Insurance Companies Suck
Yesterday I got a letter from my HMO indicating that they would not be paying for the MRI/MRA I had done last month until they got further documentation from my doctor as to the exact nature of injury, prior treatment, etc. This just sucks. The bill is approximately $4000. Why it cost that much is a mystery to me. I sat in that closed machine for like maybe 30 minutes maximum. What sucks is that even if they do end up agreeing to pay some of it, I’ll probably have to pony up a good chunk of change. Goodness, I hate PPOs. I know a lot people have problems with HMOs but I miss the one I had. Ok, sure I didn’t have to battle with them since I haven’t really been sick, but I never had this much trouble getting bills paid. As long as my doctor wrote a referral, they always processed right away. Being in a PPO I sometimes feel like I’m just paying for the right to go to the doctor. There is no real discount for paying into the system all these years without taking much out. Goodness! Here’s hoping my PPO provider comes to their senses and pays this bill.
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August 15, 2003 at 10:27 am
san
I’ll tip in my two cents on a strategy that worked for me one time. I got a similar notice from my health carrier about not having enough documentation — for a renal work-up, so not cheap. Called the nephrologist’s office and had them send everything they had to the insurance carrier. Then I got a bill stating that my insurance would only pay roughly 60% of the claim. So I called the carrier and asked them why, since they were supposed to pay 100 percent less flat-rate copay (about $20). They told me it was because the prices for various tests performed by the doctor were outside their cost guidelines. I confirmed that the specialist was indeed on my health plan. He was. Then I asked the insurance rep if they didn’t contractually negotiate rates and costs with their participating physicians and specialists. She said they did. So I told her that since the insurance carrier had a binding agreement with the physician, the problem was between them and had nothing to do with me. I got a notice about a month later indicating that the bill — downward adjusted by the doctor by about 20 percent — had been paid in full.
Of course, this method may or may not work depending on how your insurance carrier negotiates with plan participants, but it’s worth a shot.
August 14, 2003 at 11:38 am
Toonces
I would call the PPO and ask what they need…I would not be surprised if the MRI place did not submit the prescription to the PPO and that is what was missing.
August 14, 2003 at 11:31 am
Ursula
Thanks for the feedback. But I submited a copy of the MRI prescription to company doing the MRI and I’m sure they submitted it to my PPO. Heck, I had to fax the darn thing before I went on the appointment. That’s why I was really surprised that they are asking for additional documentation. Oh well, I’ll just take a wait and see attitude.
Btw, I still get the headaches but the medication I’m taking helps.
August 14, 2003 at 11:08 am
Toonces
I just talked to someone in my office. She thinks that the insurance company just needs a copy of the prescription you got from your doctor to get the MRI. It will contain things like the diagnostic code, which the insurance claims people need to put into the system.
She also confirmed that the insurance company can’t back out of paying, based on a decision that the MRI isn’t medically necessary. That’s an advantage of a PPO over an HMO.