So this sucks but you can avoid this with a simple trick. Call your insurance company first with the CPT codes for what you need done and where you plan to get it done. Your doctors office can give you the codes. They aren’t a trade secret or anything. Get diagnoses codes too if you can. Have the insurance company run the codes for you before you go. This does a couple things:
You verify everyone involved is in network (be wary of anesthesiologists)
You are getting a quote on a recorded line. The end price won’t be exact (especially is if the claim involves a hospital, fuck them, go to smaller providers whenever you can)
if you get sticker shock anyway, you can call the insurance company back on that same recorded line and say the word “misquote”. This triggers an investigation that can strengthen your appeal.
You now have evidence you can file internally with a quality of care/quality of service complaint if the provider did something shady with the billing, or with your state’s department of insurance if your insurance company is being bitchy.
Ideally, we would have single payer insurance, but we instead have a government that pays itself to make private enterprise do its job, then the shareholders in that private enterprise make sure nothing ever gets changed. -sigh-
In the mean time, if you really want to fuck them over, consider switching to health insurance company that does not have shareholders. In many states, they are legally mandated to refund any profit they make over a certain percentage at the end of the year and without shareholders, it’s harder to hide the money, which puts much more pressure on them to spend it on patient care.
United Health Care want you to believe their way is the only way to do this. They are wrong. A shareholder-free insurer still isn’t perfect but the pressures are different without the parasites.
jfk. I had to take someone to the hospital yesterday for an acute problem (which turned out ok). When leaving, after 7 hours at the hospital, I started to reach for my wallet and the lady looked at me and said wtf are you doing put it away. And the two presriptions- free instead of the usual $5 each. I laugh when those repubs call my country a “social hellscape”
Agreed. But the fact is there is a lot of money in paying for medical expenses that keep going higher and not a lot of money going to the pot that pays it out. Single payer would address all of that instantly but the rich would be unhappy so we basically have to pay a survival tax to insurance companies every month.
There are those of us in n this industry that want that changed but we don’t have as much power as the bigger companies do so the best we can do is play by their rules. :(
Any tips on finding an insurance company in your state that doesn’t have shareholders? A big part of the insurance issue is that you have to practically be an industry insider to navigate… Anything in insurance, really.
So this sucks but you can avoid this with a simple trick. Call your insurance company first with the CPT codes for what you need done and where you plan to get it done. Your doctors office can give you the codes. They aren’t a trade secret or anything. Get diagnoses codes too if you can. Have the insurance company run the codes for you before you go. This does a couple things:
Ideally, we would have single payer insurance, but we instead have a government that pays itself to make private enterprise do its job, then the shareholders in that private enterprise make sure nothing ever gets changed. -sigh-
In the mean time, if you really want to fuck them over, consider switching to health insurance company that does not have shareholders. In many states, they are legally mandated to refund any profit they make over a certain percentage at the end of the year and without shareholders, it’s harder to hide the money, which puts much more pressure on them to spend it on patient care.
United Health Care want you to believe their way is the only way to do this. They are wrong. A shareholder-free insurer still isn’t perfect but the pressures are different without the parasites.
is this seriously what you americans have to do?
Freedom isn’t free
Most of us bend over and die.
jfk. I had to take someone to the hospital yesterday for an acute problem (which turned out ok). When leaving, after 7 hours at the hospital, I started to reach for my wallet and the lady looked at me and said wtf are you doing put it away. And the two presriptions- free instead of the usual $5 each. I laugh when those repubs call my country a “social hellscape”
Yes. Everything is a fight against the rich.
The fact you have to jump through these hoops at all IS FUCKING STUPID AND ISNT HOW IT SHOULD WORK.
Agreed. But the fact is there is a lot of money in paying for medical expenses that keep going higher and not a lot of money going to the pot that pays it out. Single payer would address all of that instantly but the rich would be unhappy so we basically have to pay a survival tax to insurance companies every month.
I hate it here.
It’s like they’ve made the system so convoluted that you have to be an underwriter to receive services.
There are those of us in n this industry that want that changed but we don’t have as much power as the bigger companies do so the best we can do is play by their rules. :(
Any tips on finding an insurance company in your state that doesn’t have shareholders? A big part of the insurance issue is that you have to practically be an industry insider to navigate… Anything in insurance, really.