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Insurance..arggggg!!

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Crohn's Disease
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Posted 4/13/2012 8:04 PM (GMT 0)
I just spent 5 HOURS on the phone between the hospital, insurance company and my doctor's office trying to figure out my payment for the Prometheus TMPT test. I called about a different bill and asked why I didn't get a bill from the hospital yet. I was told they were appealing it and if it got denied (which it was), they'd send me a bill for $1200 that the hospital charged shocked . So hospital told me to call insurance. I call insurance who says basically it's denied, file an appeal and call the hospital. So I call my doctor's office just to figure out what's going on. They tell me I'm supposed to get a bill from Prometheus for like $250. So I call the hospital again (really just because I was mad and wanted to yell at someone skull ). This time they say they're filing an appeal with insurance and they'll write off the balance if it doesn't get paid. Um, what? Five hours of runaround and headache for that. Why couldn't they just say that at the beginning?

I'm beyond confused and really mad, but I figured you guys would understand. It's incredible how much we have to be our own advocates with this disease. Like we didn't have enough to worry about with being sick!!
Posted 4/13/2012 8:15 PM (GMT 0)
I hate the whole medical billing system, and I think what goes on with regard to the shuffling of paper back and forth costs a ton of money. I just heard on the news earlier in the week how the business of medical billing has grown so much in the US that a single DR needs like 10 employees just to keep up with insurance filing requirements, and that there's a whole subindustry of coding so that DR's offices can charge for every single thing they do. Not that I want my DR to go out of business - it's just the nature of the beast.

I get a regular monthly statement from the breast care center where I get my annual mammos. Every month it tells me that I have an outstanding balance of several hundred dollars, but that I should not send in a payment. What is the point of the whole thing? Just keep your paper until you want me to actually pay you!

And yes, if you are covered under insurance, the hospital typically writes off the difference btwn the price they negotiated with the insurance company and you. You should never pay a medical bill until you get the final EOB from your insurance company, and then you should read it and only pay what the INSURANCE company says you owe.

Every procedure that we get in the US now comes with like 3 separate offices billing you. The anesthesiologist bills separately from the hospital. So does the lab. And your DR. Each one has a different filing system and rhythm, so the EOBs trickle in at random times. And if there's a denial the whole thing can blow up in your face. I once got a call the morning of a CT appt that the thing was not approved and I shouldn't show up. So I didn't. It took the imaging facility and my DR another week to communicate with my insurance company so that they understood why I needed a CT. Ugh. And when I finally got the bill for that one thing - I got three bills. Radiolologist, imaging facility, lab.

so messed up. Sorry for griping all over your post. You hit a nerve, I guess.
Posted 4/13/2012 10:59 PM (GMT 0)
I was in the hospital in January and I'm still trying to sort out all of my bills. My Blue Cross messed up in the computer concerning my deductible, and I have had to be on hold at least five times for about 45 minutes each time to try to get it straightened out. Like Kaz said, I have bills from so many different places, that it's hard to tell if I am being billed properly...it is unbelievably time consuming and frustrating! I'm well organized and relatively intelligent.....I feel terrible for folks who struggle cognitively...I don't know how they sort all of their bills out!!!!
Posted 4/13/2012 11:01 PM (GMT 0)
BTW, I also had the TMPT blood test. I came out good and I still ended out with elevated liver enzymes from the 6MP. That test didn't end out being worth it for me, anyway
Posted 4/14/2012 1:05 AM (GMT 0)
Yeah, it's incredibly frustrating. My mom used to work for an insurance company, so I know some codes for Crohn's and test codes and how billing works. It drives me crazy that when I try to "speak their language." Sometimes they don't know the codes.what things are for and it drives me nuts.

@gumby - I think I had the TMPT a loooong time ago and had the same thing. I was more interested in taking the test to make sure I'm in a therapeutic range with Imuran since I had surgery just under a year ago. I will pay anything or fight with anyone to help prevent that from happening for a long time!! I hope your hospital bills get sorted out soon! It's amazing how you start getting so many from so many different places as soon as you get home from the hospital!
Posted 4/15/2012 2:36 AM (GMT 0)
it's times like that that I am glad to be under the public system ;-D good luck guys!
Posted 4/16/2012 3:55 AM (GMT 0)
I'm eating my words :-(
Posted 4/17/2012 4:16 AM (GMT 0)
Sounds stressful, tooth, but try to stay as calm as possible. True, that we often have to be our own advocate in this illness. Don't give up. It will work out in the end.

Good luck!
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