A fight

I am lucky to have very good insurance.  Years ago, when I had my gallbladder out, it was supposed to be covered in full, but it was emergency and billed differently than normal–insurance denied the claim.  I ended up having to involve my employer, who quickly ensured that the bill was paid.

Because of my plan, I have to be very careful about who I see and where I go, as most In-Network things are covered 100%, but out-of-network would cause me to be 100% responsible.  As a result, during this pregnancy, I’ve spend a lot of time on the phone with the insurance company and doctor’s office billing area to ensure certain things would be covered.

When I was diagnosed with gestational diabetes, my doctor told me I had to see a nutritionist.  The insurance company said it was cover in full, no copayment.  And then I found out it was at the hospital, insurance still said it was covered in full.  I went, but still fretted a bit the bill.

A week before Lynzie was born, I got the bill.  Insurance had covered nothing and I now owed $246.  Now that isn’t a TON of money, but I was still rather pissed.  I spent my Monday calling the hospital, calling the insurance company, calling the hospital, calling the insurance company, calling the hospital, being transferred, calling the doctors office, talking with the dietician….I was so very frustrated.  It eventually came down to the fact that the codes the hospital billed under didn’t reference diabetes and the only nutrition counseling for diabetes.  I was assured that it would be re-billed with the correct codes.

Then I had Lynzie.  I didn’t even think about the bill, until about a week ago when I got a second notice.  I called the hospital again to see if they rebilled and spoke with a man who told me they hadn’t, I was responsible and that there was a note on the account that I called on the 28th and said it was billed correctly.  WHAT?  That was a Sunday and I was just being released from the hospital with Lynzie.  I am 100% sure they did not speak with me on that day.  But one good thing came of that conversation–he vaguely mentioned a secondary billing code that was on the bill to the insurance that referenced maternal diabetes.

Loaded with that info, I called the insurance company AGAIN, after explaining my situation, I was put on hold for a long, long time.  In the end, she told me that she was going to resubmit it to the claims department for processing.

Now, for some reason I don’t get statements about my claims, so I had to call back to find out what was determined.  Insurance paid $120 on the day I last called, and the rest will be written-off, so they say.  I called back to the hospital to see if they had received the payment and to ensure I owe nothing.  I’ve heard too many horror stories of things like this getting messed up.  As of today, the hospital has nothing on my account, but she said it can take several days for them to receive the payment, review the statement of benefits, agree with what was sent and post it to the account.  So now I have to call back next week.

But here’s the thing.  My parent’s don’t have insurance and a great many people don’t.  How come these people would have to pay $140 more (over twice as much) as the insurance company does?  I know it’s what is been negotiated, but man, it really screws the people who don’t have money for insurance in the first place.  I remember having this same feeling with the billed from my last hospital stay.  It’s no wonder this is such a hot topic in the political world.


One thought on “A fight

  1. YES. Our healthcare system is majorly screwed up. I’ve learned a lot about it after our insurance debacle and the whole thing is so frustrating. Good for you for staying on top of it. Good people get screwed every day because of crap like this. I hope it’s resolved soon!

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