Health insurance question (non-political)

Some of the crazy insurance rules vary because of state laws.

 

I just can't see an imaging facility administering an MRI without insurance verification and authorization.
This is a failure on many levels.
1-PCP needed to submit for pre-approval.
2-Patient then receives authorization.
3-Diagnostic imaging center verifies the authorization.
This is awful.

 

Bottom line is doctors don't have the time or temperment or inclination to deal with insurance issues. That's not what they went to medical school for.

So the people in the office that do that kind of work make about $8 an hour and are busy with all the crazy insurance information that is written at a grad school level.

You've got to look out for yourself.

 

Just remembered that about 12-15 years ago I had an MRI denied because at the time I was in an HMO and the PCP (or specialist) put the wrong facility code on the referral. So although everything was according to procedure, the referral was to have the MRI done someplace else and the HMO refused to pay until I went to the doctor's office, go a corrected referral form and brought it to the MRI facility so they could resubmit it.

 

I had a $700 lab test done that I later found out wasn't covered by my plan. They took my insurance card and everything, but never bothered to tell me that that facility didn't accept my insurance. Then I got the bill.

 

If my doctor is in an approved network, ANY procedure they recommend must be covered.

If you are in a network, you know what is approved and what isn't.

I wouldn't pay one cent of a claim for a procedure done by an in-network doctor. Eventually, it will be dealt with.

 

Depends on the insurance, Simon.

You could have an in-network doctor recommending and MRI but the facility he sends you to is out of network. This happends a lot.

 

Negative. Many non-profit health care systems use banks for interest-bearing loans. Not doing so gives customers the impression that it's otherwise a lending institution, a big no-no for non-profits.

S-P, as usual, is spot-on. So many different rules for different insurance companies and, to take a step further, different for different levels of coverage within the same company. And to echo Ace, take detailed notes of who or what is considered in-network and out-of-network by your provider ... most physicians and private practices aren't jumping through those hoops for you.

There are more Bouncing Bettys to maneuver around than are still planted in Southeast Asia.

 

Or it could be like mine where it is approved, but they will only cover up to say, 80 percent of certain procedures.

 

Anyone who needs to see evidence that our health care system needs to be reformed should only have to look at this thread.

And it must be REAL reform, not the Band-Aid measures being discussed in Congress.

 

FT--I concur 100%. I am the poster child for someone with health insurance (well, it's Aetna so one must consider that), and my out of pocket costs are through the roof.

And what boggles my mind is that they don't have an agreement with UPMC, the gorilla of health insurance in Pittsburgh. I had to change nearly all of my doctors which just irritated the hell out of me. My PCP has figured out a way around them...I have no idea how, but he has.

I almost had to wait 8 weeks to have a procedure done because the doc only sees people with non-UPMC insurance one day a week (fortunately there was a cancellation).

 

We learned this the hard way, too. Labs ARE NOT affiliated with any medical network and are some of the most profitable in the industry. Low overhead, high profitability.
When you go to an outside lab for tests, chances are, YOU ARE NOT COVERED.
Unfortunately, it is explicitly spelled in your coverage manual.