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9 Secrets Health Insurers Don’t Want You to Know

health.com — Health insurance companies like to keep secrets. And they like to save money. Example: You have surgery, and weeks later you get a bill for using an out-of-network anesthesiologist. Ridiculous, right? You didn ’t choose who put you under, so you shouldn’t have to pay extra. But your insurer sent the bill anyway, hoping you wouldn’t notice.

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  • rpi22, on 02/06/2008, -33/+5#1 ) you're doctors don't know sh*t
    • Zarokima, on 02/06/2008, -6/+28And you don't know ***** about grammar.

      The word you should have used is the possessive "your," not the contraction "you're" meaning "you are."
      • borez, on 02/06/2008, -6/+14You went with a grammar correction?
        • pschommer, on 02/06/2008, -2/+16Damn straight. The first word of the first comment is incorrectly used. Great start.
      • Goldfire, on 02/06/2008, -1/+0Actually, the grammar is correct, or at least permissible; it's the usage that's wrong. ;)
    • docbob84, on 02/06/2008, -2/+4Yeah, you're right. You can get all the health information and treatment for any problems off the Intarwebs. Hope the tubes aren't clogged for you when you're sick though... Anyway, you might be more interested in LIFE insurance than HEALTH insurance. I'm sure your family will be, so they can at least get some money from your stupid ass after you kill yourself by not going to your stupid doctor when you're sick.
    • Rikkochet, on 02/06/2008, -2/+6MY doctor went to medical school for 8 years to achieve his PhD and become a general practitioner. He's immensely qualified in a wide range of human medicine.
      What the ***** do *you* know?
      • lex0nyc, on 02/06/2008, -5/+1He plays a lot of golf.
      • InfiniteNothing, on 02/06/2008, -2/+3While your doctor may be smart compared to an average doctor or the general population, I would say the entire spectrum of human knowledge on the complex biological systems comprising the human body is limited.
      • tightscrummy, on 02/06/2008, -0/+5Er, your doctor most likely does not have a Ph.D. He has an M.D.
        • docbob84, on 02/09/2008, -0/+0If he went for eight years, he most likely has both.
    • staticoranges, on 02/06/2008, -3/+5#1 ) you are doctors don't know sh*t
      wow. just wow.
  • Crimsoneer, on 02/06/2008, -4/+75Secret from me: the point of insurance companies is to make money. If they can rip you off, they will. Expect it.
    • obliviousfool, on 02/06/2008, -5/+35The ideas of making money and providing health care seem fundamentally opposed to me. I don't know why we put up with health care structured around profit instead of health care structured around health care.
      • bieber, on 02/06/2008, -15/+5Because we're not dealing with just one massive health entity that's guaranteed business no matter how badly they try to screw their customers over. Private health care means competition, which by definition forces all the firms involved to offer the best services they can (ever looked at just _how many_ different specialist doctors there are in your local phonebook, usually with multiple doctors per specialty?)
        • saranagati, on 02/06/2008, -1/+15the problem is that they can offer you low premiums however when the time comes to pay the hospital bill they don't have to pay it leaving you with the bill and them with the premiums you've paid. Then when you try to sign up with another insurer they'll deny you because of whatever ailment sent you to the hospital. It's kind of like hiring a personal security firm, the only people who can recommend them are the ones still alive, most of which will have never had an attack on them however, all the dead people the firm failed to secure can't complain about their service.
        • captinherb, on 02/06/2008, -0/+8The difference is that the consumer, the patient, isn't the same one who choose the provider. Since people's employer usually choose the insurance company they go with the cheapest one or the one that treats *them* the best. Then the employee has the headache of trying to get them to cover a claim.
        • brufleth, on 02/06/2008, -1/+4You're competition model breaks down when it comes to health care. Health is a good unlike sneakers or cars. You can't test drive a insurance company. Either way it isn't like insurance companies are competing to make less money. They make money by collecting premiums from healthy people. A sick person is more likely to miss work or lose their job all together and an insurance company isn't going to continue covering them even if they've paid premiums for decades.

          It'd be great if health insurance worked but in the US, where almost all health insurance is private, we pay more per capita and more GDP than any other country for health care. Health care costs are one of the most popular reasons for bankrupsty, and our health care is still ranked poorly relative to other developed countries.
      • simpleblob, on 02/06/2008, -0/+2Private hospital versus Public hospital?
      • Swivelstick, on 02/06/2008, -0/+8Because anyone who wants to change the health system in the US is deemed a socialist or people decry not from my tax dollar. When the fact is they pay more from their tax dollar then most if not all of the countries that do have universal health care.
        • brufleth, on 02/06/2008, -0/+5Exactly. And to clarify, we in the US do pay more per capita and more GDP than any other country on earth for health care. So if you have health insurance now then you almost certainly lose more of your income to health care than citizens of any of those countries with socialized medicine.

