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View Diary: My Christmas Eve Health Care Story (55 comments)

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  •  Thanks for another reminder just how screwed up (4+ / 0-)

    our system is. I voted in your poll in the "I have great healthcare" category - through employer, costs Mr. P and me $12k/year (for the moderate plan, not the Cadillac). However, we recently got a note that Mr. P's one-day hospital stay for surgery - $75k - (yes, really) would not be paid immediately b/c the company needed to do an "internal review" or something. So, we had the positively un-American luxury of never worrying once about the cost when Mr. P needed surgery - but now I'm not sure what they're up to.

    Our system of law is premised on the idea that an unfettered government - rather than criminals - is the greatest danger to our lives and liberty.

    by pixxer on Sat Dec 26, 2009 at 08:37:47 PM PST

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    •  Internal Review is Insurance speak for (1+ / 0-)
      Recommended by:

      we don't want to pay this bill and will look for a way not to pay it.

      Be prepared for months of

      Letters from your insurer stating that they are still 'reviewing' the claim.
      Letters from your insurer demanding paperwork (which you and/or your treating physician/surgeon may very well have already sent more than once).
      Letters from your insurer requesting a list of all physicians seen and conditions treated for a period of up to ten years in the past.
      Letters from your insurer....

      Ok, so you get the point.  They will bombard you with paperwork.  It is likely that they will request/demand you send them hardcopy paperwork by mail, and repeat the request over an extended period, claiming that paperwork you previously sent was not received.

      Send everything to them via registered USPS mail.  You get a receipt proving that it was delivered, and on what date and time.  Keep those receipts.

      Talk to your physician/surgeon's administrative staff, and let them know the insurer has notified you about an 'internal review' and the billing for the services may not be paid for an extended period of time.  They have every reason to assist you in overcoming any negative review results - it will get them a paycheck.

      I'm serious, and you need to be proactive.

      How would you react if the insurer finds that your spouse's surgery was not a covered benefit, and that now you owe the entire bill (which you state is in the $75K range)?  

      Good luck, you're going to need it.

      •  Thanks, Angie. (1+ / 0-)
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        Angie in WA State

        I have one additional ace in the hole (or I hope it's an ace. Could be a Jack or something ;) which is an advocacy company retained by my employer. In truth, we have never had a problem with this HMO, including an outpatient surgery of mine (less than $20k), but this was spouse of the insured, and considerably more. I'm not really worried at this point, but we do have a lot of experience with registered mail {{sigh}}.

        You reminded me of an interesting experience we had with a record club. They said we owed them $, we said we didn't. We said "send copies of the bills, and copies of the receipts". They sent a partial list of things we'd ordered, but not a complete list - plus it wasn't arranged into bills and shipments. Finally they told us their records weren't arranged that way, and didn't go back any farther than what we'd sent.

        We just said "we'll pay you as soon as you show us that we owe you," and waited. Anyway, quite awhile later, we got a notice from a collection agency. Their letter said "let us know if there is any additional information you need." I bet they were surprised by our response. We wrote back "On thank you so much! We have been trying to get this information for months!" and we included a copy of every letter we had sent, and a complete history. Next thing we heard was a notice from the record company "forgiving" our account or something. Anyway, we ended up being pretty amused by the whole thing.

        Our system of law is premised on the idea that an unfettered government - rather than criminals - is the greatest danger to our lives and liberty.

        by pixxer on Sun Dec 27, 2009 at 01:52:18 PM PST

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