Why do I have all these bills when I pay for Insurance?

[ckramer]

What is the name of your state (only U.S. law)? Florida

First off I really do not understand how the medical insurance system works and I have been given so much advice that I am overwhelmed, confused, frustrated and fed up.

I pay for BCBS insurance through my employer (5 years now). I pay for me my husband and now for my son who is 7 months now. When I found out I was pregnant I got preapproved through my insurance company for delivery etc. Great. I paid my deductible ($1000) and separate "promissory note" ($1800) to my doctors office. Done. I had to have a c-section, ordered by my doctor because the baby was breech. I stayed in the hospital for 3 days. I added my son to my insurance with two weeks of his birth and had it backdated to his birthdate..... My parents very kindly paid my ‘hospital stay’ bill. Which ended up being $2000! My stepdad bartered them down from nearly $4000 and paid by credit card.

Why am I still responsible for thousands more dollars to the anestatician, pediatrician, blood work lab, obgyn...?

The bills keep coming. What the heck am I paying Insurance for? Why is it not covering the birth of my baby? What can I do about this?

Please help me figure this out.

[Zigner]

Originally Posted by ckramer

What is the name of your state (only U.S. law)? Florida

First off I really do not understand how the medical insurance system works and I have been given so much advice that I am overwhelmed, confused, frustrated and fed up.

I pay for BCBS insurance through my employer (5 years now). I pay for me my husband and now for my son who is 7 months now. When I found out I was pregnant I got preapproved through my insurance company for delivery etc. Great. I paid my deductible ($1000) and separate "promissory note" ($1800) to my doctors office. Done. I had to have a c-section, ordered by my doctor because the baby was breech. I stayed in the hospital for 3 days. I added my son to my insurance with two weeks of his birth and had it backdated to his birthdate..... My parents very kindly paid my ‘hospital stay’ bill. Which ended up being $2000! My stepdad bartered them down from nearly $4000 and paid by credit card.

Why am I still responsible for thousands more dollars to the anestatician, pediatrician, blood work lab, obgyn...?

The bills keep coming. What the heck am I paying Insurance for? Why is it not covering the birth of my baby? What can I do about this?

Please help me figure this out.

What did your insurance company say when you asked them?

[ckramer]

All ive been told is 'services not covered' ....

[RRevak]

Before your child was born did you go over with your insurance company each part of what was covered and outlined that which was not?

[ckramer]

Originally Posted by RRevak

Before your child was born did you go over with your insurance company each part of what was covered and outlined that which was not?

I was on the phone with their rep for about an hour discussing 'the situation'. Should I have been asking which specific bloodwork tests was covered?

[Zigner]

Originally Posted by ckramer

I was on the phone with their rep for about an hour discussing 'the situation'. Should I have been asking which specific bloodwork tests was covered?

You need to appeal the denials. You also need to get a copy of the full policy and review it.

[RRevak]

Originally Posted by ckramer

I was on the phone with their rep for about an hour discussing 'the situation'. Should I have been asking which specific bloodwork tests was covered?

In essence yes. Before your child was born you should have reviewed your specific policy which would have outlined each proceedure that was covered and specified that which was not. The more important part would have been that which was not covered. That way you wouldnt have any surprises at the end of the tunnel. Some proceedures are considered standard while some are constituted as "voluntary". Before you appeal anthing you need to review your full policy to see what and what was not covered. If it states that X is covered while Y is not, then you are liable for the expenses of Y and not liable for the expenses of X. If you're being charged for both then definately appeal the denials. But if their policy is clear about their level of coverage then i'm sorry but you owe them the money. Sometimes we find out later than sooner that our insurance companies arent always what we want them to be.

[Zigner]

Originally Posted by RRevak

Before you appeal anthing...

Actually, there's no reason NOT to start the appeals process immediately...

[RRevak]

Originally Posted by Zigner

Actually, there's no reason NOT to start the appeals process immediately...

It might look better if she's at least somewhat informed before she goes to them on an appeal basis. Might save her some trouble, unless the policy is vague.

[momm2500]

did you receive the following:

1. eob's from the insurance company showing how much they paid for every doctor and service?

if not, you need to contact all doctors involved and have them submit to the insurance company.

then if there is a balance based on the eob from the insurance company, that would be your responsibility or you can appeal to them as to why it was not covered. the important thing here is to have the paperwork indicating what was paid or denied by the insurance company.

also, how does your plan pay for inpatient hospital? 100% or is it 90% or subject to a deductible or what?

[moburkes]

Originally Posted by momm2500

also, how does your plan pay for inpatient hospital? 100% or is it 90% or subject to a deductible or what?

THIS is likely the answer to your question. Most insurance policies don't pay 100% after the deductible. Most pay 70, 80, or 90% of the covered expenses after the deductible is paid.

[lkc15507]

I am not trying to be cruel, but why does anyone expect that a premium payment entiles them to carte blanche, much less to carte blanche forever? Contracts are contracts, health insurance is a contract. It pays what is says, it doesn't pay for what you want or believe you are entitled to.

[Wirelessany1]

Originally Posted by Zigner

Actually, there's no reason NOT to start the appeals process immediately...

I agree with Zigner. The appeals process will trigger a review of what was paid vs. all the bill submitted. At best the OP can get additional payments made to the health care providers. At worst she could be in the same position she is in today.

take care, ana