Utterly insane. It aggravates the heck out me when I am dealing with a total lack of basic common sense.
Boo has to get feeding tube supplies monthly. Has for years. The most pricey part of it is the bags - like IV bags. Have to use 1 per day (impossible to clean out formula from many feet of tubing). So our ins co has been adopting the reject reject reject strategy lately (unusual for them). Latest bologna excuse is that Boo's maxed out medication/surg supply benefit for the year - there is no max on medication/surg supplies. So whatever, called them and asked them to reprocess the claim for the fourth time.
But here's where the real insanity comes in. We have a PPO, and there's not a chance in Hades I'm ordering from their participating provider again until this last claim gets paid. The participating provider charges... sit down for this... $1690 per *month* for these bags. The negotiated fee is $195, so the provider writes off the difference and our ins co pays 80% of the $195 until we meet our stop loss, which we do every year with- him, and then they pay 100% of it.
So I pop on to good old Amazon and find the identical bags for, catch this, $150. Yep, less than 10% of what the preferred provider would charge me if I had no insurance and $40 less than the negotiated rate our insurance co pays. by the way, bags have arrived and actually are identical, plus they got here in 2 days.
So, because I try to be economical, I ask ins co if they will pay the significantly lower rate for these bags at preferred provider rates. They say no, they will only pay as a nonparticipating provider (which means a $900 deductible first and then they would pay only 60%). So I call husband's employer (huge international corporation that is self insured, ins co just administers). Could not have been more unhelpful, punted me back to ins co. So I call ins co again.... well, you can imagine how that went. I finally in frustration put it in the bluntest of terms.... Ins co would much rather pay more $$$ to someone they have a "contract" with- than pay a cheaper provider who they don't have a contract with without burying us in a hole of medical debt because we would have to pick up the nonparticipating deductible/copay/stop loss. They would save $ not only by paying less for the actual service, but also because that would mean we would hit our stop loss later in the year meaning they'd have to pay less claims at 100%. They would save roughly $400/yr. Granted, that's probably nothing to them, but still, a savings is a savings.
So I told this ridiculous woman who couldn't stop harping on and on about contracts that fine, we'd just keep on ordering the more expensive supplies and they could just keep paying more than they have to.
It's just ridiculous. Honestly, they ought to let people who actually have to make ends meet administer these plans.
Stepping down now, LOL.
Boo has to get feeding tube supplies monthly. Has for years. The most pricey part of it is the bags - like IV bags. Have to use 1 per day (impossible to clean out formula from many feet of tubing). So our ins co has been adopting the reject reject reject strategy lately (unusual for them). Latest bologna excuse is that Boo's maxed out medication/surg supply benefit for the year - there is no max on medication/surg supplies. So whatever, called them and asked them to reprocess the claim for the fourth time.
But here's where the real insanity comes in. We have a PPO, and there's not a chance in Hades I'm ordering from their participating provider again until this last claim gets paid. The participating provider charges... sit down for this... $1690 per *month* for these bags. The negotiated fee is $195, so the provider writes off the difference and our ins co pays 80% of the $195 until we meet our stop loss, which we do every year with- him, and then they pay 100% of it.
So I pop on to good old Amazon and find the identical bags for, catch this, $150. Yep, less than 10% of what the preferred provider would charge me if I had no insurance and $40 less than the negotiated rate our insurance co pays. by the way, bags have arrived and actually are identical, plus they got here in 2 days.
So, because I try to be economical, I ask ins co if they will pay the significantly lower rate for these bags at preferred provider rates. They say no, they will only pay as a nonparticipating provider (which means a $900 deductible first and then they would pay only 60%). So I call husband's employer (huge international corporation that is self insured, ins co just administers). Could not have been more unhelpful, punted me back to ins co. So I call ins co again.... well, you can imagine how that went. I finally in frustration put it in the bluntest of terms.... Ins co would much rather pay more $$$ to someone they have a "contract" with- than pay a cheaper provider who they don't have a contract with without burying us in a hole of medical debt because we would have to pick up the nonparticipating deductible/copay/stop loss. They would save $ not only by paying less for the actual service, but also because that would mean we would hit our stop loss later in the year meaning they'd have to pay less claims at 100%. They would save roughly $400/yr. Granted, that's probably nothing to them, but still, a savings is a savings.
So I told this ridiculous woman who couldn't stop harping on and on about contracts that fine, we'd just keep on ordering the more expensive supplies and they could just keep paying more than they have to.
It's just ridiculous. Honestly, they ought to let people who actually have to make ends meet administer these plans.
Stepping down now, LOL.