Wednesday, April 13, 2011

Public Service Announcement

If this helps just one person out there - then my job is done.

I work with health insurance companies every day. I have learned that while I would like to believe that healthcare is a right rather than a privilege, I do understand the layers of argument beneath that. People will always want choice and the idea that they can spend a little more and get a little extra. Especially in this country. Everyone thinks that if they just work a little harder they can create a better life for their family. People blithely underestimate the chances that a medical condition will swoop in and take everything. I can understand that, I buy lottery tickets, I'm even looking at a private school for Anna (more on that later). I've lived here long enough to understand the entrenched desire for a free market, nobody wants to feel dictated to, everyone wants to feel like they're making an informed choice (even though OMG you have no idea how many times I hear people crying 'but I thought we were covered!!').

This is not a political blog, so I need to veer back on topic.

What I need to tell you: one thing I have learned that a staggering number of people do not know, is that if you have PPO insurance and are seen in a hospital and you are treated by a non-PPO doctor you do not have to accept out of network reimbursement as your final answer. 

It happens every day at our medical practice. People are rushed to hospital, treated by the on-call specialist, who just so happens to not be covered by their insurance, and they get a huge bill as a result. You can appeal this. It's very easy. You call the number on the back of your insurance card and tell your insurance company that while sedated in the ER, or semi-conscious on the ward upstairs, you were not selecting the physicians who were treating you. They were assigned to your case. The fact that there was no cardiologist, nephrologist, or other ologist on call who was contracted with your insurance company at your moment of need is not your problem. Your insurance needs to reprocess the claim as if the physician in question was contracted. They are not going to volunteer to do this, and the doctor sending you the bill will probably not either. If you make this call they have to reimburse as if the physician was part of their PPO. The doctors get paid what is rightfully theirs, and you have less out of pocket. These are your rights and your insurance company is sure as hell not going to inform you of this.

If this has happened to you, then this one phone call could save you a lot of money.


Announcement Letters said...

I think someone should take some action on it, hospital staff are in charge to take care of the patient and all his insurance stuff.

AliBlahBlah said...

Yes I agree, but this happens many weeks after the hospital visit, and the bills are coming from separate providers, not the hospital, which often means the patient does not consider the hospital as a informational resource.

Heather said...

I really appreciate this post, actually, because I just went through this because of an ER visit with my daughter. I (wrongly, obviously) assumed that since my insurance company covered the hospital we were at, they'd cover the doctor, too. Cue angry phone calls.

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Tommie said...

Thank you!! As an HR coordinator, I'm often telling employees that they need to fight the insurance companies. They have to make the calls because insurance companies do this thinking no one will fight them. Again, thank you!!!

AliBlahBlah said...

Hooray! Thankyou! If we could just get the word out about this to everyone, just think how much owed by insurance companies would actually go to the patients and providers instead of the to the fat cat bottom line!

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