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UUGHH!! Im so frustrated!!

I hate health insurance companies!! My son had his tonsils/adenoids out and tubes in on Dec 29. We have private ins we pay for out of pocket! and yet we are still paying for it. We're supposed to have 90/10 coveragem w/a $1900 deductable, which we met. Yet we are still paying well over $1000. how does that work! and it looks like they only paid 50% of some of the bills! we started looking last night cuz it didnt seem right. I just don't get any of this stuff, its so confusing to me! Does anyone else feel this way?

Answer Question

Asked by RhiannonHunt at 1:35 PM on Jun. 24, 2009 in Money & Work

Level 3 (18 Credits)
Answers (7)
  • Hmm yeah. This happens all the time at the pharmacy I work at. People expect to have alow pay for their prerescription and they find out its not the case. Honestly,

    I dont know your plan but some people find the deductible is just for the insurance itself and not for the prescription coverage. I don't know.

    Have you called to see the hold up? Have you sent in your proof of payments and have they updated their systems?

    These are some of the reasons I do what I do at Procard International. Let me know if I can be of any more help.


    Answer by IraqiVetWife at 2:19 PM on Jun. 24, 2009

  • I worked with a couple of insurance companies, maybe I can help. If your interested let me know. What company were/ are you with? The main one I was associated with was BCBS. Let me know if you need any help. :)

    Answer by southernstyle88 at 2:34 PM on Jun. 24, 2009

  • It's all confusing but are you paying $1000 for the surgery only? Is this a bill from the Dr or the Hospital? Did you add everything up? Is the Drs part included in that same bill.
    See, You should get a bill from the Dr. and the hospital and the anesthesiologist and a hundred other Dr.s it seems. Look at the EOB and see what each entry says. Mine shows you how much your part is. It shows how much the covered part is and how much they paid the dr. There should be a number in your packet or on your card you can call and they will go over it with you.
    Also I always wait until I have my EOB so I can compare the bills with what the Dr was paid.

    Answer by itsmesteph11 at 2:50 PM on Jun. 24, 2009

  • I hate insurance period!!!! the whole idea that you pay into it your whole "life" whatever esp car insurance...and then you use it...once or twice maybe..youve paid ALLLL that money but still have to pay out more in alot of cases, or they raise the premiums...its annoying as can be!!! i know hospital visits arent cheap but seriously...if youve paid into insurance for a year youve paid them the cost of the surgery (sometimes....)...its all an annoying scam to me!!! LoL

    Answer by Anonymous at 5:42 PM on Jun. 24, 2009

  • wow, you ladies are so sweet. I will PM a couple of you in a little bit. i jsut got home from fishing and swimming all day and trying to get kids and DH to bed, so then ill be able to concentrate! THANK YOU SOO MUCH FOR YOUR SUGGESTIONS AND OFFERS SO FAR!!!

    Answer by RhiannonHunt at 11:48 PM on Jun. 24, 2009

  • I work insurance for a living and 20 years now. I've been with Travelers, BCBS and now a TPA (Third party admin) for the last 11 yrs.
    I can help.

    I agree- I hate insurance also!!!
    I'm trying to get out of it. I'm tired of all I see.

    But I am currently in the BIZ..
    Your 50% means - some things they paid Out of network (Probably a mistake), you can get this corrected.
    Also, your $1000.00 OOP, may be seperate from UR Deductible. Some are, some are combined.
    If they are combined - you should be done. If they are seperate, then UR $1000.00 is your 10%.
    When you are looking at UR EOB's - look at the "Insured Owes" portion, Look for the "Ineligible" amt - their shld be a # or Ltr and an explanation on your EOB as to what that # or LTR meant. If it says Out of network provider (the 50%) reason - and ur hospital stay & all was In-network, call the C/Service at the INS company and have them look at it.

    Answer by gr-mom2 at 9:40 AM on Jun. 26, 2009

  • Ahhhh.. never enough characters.

    You can send Chat to me or email... I can help.

    Answer by gr-mom2 at 9:41 AM on Jun. 26, 2009

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