Getting shafted by the insurance company

Just got one of those "Explanation of Benefits" forms in the mail today. My insurance company has suddenly decided that pdoc won't be covered. They were covering at 50%.

Either they are sadistic or the medical coder really screwed up. Pdoc is listed as "other services" instead of "medicine management", and so it isn't covered at all.

This is the notice for an appointment at the beginning of September. I had another appointment toward the end, and another one tomorrow.

I am so angry that I am triggering. Unless this is all a big mistake, I either need to cough up the money or find a new pdoc.

I hate insurance companies.

If your insurance company had been covering your pdoc before.....they haven't changed anything without notifying you.....so I would definitely think it's a big mistake with the records....at least that's the way I would approach it.

"Don't make something into something bigger than it actually is until you find out the truth". After many years of doing this, I have learned that things usually aren't as bad as I first think they are....I tend to jump to conclusions too, but have learned over the years to wait & see before reacting & then I usually don't have to react.....But if I have to react, they usually better watch out!!!!

I'm sure everything will be just fine since you haven't had a notice of change in your insurance coverage.

It'll be ok,
Debbie

I hate insurance companys too!

That being said, you should look into the fact that it may be a medical code error and call the insurance company.

I hope everything works out for you. I know how hard it is to have to change Drs.

Take care

How frustrating all that can be. So sorry you are upset.

Sometimes insurance companies change policies to state that prior authorization is needed for certain kinds of coverage. It's possible that is the issue here and you were not made aware of it.

I would definitely call the insurance company and find out why all of a sudden the coverage is not there. Sometimes they only cover so many visits per year. In that case, you may be able to get around it by submitting a letter from your doctor about how medically necessary your pdoc is. I might be grasping at straws here, but those are possible scenarios.

I wish you luck with all this......don't forget to breathe

Hugssss
sabby

My EOB's for mental health coverage are more often incorrect than correct. I've had to call a number of times. It gets really old. Hopefully when you call, they'll tell you it was a coding mistake or something. I even had one wrong for a GP visit. They had entered the wrong CPT code, or maybe diagnosis code, and that caused it to not be paid. You might also call the pdoc and ask them. They'll be looking for that 50% insurance payment as well, so they may have already re-sent the bill.

Good luck. It's so aggravating, I know!

gg

Hope it gets straightened out in your favor. I'm inbetween insurance coverages and they mailed my husband his info but not me; he called to find out what's going on and they didn't have me :-(

((((perna))))) i know. insurance companies can be more trouble than it is worth. talk with you pdoc and, maybe, he can get help get his office worked out. a lot of times, it's a coding issue. i know it's like banging your head against the wall, since they are a pain. insurance companies are a pain for docs, too. believe it or not, docs are in over their heads with insurance companies' rules, policies, coding, and all that, and they feel it, too.

Thanks everyone for your insight. We called the insurance company this morning, and they said it was a code mixup. I was also in to see my pdoc this morning, and he was going to check his computer to see if there was some code missing (he recently moved his office).

I am so happy that was all it was .

Take care everyone!

I HATE INSURANCE COMPANIES TOO!!!!!!!!!!

Yes I too have been "shafted"by them.

It is amazing to me how they can decide who gets what.
My insurance co. dropped my meds - said that I hit my limit.
I really do feel for you.

Islander

that's great, perna. i know it's a pain to go through. many of us have to go through something like this. sending good vibes to you. ((((perna))))

I am glad that you have it all straightened out. I do not direct my anger at the insurance companies, but the billing department my doc uses. We have excellent insurance they know this (small area) and if we have an outstanding balance, then they've made a billing error. The medical profession is the only one I know of that can make a mistake and still collect the entire balance. They say its a courtesy to bill the insurance and it is my responsiblity to pay. My question to them was "when you make a billing error my insurance is NOT going to pay it! If you'd fix these errors the first time I call then the insurance would still pay in full!" If they had to be financially responsible for their mistakes there would be a lot less billing errors. Sorry for going off topic but this is one of my biggest triggers.