My husband and I have the same insurance. His colonoscopy was covered and mine was not. My doctor recommended I use Cologuard first. Cologuard detected something so ended up getting a colonoscopy anyhow. It was all in the coding. My husband's was coded as routine and mine was coded as diagnostic (because of the Cologuard results) which my insurance didn't cover. My husband paid nothing and I paid $4500.
Shhh bby is OK - 2 years ago
When I had my now healthy and strapping son 16 years ago, I had a similar experience as SEH. I had PROM at 33 1/2 weeks and was admitted to an in-network hospital with a level 3 NICU. Turns out the peds group in the NICU didn't accept BC/BS - and with a 12-day stay, the provider charges were pretty hefty. I was able to get BC/BS to pay as an emergency admission, but I was still on the hook for about $7K. Like SEH, I frame this as a predatory practice.
More recently - a couple weeks ago I booked telehealth visit online with a grief counselor through my employer's EAP. I was careful to select a provider who also accepted my insurance so I could see her beyond the 3 free EAP visits. After my first visit, she sent me a text letting me know my charges were applied to my insurance deductible and asked that I Venmo her $115. Ugh. Conflict is beyond me right now. I paid the bill out of my HSA and canceled my next appointment. Predatory? Not at all. Just a solo practitioner who should probably outsource her billing.
SEH - 2 years ago
Going back four years - I was billed over $1,000 for an out-of-network anesthesiologist for the epidural when in labor with my son. Forgive me for not asking to check their individual network status while laboring with a nine-and-a-half pound baby in a hospital that I had pre-verified as in-network. Not that there was likely any other option, it was a Sunday and this doc was the only one in the building. Luckily when I received the bill I poured over my plan documents and realized that I was protected from balance-billing. I still had to get on multiple phone calls and send multiple documents to get the bill rescinded. I'm sure others who don't work in the industry would either pay the bill or get their credit ruined by a bill sent to collections. I still wonder if this was a predatory practice who intentionally billed everyone knowing that most people won't know to fight.
Holly - 2 years ago
My biggest issue was rushed pharmacy staff that didn’t take the time to deal with Rx assistance cards or help me understand the cost breakdown. I was just told if I didn’t like the price to call my insurance or my doctor. Insurance staff were outsourced and had no clue about Rx cards. The Rx card company had no clue about insurance. The doctor is stuck in the middle signing all sorts of authorizations and trying to find substitutes. It’s insane. I just gave up and paid $400 and the following month the sale Rx was $25. And I still don’t understand why - I understand my coinsurance, deductible, and per rx maximum, but it doesn’t add up and no one can tell me why.
My husband and I have the same insurance. His colonoscopy was covered and mine was not. My doctor recommended I use Cologuard first. Cologuard detected something so ended up getting a colonoscopy anyhow. It was all in the coding. My husband's was coded as routine and mine was coded as diagnostic (because of the Cologuard results) which my insurance didn't cover. My husband paid nothing and I paid $4500.
When I had my now healthy and strapping son 16 years ago, I had a similar experience as SEH. I had PROM at 33 1/2 weeks and was admitted to an in-network hospital with a level 3 NICU. Turns out the peds group in the NICU didn't accept BC/BS - and with a 12-day stay, the provider charges were pretty hefty. I was able to get BC/BS to pay as an emergency admission, but I was still on the hook for about $7K. Like SEH, I frame this as a predatory practice.
More recently - a couple weeks ago I booked telehealth visit online with a grief counselor through my employer's EAP. I was careful to select a provider who also accepted my insurance so I could see her beyond the 3 free EAP visits. After my first visit, she sent me a text letting me know my charges were applied to my insurance deductible and asked that I Venmo her $115. Ugh. Conflict is beyond me right now. I paid the bill out of my HSA and canceled my next appointment. Predatory? Not at all. Just a solo practitioner who should probably outsource her billing.
Going back four years - I was billed over $1,000 for an out-of-network anesthesiologist for the epidural when in labor with my son. Forgive me for not asking to check their individual network status while laboring with a nine-and-a-half pound baby in a hospital that I had pre-verified as in-network. Not that there was likely any other option, it was a Sunday and this doc was the only one in the building. Luckily when I received the bill I poured over my plan documents and realized that I was protected from balance-billing. I still had to get on multiple phone calls and send multiple documents to get the bill rescinded. I'm sure others who don't work in the industry would either pay the bill or get their credit ruined by a bill sent to collections. I still wonder if this was a predatory practice who intentionally billed everyone knowing that most people won't know to fight.
My biggest issue was rushed pharmacy staff that didn’t take the time to deal with Rx assistance cards or help me understand the cost breakdown. I was just told if I didn’t like the price to call my insurance or my doctor. Insurance staff were outsourced and had no clue about Rx cards. The Rx card company had no clue about insurance. The doctor is stuck in the middle signing all sorts of authorizations and trying to find substitutes. It’s insane. I just gave up and paid $400 and the following month the sale Rx was $25. And I still don’t understand why - I understand my coinsurance, deductible, and per rx maximum, but it doesn’t add up and no one can tell me why.