          The cry of "not my tax dollars" is based entirely on propaganda. We over pay for sub standard health care already.
        • obliviousfool, on 02/06/2008, -0/+1The really sad thing is that a big chunk of our taxes go to paying interest on the national debt. Instead of actually getting something for our money, we get taxed for someone else's bad fiscal policy.
      • TypeEE, on 02/06/2008, -0/+1how?
    • jgzman, on 02/06/2008, -3/+17Ripping people off is not acceptable business practice. If I am paying for a service, I should pay a fair price, and get fair service. The relationship with my insurance company should not be adversarial, but cooperative.
      • TomK88, on 02/06/2008, -1/+20The only responsibility a corporation has is to its shareholders. It's all about the bottom line. Hence why essential services should be socialized. Police, fire fighters, and medical care.
        • kingmanic, on 02/06/2008, -0/+18Seconded. The rest of the western world has, why hasn't the states? because the insurance lobby has a lot of money. They are trying to muscle their way into Canada and that is just plain stupid. Wait 15 years every problem with the Canadian health care will resolve itself. Wait 15 years and the US will still be a monolithic mess.
          • nick111, on 02/06/2008, -0/+13Because so many people in the US are utterly brainwashed - if you mention any word starting with "social" they start going on about Russia and get all angry and abusive

            It's purely a pavlovian response... which is ironic really, as pavlov's dog was in fact Russian.
        • Pinkertinkle, on 02/06/2008, -2/+3Can we socialize gasoline too? The oil companies make much more profit than insurance companies and I really need cheaper gasoline.
        • Rakuseki, on 02/06/2008, -3/+0Because it's alright for our government to mandate just how much a doctor can charge his patients for his services?
        • jgzman, on 02/07/2008, -0/+1A corporation is also responsible to its customers.
      • Pinkertinkle, on 02/06/2008, -0/+1Yup!
      • brufleth, on 02/06/2008, -0/+4You're living in a fantasy. Your insurance company makes money by collecting premiums from you when you're healthy and not costing them anything. When you get sick you become a less appealing customer. If you get really sick or require any expensive treatment then you start actually costing them more than they make off you. Why would a company have any interest in keeping you as a customer at that point?

        The capitalistic model breaks down when you look at something like health care. It just isn't in a companies best interest to keep paying out for you if they can find some way of dropping your coverage instead. It isn't evil it is just how a company works if they want to stay profitable.
        • burrgrinder, on 02/06/2008, -0/+1If that's the case, why do we have insurance at all if they'll drop us or screw us at any given chance? Why not just a financial holding company where you deposit your money you'd normally be spending on insurance, that way we know up front how screwed we're going to be when the hospital bills us for 70 grand?

          If they're not going to actually act as real insurance, there is no motive to use their services.
        • jgzman, on 02/07/2008, -0/+1They sign a contract stating that they will pay for my medical expenses. In addition to the legalities, they represent to me that they will cover my medical. If they fail to do so, they are violating either the letter or the spirit of our agreement, or both.
          Again, it is totally unacceptable to operate a business this way.
    • angelkinz121, on 07/14/2008, -0/+0I worked for Highmark and now I work for UPMC which are both very big health insurance companies in PA. Everyone thinks that it is the health insurance companies that bill you and it is not! It is the provider that you see, the dr's office, the hospital's where ever you may have went. The health insurance company doesn't get any of your money at all, the providers get your money. All your copayments and your deductibles, and coinsurance go to the providers. the only money that your health insurance company gets is your premiums. AND THATS IT! The health insurance company doesn't bill you for your visits. All you should get from them is your Explanation of Benefits, and that will tell you if you owe the provider anything, and you should look at these because the providers try to over bill you for things that they aren't allowed to. So my advice to you is contact your health insurance company if you have questions about a bill, and alot of times, they will call for you and talk to the providers, especially for older people they call. I don't think people should post things that they don't know what they are talking about, your giving false information, and its not helpful at all.
  • daxsymbiont, on 02/06/2008, -5/+13they are business and the fundamental reason of existence of a business is profit.
    • aznhomig, on 02/06/2008, -1/+2Explain me this: helping the patient to live or letting them die because it costs the company some money?

