airial95 Posted June 2, 2011 Report Share Posted June 2, 2011 Sorry - this isn't directly PANDAS related, but I needed to vent, and I knew this community could relate to the issues of non-sensical insurance billings!!! I spent the last 2 hours on the phone and another 2 yesterday with no less than 5 different billing specialists and 2 insurance company reps trying to straighten out all of their billing nightmares from my non-PANDAS daughters adnoid surgery in February. We had to pre-pay the surgeon, surgery center and anesthesia the day of the surgery, which went towards our deductible and co-insurance after that was met. Unfortunately, the ins company didn't process their claims in the same order that we paid so the deductibles didn't get applied properly (even though they were totally met!) - so the co-ins requirements got all screwed up. Now anesthesia is trying to say we still owe them over $800 (incl $500 towards our deductible - which was met, and we PREPAID $430 to them the day of the surgery.) The surgery center hasn't cut them any ck yet from our payment, and now they're saying they didn't collect the right amt anyway because the surgery center didn't apply the deductbiles right. We had the SAME issue with the surgeons bills last week, but that one was only 3 phone calls and maybe an hour total - very pleasant experience compared to this. The woman from the anestehsia office actually had the nerve to tell me this was all very simple and treat me like an idiot (rudely) when I was trying to understand where all the $$ we pre-paid them went to (which she still had no idea either - but apparently wasn't an issue). She actually told me that medical billing is "common knowledge" and "everyone knows" who you're supposed to pre-pay, what amount and when, etc... Well really lady - if it was such common sense - why don't you know where my darn $$ is, and why would they have to pass a HUGE national healthcare bill to fix a system that "everyone" can navigate easily??? After I hung up with all of them (very frustrated, although the surgery center rep was very helpful). I pulled my EOB statements and actually put together a spreadsheet of what the charges were, what our deductibles/copays etc. should be, and pulled our reciepts and how much we paid. In 10 minutes I discovered we owe SOMEBODY $356.00 because of the confusion. At this point I have no idea who...I'm thinking of writing them all a little note with a scavenger hunt saying the $$$ will be buried only after they have solved a series of "common knowledge" clues - whoever finds it first can keep it. In the meantime, I'm moving to Canada... Link to comment Share on other sites More sharing options...
Guest TwinCitiesMom Posted June 2, 2011 Report Share Posted June 2, 2011 Sorry - this isn't directly PANDAS related, but I needed to vent, and I knew this community could relate to the issues of non-sensical insurance billings!!! I spent the last 2 hours on the phone and another 2 yesterday with no less than 5 different billing specialists and 2 insurance company reps trying to straighten out all of their billing nightmares from my non-PANDAS daughters adnoid surgery in February. We had to pre-pay the surgeon, surgery center and anesthesia the day of the surgery, which went towards our deductible and co-insurance after that was met. Unfortunately, the ins company didn't process their claims in the same order that we paid so the deductibles didn't get applied properly (even though they were totally met!) - so the co-ins requirements got all screwed up. Now anesthesia is trying to say we still owe them over $800 (incl $500 towards our deductible - which was met, and we PREPAID $430 to them the day of the surgery.) The surgery center hasn't cut them any ck yet from our payment, and now they're saying they didn't collect the right amt anyway because the surgery center didn't apply the deductbiles right. We had the SAME issue with the surgeons bills last week, but that one was only 3 phone calls and maybe an hour total - very pleasant experience compared to this. The woman from the anestehsia office actually had the nerve to tell me this was all very simple and treat me like an idiot (rudely) when I was trying to understand where all the $$ we pre-paid them went to (which she still had no idea either - but apparently wasn't an issue). She actually told me that medical billing is "common knowledge" and "everyone knows" who you're supposed to pre-pay, what amount and when, etc... Well really lady - if it was such common sense - why don't you know where my darn $$ is, and why would they have to pass a HUGE national healthcare bill to fix a system that "everyone" can navigate easily??? After I hung up with all of them (very frustrated, although the surgery center rep was very helpful). I pulled my EOB statements and actually put together a spreadsheet of what the charges were, what our deductibles/copays etc. should be, and pulled our reciepts and how much we paid. In 10 minutes I discovered we owe SOMEBODY $356.00 because of the confusion. At this point I have no idea who...I'm thinking of writing them all a little note with a scavenger hunt saying the $$$ will be buried only after they have solved a series of "common knowledge" clues - whoever finds it first can keep it. In the meantime, I'm moving to Canada... Link to comment Share on other sites More sharing options...
Guest TwinCitiesMom Posted June 2, 2011 Report Share Posted June 2, 2011 I can relate. Our non-pandas 5 yo had T&A done in March and it is impossible to follow the billing!!! Very frustrating. Link to comment Share on other sites More sharing options...
nicklemama Posted June 2, 2011 Report Share Posted June 2, 2011 Right there with you. If that's not enough, I received a letter on Sat saying our family had been removed from the "Healthy Living" (that we had to qualify for and which is lower in deductible and out of pocket) because we failed to meet all the qualifications. Of course, no one answered the phone on Sat and I had to wait until Mon. Dh called because I was fed up. Turns out, they accidentally sent everyone the letter instead of those that didn't meet the qualifications (physical w/ PCP, no smoking, high bp, high cholesterol, high blood sugar, obesity, etc....). The rep made changes in the system. Now they have to reprocess every claim after April 1st. We've not only met our deductible this year, but out of pocket thanks to IVIG. Its a mess and if PANDAS isn't enough to send you over the edge, the health care issues will. Link to comment Share on other sites More sharing options...
tpotter Posted June 2, 2011 Report Share Posted June 2, 2011 In the meantime, I'm moving to Canada... My DS and I were just discussing the fact that he and his brother may end up having to actually move to Canada (we actually were very serious,) because with all their preexisting conditions, they'll never be able to afford insurance, unless they get great jobs with paid insurance! Link to comment Share on other sites More sharing options...
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