ChocolateBabz

OK so 8 months in. We have been through most of the trials - SSN's, Bank Accounts, Insurance, Credit Cards, Mortgages etc and at least we know we won't have to do those things again.

We are in the middle of doing the tax return (with help provided by hubby's work) - they ask for everything and then file on our behalf - which doesn't really help us understand it but bugger it, at least it will be done.

My rant is this - Health Insurance . I can't get my bloody head around it. I went to the doctors office and after my visit the doctor charged me @ $80. I then got a statement from Aetna which showed how much the visit had actually cost - @ $180, what they had paid and a note saying that my doctor could charge me the remainder @ $100. The doctor never got in touch so I assumed all was OK.

Thne sonny went to the doctor and after the visit I was charged $20 - OK I thought maybe after the first visit we are now only paying co-insurance so it's cheaper. Statement followed from Aetna showing actual cost and what they had paid and again stated that the eoctor could charge me the remaining @ $100.

Letter then followed from doctor saying I was due the other $80. OK I thought - they screwed up so I sent the remaining $80.

Then letter comes from a Credit Collection Co regarding Appt #1 saying I owe $10 and if it is not paid I will be reported to the Credit Agencies. So I have sent off a cheque.

But for god's sake how do you ever know what you are supposed to pay. We are paying almost $300 a month with hubby's work scheme and it is costing $100 each time I visit the quack. It does say we have an annual deductible of $500 so presumably once we reach that the one off charges will go down? But I just don't understand any of it. At the end of May we will be into a new year and starting off with the $500 deuctible again.

I feel like getting really sick just so I can be quids in. (I know I don't mean that really!!)

Does anyone understand their health insurance policy? Or am I just thick?:curse:

Rete

Could a number of things and most of the issue would be the plan you have and the doctors you have chosen.

Healthcare plans are either PPO or HMO. On the PPO you can go to any doctor that accepts your healthcare insurance and all you pay is a co-pay (usually $20 a visit) and the doctor accepts what the healthcare plan pays him as payment in full or any doctor outside of the group and you pay what the insurance does not cover.

While the HMO means you not only have to go to a doctor within their group but you must have a primary physician from within their group of affiliated doctors and if you need to see a doctor other than your primary you need a referral slip from the primary. Again the co-pay is usually $20 and the doctor will accept healthcare payment as payment in full.

For example, I have a PPO. I went to my internist last night for a pre-op physical. He draw blood, did a cardiogram and all it cost me was $20. He accepts payment in full from the healthcare plan. The same with the opthamologist I saw this morning who is doing the surgery. So two doctors in two days and cost to me was $40.

It clearly sounds as if you are going to doctors that do not accept your healthcare plan as payment in full. When you make your next appointment, be sure to ask if the doctor accepts healthcare payment as payment in full with just a co-pay from you.

Rete

If your husband can't do it, then you will have to do it. Sit down and talk with HR about the policy and also call the healthcare plan after you have read their booklet. Find out exactly what type of coverage you have.

NC Penguin

You can acquaint yourself with your health insurance policy by studying your health insurance provider's website. The site should allow you to see the co-pay, the deductibles and the percentages split between you and your health insurer for services.

For example, I don't have any co-pays for appointments (primary care or specialists). So, I don't pay anything at the time of service.

However, when the paperwork starts coming in, from both the provider and my health insurance, that's when I start paying and this is to the service provider (usually the physician's office but sometimes the laboratory for lab work).

I carefully compare documentation from the service provider and my health insurer to make sure that they're both correct and have the same figures.

Tip: whenever you go for any kind of medical appointment, get a copy of the "Encounter Form" before you leave. This is a summary of the services provided at the time of the appointment by the person (doctor, nurse, PA, etc.). Sometimes, providers give a copy to the patient automatically but sometimes I have to ask for a copy. This should not raise any eyebrows from reception. This is the initial document that kicks off the slew of subsequent bills and Explanations of Benefits documents you will receive.

I have had some minor nightmares regarding medical billing under my health insurance in 2008. I have entries in my blog about this that you can read about, if you're interested.

