Like sequ said. I have always been told that preapproval is a guarantee of benefits, not of payment. Usually upon that guarantee the facility will accept what they estimate you will have to pay after insurance pays their part, as a gesture of good faith. This does not negate your obligation to pay the debt if insurance fails to pay. On the other hand, like S y said, things get mis-coded all the time. I have had claims that have needed to be resubmitted 3-4 times before the coding was right for the system to accept it. Also, even if your primary insurance denies it. your secondary insurance may pick it up and pay most or all of it. And if your primary insurance denies it maybe it will go towards your deductible if it was after the first of the year. Althought it doesn't sound like it since you've already gone a couple of rounds with the insurance.
Ask for a case manager at your insurance company. Usually you get better service that way. It's usually an RN who will look over your file and determine if your tests are necessary. If you don't get help there you can file an appeal with the insurance company.
Thanks 2Blonde.
Whatever the case is ... The test was necessary. Plus, my doctor's office told me my insurance approved it days before I went to the hospital. The hospital told me that my insurance approved it when I arrived. And perhaps I would have opted to put off the test if they made me sign anything saying that I had to pay if my insurance didn't.
So, I'm going to do whatever I need to do not to pay it. I don't pay over $330 per month to be shafted.
Sorry, read the original post. I didn't pay the $45 .. it wasn't a co-pay, it was the balance and they billed it to my secondary insurance.First like stated above fax your insurance carrier your medical bill with 45$ co-pay on it. And the letter saying if your not approved you pay in full upfront as thats some kind of proof although weak that they approved the test. Since you paid the 45$ if you don't have that reciept get a bank statement or credit card statement showing the payment.
I agree. You shouldn't have to pay a dime. Usually if you keep calling them enough and are firm but nice and they see that you aren't going to let it lie then they come around. It also helps when they know you are intelligent enough not to take their usual BS garbage that they throw at the general public. The case manager thing has always worked for me because then I get one person who I can talk to multiple times and build a relationship with and it helps because then they will go to bat for me with their superiors. Just a thought. Good luck.
I hope you get some answers and cures soon.
Thanks I'll call them on Monday (or Tuesday if they are off for MLK).
No, you aren't an idiot. I figured you were reading the end of the thread moreso than the beginning.
Anyway, I have faith it will work out.
Thanks for everyone's input.
Sequ - I still want to know why you say that Unicare isn't "traditional insurance".
Kori, I really can offer no helpful advice, (got burned by Humana, whom I have no fond feelings for) but all I can say if fight it. For whatever it's worth, we'll be here.
Unicare, depending on the plan, can have a WIDE variety of reimbursement procedures.
We never accepted Unicare or tried to contract with them because their approval process and reimbursement process was different than everyone else.
Usually, there is copays, a deductible, a coinsurance and thats it. It's pretty easy to figure out based on percentages, but for some reason Unicare was impossible to collect from or figure out what they were going to pay for. In fact, all of our Unicare claims were paid by the patient and they were asked to collect from their own carrier or sent somewhere else.
Weird. Mine is a straight forward PPO with generally the same rules as the BC/BS PPO that I had in California. I never have had to handle my own claims.
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