Discussion in 'The Watercooler' started by gcvmom, Feb 18, 2009.

  1. gcvmom

    gcvmom Here we go again!

    We never stopped to consider that the sleep center husband's GP sent him to might not be in network. :ashamed:

    I got the EOB yesterday and OUR share of the bill is $1,500! And that doesn't include the machine he has! :surprise:

    Which meeeeaaaans..... we're in for a similar financial whammy with difficult child 2's recent test. :sick:

    I was supposed to go in today for the followup for difficult child 2, but easy child is sick. I don't think we'll be buying a machine for him right away, even if it turns out he needs it. I guess I'll be hunting down a brick wall to bang my head against today...
  2. totoro

    totoro Mom? What's a GFG?

    I hate that!!!
    We just had the same thing happen with husband's allergy testing... almost all of it was covered except for oh, about 1500.00$ !!! We wouldn't have done it either if we had known!

    Half the times they (insurance co.) can't answer your questions anyway!
    I am sorry, that just stinks
  3. WhymeMom?

    WhymeMom? No real answers to life..

    I thought one of the first questions any medical place asked was what is your insurance company? I guess maybe they do, but then don't inform you of what is covered? Bummer, guess I would see if you could work something out..... hate to send back the machine if it's working........ yikes.......
  4. gcvmom

    gcvmom Here we go again!

    I spoke with the billing manager at the sleep center this morning. She said not to panic about the number on the EOB because they do not penalize for what's not covered by insurance. She said to wait until we got the actual invoice from their office, and that it should be less than what's on the EOB. The $1,500 is just the doctor's portion. That isn't even the amount for the study itself! Or the machine!

    She was actually pretty funny about it -- she said, "Yup, you are personally financing the stimulus plan for the nation!" :p
  5. Star*

    Star* call 911........call 911

    Sends a nice floral Vera Bradley material head cushion and matching butt cushion for when it goes the other way and kicking ensues.

    Hugs.....and Helmets
  6. susiestar

    susiestar Roll With It

    I am sorry. I hope they give a really good discount. Are there ANY sleep study centers on your insurance? If it is a medically necessary test and there isn't a place near you that does it you may be able to get the insurance to cover it as in-network. It couldn't hurt to ask, could it?
  7. mstang67chic

    mstang67chic Going Green

    That definately hoovers. I would think they would have told you that when you gave them your insurance info. But...like the lady said....wait to see I guess.

    Star...don't buy that yet! The wife of one of the guys at work is employed at VB...I maybe could get you a discount! LOL
  8. Andy

    Andy Active Member

    Try a formal appeal. If you can show that 1. Doctor referred you, and 2. There is not a sleep center any closer you just MIGHT have a chance. difficult child's psychiatric hospital was paid by our insurance because there is not another child's psychiatric hospital within a certain mileage from difficult child's doctor that is in network.

    I have heard that insurance a lot of times will automatically deny claims and only pay those who are appealed because how many people bother to even try to appeal?

    I hate that many medical facilities are refusing to look into coverage up front. They expect you to know your policy. The problem is that you do not know the terminology to use to check your coverage for many things.

    I work at a facility that is an IMD facility. About the ONLY IMD Chemical Dependency facility there is out there. We are learning that when we call the insurance of a client for benefits, if we do not specify that we are IMD, the company will approve coverage and later when they find out then take the money back. It was something we were unaware of and will be adding to our terminology when calling in the future. We were not being fraudulant, we just didn't know that info was another criteria to not be met. UGH!!!!

    Many companies also look up coverage via diagnostic codes. I barely know how to pronounce or remember the name of something let alone know what code the medical world has given it.

    So, ask the sleep center to help you appeal this.
  9. gcvmom

    gcvmom Here we go again!

    Andy, turns out insurance did cover the test itself, picked up $3100 of the $3500 -- but the DOCTOR'S charge to analyze the data is what they're shifting the majority of payment for over to us. I'm going to try to just sit tight until I get an actual invoice and the I'll go from there.

    My brother in law (the one who just had the melanoma surgery) is a type of insurance advocate. People hire him to negotiate lower payments for stuff like this (mostly people who are cash patients with a hefty hospital bill and already wealthy since he gets a percentage of whatever he saves you off your bill). Anyway, his point is that everything is negotiable. So we'll wait and see what happens.
  10. TerryJ2

    TerryJ2 Well-Known Member

    Whew! My heart was racing there for a minute!
    I'm glad you got part of it straightened out.
    "Negotiable" is the operative word. :)