Michael

Use the following link to determine if your doctor is in the AETNA network.

http://www.aetna.com/docfind/home.do

penguinsix

Aetna is the anti-Christ of insurance agencies. What goes on is that they agree to pay the 'prevailing rate for the cachment area' for a specific service. So say you live in Washington DC. They'll look at the rates of doctors as far away as Huntington WV or so and say 'hey, this is part of the Metro DC area, and for there they only charge $100 for this procedure, so we only pay $100 for this procedure eventhough the doctor billed $180. If the doctor wants to get the rest from your hide, they might...." Usually the doctor's just write it off.

Doctors hate Aetna.

You really need to get your head around your insurance. You can find some information online and in your books, but you should also check to make sure you are seeing the right doctors, i.e. 'in network' and not someone outofnetwork who is costing more. You may want to talk to the HR person in your company who may know more about the plan and procedures. 30 minutes one day might save you several hundred down the road.

Good luck.

Rete

Also see if your husband's company has a flex spending plan. This enables you to specify how much you want to have taken out of your check each check and put aside for pocket of out healthcare costs, i.e. co-pays, aspirin, tampax, deductibles, etc. It is taken out before taxes are calculated so if will save you some money.

Michael

I had Aetna a while back and they were nothing but great. All insurance companies pay a certain amount for precedures and if the doctor agrees to be in the network, they must accept the costs that are set by the insurance carrier.

I have never been charged one cent more for the procedures than the co-pay indicated even when I went to even specialists as long as they were in the network.

ChocolateBabz

Have been reading docs again for the past hour and think I have it figured out. I have a PPO plan and can choose any doc I want but in-network will be much cheaper. The doctor I have been using is definitely in-network. She trained in Edinburgh so I have a soft spot for her being a Scot.

Our 'family' plan is costing us $261 per month and according to info from company they contribute $485 per month.

We have an annual deductible of $250 for an individual but $500 maximum for the family so we won't pay more than $500 per annum.

Then we pay 20% co-insurance up to a maximum of $1,500 per individual or $3,000 max for the family but our deductible is also subtracted from this so really the amounts are $1250 individual/$2500 family.

Can't believe it's taken me 8 months to get around to really looking at this. Do these figures sound reasonable to others? Hate to think we are being diddled cos we are newbies and don't know the system.

Michael

The only thing that seems wrong is that if she is in-network, she should not be able to charge you more than the co-pay amount. If she can, then your maximum out of pocket amounts would probably be more than stated in your plan.

I would talk to the doctors office to see why this is occuring and if they plan to continue to do that, I would change doctors

AmerLisa

All I know about ours is that we pay about $98 a month premiums and have (it went up a $100 from last year) a $2300 deductible per person to meet before we get to pay a small co-pay to see the doctor. The only good thing is that the doctor's fee is discounted. Oh and physicals are 100% covered. OH and the real big biggie......we have to meet that deductible before our prescription coverage kicks in.....so heaven forbid we don't get sick enough.....

Duncan Roberts

Are you sure you don't ave a copay as well? Also, what services count towards your deductible? That might explain a few things.

Mummy in the foothills

It isn't that unusual for a hospital/doctor to send stuff to collections without trying to collect first.
I had a $200 hospital bill (I had no idea at the time how much I owed) the hospital never billed me, I waited as that same hospital has taken at least 3 or 4 months to bill in the past. Two months after treatment I get a collections letter I called and asked about it, said it would have been nice if they had billed me so I could have paid it, I'd been waiting. The collection agency said I was one of many who had said the same thing, the hospital apparently just sent everything they had to collections that month, never billed anyone Idiots. I paid and I never heard another word.

tamms_1965

I have also been sent letters by a billing service saying I never paid the expected copays. Seems the billing lady at my doctor's office is a total ding dong. She wasn't always inputting the "PAID" into the computer and the billing service didn't know any better when they were "reconciling" the accounts at the end of the year. I always paid with a debit card and had proof on my bank statements so all was good. But I got 3 separate letters for 3 different visits.

Another recent situation was I kept getting a bill for an x-ray which comes out of the deductible portion of our ins. I called them and find out that they are about 4 weeks behind inputting payments yet they have time/money to have the printer spit out bills and mail them without even knowing if they've been paid or not.

So OP, make sure your bill is not being paid 2x. Rant over.

cindyabs

I had that with my dermatologist (I get a yearly check up for skin cancer). They had done a biopsy on me in April and in December I get a threatening letter about the money due for the biopsy. First I had heard that I owed anything and told them so. Seems they were a "bit behind." A bit- 8 months??? DOH!