We all know the Health Insurance Industry is f-ed up, but let me give you a taste of what the average American who does have insurance has to deal with. As many of you know , I went to the ER last December with abdominal pain . Six hours and several CT Scans later , I was sent to a specialist who would later determine I had Endometriosis and would have to perform a TAH/BSO. Okay , it's all done and over with. Then the bills started coming in. This is where it get's crazy as if it already weren't.
I have United Health Insurance through my job, (same as MSNBC employees by the way) and they have a website that I can go to and check out my billing and what have you. Now, so far I have 14 lines of charges from Decembers ER visit and Januarys surgery. But look at all the confusing bullshet and tell me that this system is not designed to keep United Health from having to live up to their end of the bargain. Now, I paid my Deductible which is $500.00. My Maximum is set at $3,000.00 which when I am finished paying that , United Health has to pay for everything else for the rest of the year. My out of pocket expenses has already exceeded that amount , but they only have me paying $1,588.74. How do they do it ?
CODES like this:
Remark Code UG: We Have Applied This Physician's Or Health Care Professional's Discounted Rate Towards Your Deductible. You Have Not Yet Exceeded Your Deductible Amount; Therefore No Benefits Are Payable.
and
*Remark Code I4: This Is Not A Separately Reimbursable Service Or Supply.
They have codes that they can put certain charges under that are not considered out of pocket expenses even though I still have to pay for them. Why ? Because if I reach that $3,000.00 amount , they have to pay for it. Let me show you how they do it. Here is just ONE charge. It's for the CT Scan they did on my stomach in the ER.
Date of Service: 12/13/2008
Ct Imaging Llc
Medical
More Details Processed
01/22/2009 $3,324.00 $500.00 $652.20 $572.47
Paid at Visit
$0.00
*******
*******
Pay attention to the $3,324.00 amount okay ? The 572.47 is my portion. Looks okay . Fair enough. I have to pay 572.47 for those tests. Even though, I am only supposed to pay $200.00 , which I already paid, per ER visit. Not sure what that covers because I still have to pay for these tests. Okay fine. Oh but wait. When you click on "see details" you get this.
Remark Code
Description
Date of Service Billed Amount Network Discount Applied to Deductible Paid by Plan Patient Responsibility
UG*
Radiology Services
$351.20 $197.63 $153.57 $0.00
Deductible
$153.57
VD*
Radiology Services
$1,568.00 $1,568.00 $0.00 $0.00
Not Covered
$1,568.00
VD*
Radiology Services
$1,756.00 $1,756.00 $0.00 $0.00
Not Covered
$1,756.00
UG*
Radiology Services
$313.60 $174.08 $139.52 $0.00
Deductible
$139.52
D1*
Radiology Services
$1,404.80 $783.63 $206.91 $372.83
Coinsurance
$41.43
Deductible
$206.91
$248.34
EC*
Radiology Services
$1,254.40 $943.99 $0.00 $279.37
Coinsurance
$31.04
Subtotal(s)
Coinsurance
$72.47
Not Covered
$3,324.00
Deductible
$500.00
Totals $3,324.00 $5,423.33 $500.00 $652.20 $572.47
Paid at Visit
$0.00
Already Paid
$0.00
Amount You May Owe
$572.47
Here's some of those "Codes" I was talking about;
Claim Notes
*Remark Code UG: We Have Applied This Physician's Or Health Care Professional's Discounted Rate Towards Your Deductible. You Have Not Yet Exceeded Your Deductible Amount; Therefore No Benefits Are Payable.
*Remark Code VD: This Service Line Submitted As The Global Service Will Be Recoded To The Professional And Technical Component Lines.
*Remark Code D1: Thank You For Using A Network Physician Or Other Health Care Professional. We Have Applied The Contracted Fee. The Patient Is Not Responsible For The Difference Between The Amount Charged By The Physician Or Health Care Professional And The Amount Allowed By The Contract, Except In Situations Where There Is An Annual Benefit Maximum For This Service. The Patient Is Also Responsible For Any Copay, Deductible And Coinsurance Amounts.
*Remark Code EC: We Have Applied The Maximum Allowed Expense For The Primary Procedure. For Each Subsequent Procedure, We Have Applied A Portion Of The Allowed Amount.
Hmmmm. Check out the "not covered" portion. WTF is THAT supposed to mean and why does it say. "Patient Responsibility" ?. Well, when I clicked on it , here's what I got.
Definition of: Not Covered
Charges for services not covered by your benefit plan. These charges are your responsibility. These may include coverage exclusions such as cosmetic, alternative medicine, and amounts above reimbursement. View the Benefits Coverage section for details about your plan.
Let's see. A CT Scan on my abdomen. It can't be cosmetic. It sure ain't alternative and it doesn't exceed my reimbursement amount. Looks to me like they didn't want to pay it and they anticipate the Hospital making me pay it. And if I had to pay it, it would be an ...out of pocket expense which would put me over the 3,000.00. and they don't want that so what do they do ?
Look at the amount $3,324.00 . Do you notice something? The uncovered charges posted total $3,324.00 of which I am to pay $572.24 of. So why is there $3,324.00 not covered ? Are you confused too? On the FINAL Bill sent to me from the Hospital it had the following:
YOUR INSURANCE COMPANY HAS PAID THEIR PORTION OF THESE CHARGES . PAYMENT OF THE REST OF THIS BILL IS YOUR RESPONSIBILITY.
12/13/08 Supply of LOCM 75.00
12/13/08 CT Pelvis With Contrast 1,568.00
12/13/08 CT Abdomen with Contrast 1,756.00
02/11/09 United Health Payment -33.08
02/11/09 United Health Dissalowance -38.25
02/11/09 United Health Payment -652.20
02/11/09 United Health Dissalowance -2,099.33
Balance Due: 576.14
When I looked up Dissalowance , all I could find was that it means United Health rejected the amount that the Hospital was asking for. But who pays for that $2,099.33 ? I sure as hell am not going to. Mind you, I have 13 other bills just like this one on my account. I read somewhere that the Hospital usually writes this off and cannot or does not charge the patient. How do I know for sure? And if so , is United Health using codes to make sure I don't reach the $3,000.00 out of pocket mark based on their records so they don't have to pay for future expenses ? Mind you , they are still taking money out of my check every two weeks just to have the insurance.
This is the confusing crap that Americans all over this nation have to go through and mines is nothing compared to them.