Posted on: Jul 18, 2010 11:35pm
My profession has been dealing with dental insurance, have been doing it for 25 years. So dealing with my own medical insurance is a bit easy for me.
When I received a Explanation of Benefits (EOB) from my insurance, stating that they requested more information from my provider as to the treatment, I figured that that would be taken care of. When I receive that notice at work I call the insurance and find out what they need, if it is information I need to provide I send it, if the patient needs to send the info I call the patient. Well I guess the large hospitals/providers are just too busy and have the attitude that "somebody" will take care of it.
After receiving a collection call from the hospital, I realized "somebody" dropped the ball and nothing was done. I called my insurance and find out they were still waiting for the information, all they wanted was a copy of my treatment record. I then called my provider and told them what they needed and that I wanted it taken care of ASAP !
After my calls the matter was corrected but it was 3 mouths from the onset. So if you receive anything form your insurance that looks like it may deny or hold up payment, get on the phone and find out what is going on. Don't wait for "somebody" to do it.Log in to post a reply
Posts 1 - 3 (3 total)
Jun 15, 2012 08:59am Cats134 wrote:
I learned this the hard way. I had my bilateral mastectomy in December. Because of the large number of nodes that were removed (not on purpose, I was only supposed to have SNB on my right side, but ended up losing 19 nodes on my right, 9 on my left) my surgeon gave me a script for PT to start in January.
All the tests and procedures I had leading up to surgery, I called and made sure that pre-certification was received. I called my surgeon's office so often, that I was told to 'let them do their job'.
After surgery, when I was such a space cadet, the Wellness Center from my hospital called and made an appointment for me to come in and hear all these marvelous things they could do for me. I showed up, let them take me by the hand, and wanted to be 'taken care of' the way they wanted to do.
I was lead to the PT department, registered once again, all insurance info taken, and had my evaluation with my therapist. I was assured that all paper work would be forwarded to my insurance company...and dumb me, believed them.
I went twice a week for 2 months. After PT was over, I received my EOB, which stated that I was responsible for the whole bill because pre-cert was never given. I immediately contacted my therapist, who told me she had filled out the clinical evaluation form. She told me she'd look into it.
A few weeks later I received a bill from the hospital for approximately half the amount due. I 'assumed' (another dumb mistake on my part) that the hospital had rectified the issue with my insurance company. I paid the bill. A few weeks later received a bill for Feb's treatment, again half the amount. Paid that one as well.
Found out when I went to get my foobs that there was a penalty against my insurance account. But all I was told was that the amount of PT was not subtracted from my annual deductible resulting in me having to pay more for the mastectomy bras and foobs.
Fast forward to last week when I received a bill from the hospital for the remaining amount. I contacted the pt department, the billing department, and my insurance co.
I was told by my insurance company that ultimately it is the patient's responsibilty to make sure pre cert is received, no matter what the provider promises you. I asked to start an appeal process, but still haven't received the paperwork from my insurance company.
Now I have to play "listen to the crappy music" while I wait for hours, pressing so many buttons on my phone, just to get thru to a person to talk to.
I have my 6 month post op appointment with my BS next week. I'm having issues with my left arm but will not go back to that PT department if he recommends therapy.
LCIS, ALH: PBM 12/19/11: No recon. 19 R nodes, 9 L nodes, Stage 0
Jun 15, 2012 09:28am Cindyl wrote:
When it's the provider who drops the ball, you can dispute the bill. For instance if you have your eob saying the insurance company requested suchandso from the provider and they didn't provide it, you have the right to refuse to pay for their mess up. It gets messy, but a friend of mine had thousands of dollars worth of charges because the hospital didn't get stuff billed out in a timely manner and was able to get them written off because she was able to show when the charges were accrued, when they were billed and when the insurance co. request more info, etc... You have to be specific about which charges and why, but you can fight on some of this stuff.
You may end up in court, and it helps to have a lawyer friend who is willing to help out but. It may not be worth it for a small sum, but the numbers get big in a hurry in this situation.
Stay calm, have courage and watch for signs.Dx 2/11/2012, IDC, 3cm, Grade 1, 0/7 nodes, ER+/PR+, HER2-Surgery 03/01/2012 Lumpectomy (Right); Lymph Node Removal: Sentinel Lymph Node Dissection, Axillary Lymph Node Dissection (Right)Radiation Therapy 04/16/2012 ExternalHormonal Therapy 05/23/2012 Tamoxifen