Insurance billing vent

[Nemom]

I've been having therapy for lymphedema and picked up a couple of pairs of new prosthetics.  I paid out of pocket for one pair because insurance will only pay for a new set every six months.  Cost was something like $96.  

 

I received a copy of the EOB yesterday with a charge for $800 and some smaller amounts which I know are for the therapy.  Called about the $800 and was told that was for the second set of prosthetics.   :eek:   Insurance company paid over $500 for what I paid less than $100 for.   :confused:

 

Un.believe.able.  

 

 

[Crimson Wife]

Yes, but the flip side is I just had an out-of-network bill that I paid $170 for only get reimbursed at $18 (70% of the insurance allowed rate). So while sometimes paying cash saves money, other times it doesn't.

[Nemom]

Yes, but the flip side is I just had an out-of-network bill that I paid $170 for only get reimbursed at $18 (70% of the insurance allowed rate). So while sometimes paying cash saves money, other times it doesn't.

 

Ouch!

[G5052]

We have a $37,000+ bill that insurance paid $11,000+ on because it was with an out-of-network provider in a life-or-death situation. It's in appeal.

 

But we're "special" and hit our max out-of-pocket in May. As long as we stay in network and within their protocols, no more co-pays or charges for tests, ER, etc.

[Crimson Wife]

We have a $37,000+ bill that insurance paid $11,000+ on because it was with an out-of-network provider in a life-or-death situation. It's in appeal.

 

But we're "special" and hit our max out-of-pocket in May. As long as we stay in network and within their protocols, no more co-pays or charges for tests, ER, etc.

 

Yikes! Fingers crossed for your appeal ><

 

I try to stay in-network as much as possible unless it's for something I'm willing to eat the full cost of (like the $170 mentioned above). But obviously in a medical emergency you do what you need to do for your family member.

[Nemom]

We have a $37,000+ bill that insurance paid $11,000+ on because it was with an out-of-network provider in a life-or-death situation. It's in appeal.

 

But we're "special" and hit our max out-of-pocket in May. As long as we stay in network and within their protocols, no more co-pays or charges for tests, ER, etc.

 

Oh my word.  Praying your appeal goes well.

[G5052]

We lost the first appeal.

 

One more level, and then we start negotiation on the amount.

 

So frustrating.

[Crimson Wife]

We lost the first appeal.

 

One more level, and then we start negotiation on the amount.

 

So frustrating.

Does your state offer Independent Medical Review? I've had to go to IMR before to resolve insurance disputes

 

 

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