OnwardandUpward

Having gone through 8 weeks of bureaucratic and computer hell ( detailed on another long boring thread ) to purchase health insurance from healthcare.gov then set it up via United Healthcare company I thought we were on track.

GP refers me to gastro-enterologist, suspect stomach ulcer. Call United HC and confirm gastro dr is covered. After all the mix-ups I get it in writing via email which doctors are covered now so if they refuse to pay later I have proof ( what a way to have to operate! )

See gastro doctor who says I do indeed need endoscopy procedure to check for stomach ulcer. Appointment set up with local surgical centre.

Called me back- they won't take my insurance.

Appointment set up elsewhere for later this week.

Called me back today- not only will they not take my insurance- NO ONE will for this particular procedure!

Receptionist said 'you must check when you ask about a specialist what procedures your health insurance covers'....does that even make sense??? How can I know what procedures will be recommended?

And if such a common procedure has no local hospital or surgical centre willing to take my insurance, what does that mean exactly- I have a book saying what's supposed to be covered but it makes no difference if there's no hospital or clinic will provide it via my insurance.

Was going to just pay but it's $750...$250 for the sedation, $500 for the camera procedure.

I'm in one of the largest cities in the US with literally thousands of doctors and medical facilities by the way!

It would all be laughable if it weren't so frustrating, and I suspect for many people- life threatening.

Suppose tomorrow I'll be spending 2 hours on the 'phone trying to sort it out.

I do hope my writing it helps anyone else who is going through all this realize they are not alone!!!

jb82

I'm sorry for your trouble especially when what you want to do is just get it taken care of.

Healthcare bureaucracy in the USA is enough to send anyone back to another country.

A couple of months ago we got a bill from the hospital for maternity services that were covered by insurance. Now bear in mind my daughter is 3 years old already! My wife's insurance had changed since then and I found out the company had recycled the insurance number to someone else or something like that so when I sent the details to the hospital again it was rejected! I had to liaise with several different companies so that everyone was on the same page. Eventually got it sorted out but it was a lot of work that we shouldn't have had to go through.

Then recently I had to visit the ER and ended up with several notices stating what my bill would be when they got round to sending it to me and then received the numerous bills all spaced over a year. I never could work out if they over charged me or not with each separate part of the hospital, radiologist, doctor etc claiming an amount separately. Except I knew that $1 bandage they billed $12 for wasn't fair!

kins

Have you called United Healthcare and asked them to suggest a facility where you can have this procedure carried out, covered by insurance?

OnwardandUpward

Congratulations on your baby jb82!

When I was self-pay I've received separate bills for facility/ equipment/ doctor etc but this is my first experience of your doctor is in network, the hospital is in network, the procedure isn't...

I'm hoping it's yet another bureaucratic mistake, because the year is ticking on and I still haven't got anywhere near proper treatment ( my GP says I have to go through the process of fixing these other things before I can have surgery/ additional diagnostics )

'Healthcare bureaucracy in the USA is enough to send anyone back to another country.'
( jb82 )

Yes, anyone with healthcare needs would be ill-advised to move here unless they are certain they will get good employer support or they can afford to pay. When I had good insurance and support for the first few years ( one employer even covered something they didn't have to for my child ) I had no idea how things really worked; or that everyone's insurance quality and benefits would subsequently be eroded year on year.

scrubbedexpat099

How do you know no one will take your insurance?

Presumably the ones that you have talked to will not do the work for the remuneration payable.

OnwardandUpward

Maybe.

The gastro-enterologist admin called me and said she couldn't find anyone.
It seems quite bizarre really, the more I think about it.

I'll call United HC and see what they have to say ( 'but it's on my list' probably ) and then I suppose I'll have to go back to the GP and have her refer me to someone else or see if there's an alternative procedure.

I really don't want to have to start paying for stuff I've bought insurance to cover!

scrubbedexpat091

Can you pay yourself and seek reimbursement from your insurance company?

This is another example as to why I could not deal with the US again, the health insurance system is a total and complete nightmare.

Move to Canada... you'd get that procedure with no direct out of pocket cost in most provinces.

Giantaxe

United Healthcare has a pretty thorough website that you can search on for doctors/facilities covered by your insurance. Not sure why the OP wouldn't use it.

OnwardandUpward

*Sigh* That is my point- I checked with the website ( and also called for an email printout ) prior to arranging all this. I insist on it now otherwise I suspect down the line I will be getting letters saying 'this is not covered'. The admin at the specialist checked when the appointments were set up and called around for me afterwards when those two places called back and said they weren't going to take my insurance. According to the website both places do.

It's SUPPOSED to be covered- then isn't. Same thing happened with 6 primary care doctors allocated before I insisted the operative called whilst I was on the telephone and made sure the GP I have now would actually take the insurance/ accept new patients.

'But it's on my list...' is what the insurance operatives say- not much use if the lists are not up to date or if the doctors refuse to take more patients/ accept 'obamacare'.

'This is another example as to why I could not deal with the US again, the health insurance system is a total and complete nightmare.

Move to Canada... you'd get that procedure with no direct out of pocket cost in most provinces. ' Jsmth321

It's crazy.

Trying to treat it with equanimity, at this point my 'horror stories' are just frustration and inconvenience- there are people who are going bankrupt and worse.

LOVE Vancouver, I can apply to live there as self-employed. Maybe later when my son is fully grown up- something to look forward to!

Giantaxe

You OP makes no mention of checking online to see whether the surgical center was covered by your insurance so how are we readers supposed to know?? You wrote:

scrubbedexpat099

I guess they just show that they deal with that Insurer but do not specify which plans they take and which they do not.

OnwardandUpward

Seems that way.
When you log into the website it lists your specific insurance alongside the doctors/ hospitals available; but I did call and never thought to ask if a specific procedure would be covered. Also when appointments were first set up the admin called and checked each time and at first it was supposed to be ok. I don't get it but I'll try to work it out later. The telephone operators are looking at the same info as me/everyone else so at first will say yes it's covered so you have to ask them to call and check whilst on the line.

It's all quite protracted since sometimes it's hard to get through to UHC then they have to get an answer from the admin at the particular service provider.

I guess it's common though- when I saw the gastro dr I was waiting for my appointment and a couple came in who were told to pay full amount, rather than copay, the man said he had just called UHC that morning and was told insurance covered it- not so according to the administrator.

OnwardandUpward

I guess it's made me a bit anxious as I couldn't sleep!

jb82

Hope you get it sorted soon.

notonuksoil

We are with United Healthcare through my OH employer. In January my daughter needed to visit the dermatologists, as usual they wanted to check our insurance was up to date. They asked who our insurance was with and I replied United Healthcare and the next question was " did we purchase it through an exchange" I said no however being curious I asked what is the difference and was told they don't accept United Healthcare it if it was purchased through an exchange which I thought was odd at the time.

Reading OP comments it appears our dermatologists are not alone in this.