Mary - I follow a few medical blogs and just from those I can only imagine the crap you have to deal with on a daily basis!
My sister worked for Humana and now works for Thrivent - so I can say with 100% certainty they are not all idiots
but the good ones are few and far between!
The over billing too, I don't think I could have made it any clearer for the insurance company: I took the records exactly from their website, combined that with the copies of the bills I received, receipts for what, when, and how I paid I showed that I met and paid my max OOP and then was billed for more than that amount. It should be pretty obvious that if my max OOP is 3750 then I shouldn't be getting billed for over 4K.
THIS
no kidding. We've spent at least 5 man hours on this issue, and heaven knows how many the insurance and billers have spent. You can't tell me this can't be done more efficiently and cost effectively under a less divided system...
Random irony: On the last EOB I bothered to open, C's insurance denied the CPR/neonatal team on the baby who went to the NICU, but paid it for the one who went to the nursery (they each got a team in the OR since they were preemies). I think we confused them by naming Baby B an A name.
oh good grief!!
This.
I know this is somewhat unrelated but I have to fight with the FSA company my work uses to get reimbursed for dental work (I have to pay OOP first, then submit the claim and then get reimbursed). This past one, I got denied b/c it said I did not submit the proper receipt showing services rendered and date of service. The statement that my dentist gave me shows ALL the work and the dates I had the work done (all this year). Nope, that is not enough information. WTF?!?