I hate insurance companies!

Dave N

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Joined
Feb 20, 2013
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Illinois
Apparently a visit from the nurse isn't always "A" visit. It's actually 2 or 3! And therapy done in our home isn't therapy, it's counted as nursing. So the visits that would be counted separately are now combined. Insurance says we get 100 visits per year. You would think that with 52 weeks in the year and taking some visits off because of doctor appointments, illness, vacations, etc. that it would work out. WRONG! We were informed of this by reading the email regarding the monthly statement of benefits. It showed a balance due. Say what? Made some phone calls for an explanation and learned of the details. Talk about fine print I never heard of! Still need to get more info about how each visit is charged.

So just now I got a new statement with the latest updates. Doing the math with visits for this year not shown yet I will owe $3200! We cancelled the one remaining therapy visit but have to have one more from the nurse. I'll be bitching to the insurance company once my itemized bill comes from the nursing outfit that I requested. I do know they are scamming for the amount they charge for supplies! A box of absorbent gauze pads from the website they get ordered from costs $5.45 but they charge my insurance $133 for it! :eek:

It just sucks finding out too late to do anything about having to start paying. Not to mention that next week starts a whole new year and new deductibles and out of pockets. Guess I'll be on the payment plan. Good thing I started taking payments from my 401K! We'll be fine, just wasn't expecting a big surprise bill at the end of the year.

Small potatoes compared to lots of things. Rant over.
 
Apparently a visit from the nurse isn't always "A" visit. It's actually 2 or 3! And therapy done in our home isn't therapy, it's counted as nursing. So the visits that would be counted separately are now combined. Insurance says we get 100 visits per year. You would think that with 52 weeks in the year and taking some visits off because of doctor appointments, illness, vacations, etc. that it would work out. WRONG! We were informed of this by reading the email regarding the monthly statement of benefits. It showed a balance due. Say what? Made some phone calls for an explanation and learned of the details. Talk about fine print I never heard of! Still need to get more info about how each visit is charged.

So just now I got a new statement with the latest updates. Doing the math with visits for this year not shown yet I will owe $3200! We cancelled the one remaining therapy visit but have to have one more from the nurse. I'll be bitching to the insurance company once my itemized bill comes from the nursing outfit that I requested. I do know they are scamming for the amount they charge for supplies! A box of absorbent gauze pads from the website they get ordered from costs $5.45 but they charge my insurance $133 for it! :eek:

It just sucks finding out too late to do anything about having to start paying. Not to mention that next week starts a whole new year and new deductibles and out of pockets. Guess I'll be on the payment plan. Good thing I started taking payments from my 401K! We'll be fine, just wasn't expecting a big surprise bill at the end of the year.

Small potatoes compared to lots of things. Rant over.
Argh, hate that as well. Luckily they didn’t charge for the vasoline.
 
"Still need to get more info about how each visit is charged."




If you have any questions or need any help on that end feel free to pm me I deal with it all day everyday at work.
I saw something about 15 minutes. If that is what they consider a visit they're nuts! So I guess if the nurse is here a half hour it counts as 2 visits? That's crazy, she only shows up once!
I'll see what happens when I get the bills in the mail and try to wheel and deal on a price.
 
I saw something about 15 minutes. If that is what they consider a visit they're nuts! So I guess if the nurse is here a half hour it counts as 2 visits? That's crazy, she only shows up once!
I'll see what happens when I get the bills in the mail and try to wheel and deal on a price.
What insurance do you have? That dosen't sound correct when I send someone out for a visit it only counts as one whether it's 15 minutes or 2 hours. Sounds like your home health agency is being pushed around by your insurance company. You need to report what's going on to your state health department. It'll strengthen your position when bargaining with the insurance if they know the state's watching.
 
I asked for an itemized statement for the year. That's where I'll start looking and talking to the insurance company. Maybe there is a mistake somewhere. That's why I started calling to begin with.

Thanks!
 
My wife is very good at calling out something that doesn't look correct.
Had a physical this year. I don't go in like they want me too. If I feel good, why go!
So, I tried to get an appointment, the doc is out 2 months. I tell them anyone available as I don't really consider a guy I see 4 times in 66 years "my doctor"(they come and go). So I get in the next week, his physician's assistant. She sits me down asks how I feel checks vitals. They also draw blood.
During the physical, I mentioned I would like to try a one a day pill for my asthma. She said her husband used it with good results. End of asthma conversation.
We get a copy of the bill and my wife calls on it. She knows the normal fee for a physical. They said the consultation for the asthma portion was $300 +
Pretty sure this is because we have insurance.
 
We’re finding out our once great health insurance is now acting more like workers comp. insurance. They’re denying all kinds of procedures they never used too. For example, my wife went through chemo and surgery for cancer. Now she’s going through radiation. The radiation was delayed about three weeks because the insurance didn’t want to pay for the scan to pinpoint where to direct the radiation. Even though they approved and paid for locators to be put in her to do just that. Doesn’t make any sense to just blast away radiation and hope you’re directing it in the right spot. Finally after allot of arguing and my wife appealing, they approved it. But makes you mad having to go through that when she has enough to deal with.
 
I'm 100% convinced that health insurance is the worst thing that happened to our healthcare system and it got exponentially worse with the ACA. If it wasn't for health insurance the doctors wouldn't be able to charge the exorbitant rates/markups they do.

I'm all for people making money but $133 for gauze pads. WTF! Reminds me of when we had our 3rd child - there were a couple complications and my wife/baby had to spend 2 extra days at the hospital. $29,000 for 2 extra days. We got an itemized list of the invoice. They were charging around $5 for a Motrin.
 
I went through the statements from my insurance and physically wrote down the date for each visit. I agree with each one. Less than the 100 they claimed. I have to convince the gal on the phone that something else is getting lumped in with them that shouldn't. Hoping they can work with me to figure it out what. Frustrating!
 
I went through the statements from my insurance and physically wrote down the date for each visit. I agree with each one. Less than the 100 they claimed. I have to convince the gal on the phone that something else is getting lumped in with them that shouldn't. Hoping they can work with me to figure it out what. Frustrating!
I feel for ya, its like fighting with the IRS
 
I'm 100% convinced that health insurance is the worst thing that happened to our healthcare system and it got exponentially worse with the ACA. If it wasn't for health insurance the doctors wouldn't be able to charge the exorbitant rates/markups they do.

I'm all for people making money but $133 for gauze pads. WTF! Reminds me of when we had our 3rd child - there were a couple complications and my wife/baby had to spend 2 extra days at the hospital. $29,000 for 2 extra days. We got an itemized list of the invoice. They were charging around $5 for a Motrin.
The funny thing is they just order from a website and have it sent to our house. Never touch the stuff.
 

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