      Seems somewhat skewed to me.
      • daxsymbiont, on 02/06/2008, -1/+4they let them die in several documented occasions.
      • TypeEE, on 02/06/2008, -0/+3As long as they won't get sued, because that will cost the company more.
    • angelkinz121, on 07/14/2008, -0/+0Most health insurance companies are non profit.....I worked for Highmark and now I work for UPMC which are both very big health insurance companies in PA. Everyone thinks that it is the health insurance companies that bill you and it is not! It is the provider that you see, the dr's office, the hospital's where ever you may have went. The health insurance company doesn't get any of your money at all, the providers get your money. All your copayments and your deductibles, and coinsurance go to the providers. the only money that your health insurance company gets is your premiums. AND THATS IT! The health insurance company doesn't bill you for your visits. All you should get from them is your Explanation of Benefits, and that will tell you if you owe the provider anything, and you should look at these because the providers try to over bill you for things that they aren't allowed to. So my advice to you is contact your health insurance company if you have questions about a bill, and alot of times, they will call for you and talk to the providers, especially for older people they call. I don't think people should post things that they don't know what they are talking about, your giving false information, and its not helpful at all.
  • lucutus, on 02/06/2008, -8/+17learn to fight these scrooges people. A letter of appeal, contact with your state comptroller, Knowing who to call or write can all help. My own father was employed by the state for the very purpose of making sure insurance companies pay what they owe. As a result I was able to craft a letter to my own insurance company after being denied ER coverage for what turned out to be "non life threatening" and since then I've not even been billed for a copay in 7 years. If they think you know what's up they won't mess with you!!!
    • lucutus, on 02/06/2008, -3/+3amazing that the truth gets dugg down.
      • mmmmmbiscuits, on 02/06/2008, -1/+4No, for me it was just too hard to believe that "since then I've not even been billed for a copay in 7 years." How many doctor visits have you had since then? Most doctors collect copay at the time services are provided regardless of what the insurance company says. You really think you're on a special secret "do not charge this guy!" list?
        • lucutus, on 02/06/2008, -0/+1Sorry I should be more specific. I have not been bill a copay for an ER visit. We've been the the ER 4 times since then.
          • mmmmmbiscuits, on 02/06/2008, -0/+1Ah, thanks for coming back to clarify.
    • kingmanic, on 02/06/2008, -2/+8"If they think you know what's up they won't mess with you!!!"
      Why do 300+ mil people insist on living with such crass health care? Why do you need to bluff a company to do what you pay them for? Why do you need to tell white lies and half truths to ensure you don't get sick or die?
    • DrSin, on 02/06/2008, -1/+0As true as this may be, it is a sick sad state of affairs that we the proletariat are forced to jump through these hoops and battles in order to get what we were promised and what we have paid for. Health insurance. I am not a fan of socialized medicine, but the status quo makes it look real good.
  • Landeyda, on 02/06/2008, -10/+89The fact we allow profit-seeking businesses to decide our health as a nation is completely sickening.
    • EXreaction, on 02/06/2008, -12/+7If you want UHC, you are a socialist, evil, terrorist hugging communist!

      // They pay me to say it.
    • Intangible360, on 02/06/2008, -8/+14No kidding, I honestly had no idea you guys had it that bad, I'll take Canada's health care system over yours any day of the week.
      • TypeEE, on 02/06/2008, -0/+1Canada's system is more moral but listening to my parents complaining pay check after paychecks about how much government takes away is bad as well.
        • masterofshadows, on 02/06/2008, -0/+2some of the countries with socialized medicine take away one half of a percent, if you are getting that much taken away your making a ton of money anyways.
    • Trav3133, on 02/06/2008, -2/+4Better go see a doctor then.
    • active1x0, on 02/06/2008, -11/+6I don't think any of us are denying that the system needs wide reform to put patients back in charge, but for crying out loud people, your answer can't be to put the GOVERNMENT in charge of it!!! Please explain that logic.
      • alwilson, on 02/06/2008, -2/+4Well, since privatized medicine has been a complete failure due to the skyrocketing prices, maybe the government can do a better job by regulating it? Seriously, two of the major things that are screwing the economy is healthcare and the cost of gas. I think the government should control both, because the private sector is ripping off the consumer.
        • blast_flame, on 02/06/2008, -0/+3We do not in fact have a private healthcare system. It is already mostly government controlled. For instance over 50% of all money in healthcare is already spent by the government.
    • cbuddha42, on 02/06/2008, -16/+3The company isn't in charge of your health care. You are. You pick the company, you pick the policy, you pick the doctor, you sign off on the procedure, ect. If you can't afford it and haven't contracted with an insurance company to pick up the bill for you, then tough luck. You can't pay for the cookie, you don't get to eat it. Just because health care can save your life doesn't mean it should exist outside of the capitalist system, you have to justify why it should. (Ex. water is also necessary for life but those bottles of Dasani aren't free are they?) All the gimme gimme, I'm entitled to it, ect whining is getting annoying.
      • Rikkochet, on 02/06/2008, -1/+13Why say more when "I hate you" pretty much sums it up?
      • thebellmaster1x, on 02/06/2008, -1/+10"You can't pay for the cookie, you don't get to eat it."
        Healthcare is the one of the most basic of all human rights, and you are simply a disgrace for suggesting otherwise.
        • blast_flame, on 02/06/2008, -0/+1The problem is that violates two other fundamental human rights. Firstly that means that someone has to be forced to pay violating their right to work in exchange for good and if no one wished to be a doctor you would have to force someone to be one, making them slaves. So called 'positive' liberties don't work only so called 'negative' ones do.
      • kingmanic, on 02/06/2008, -1/+8The problem is, you pick a good plan. You pay your premiums. You get sick. They will attempt to do what ever they can to renege on their end. If it wasn't this way then the system might work, the US might not be 19th on the big list of average lifespans, infant mortality might not be the bottom of all developed nations, and medical costs wouldn't be the leading cause of bankruptcy.
        • InfiniteNothing, on 02/06/2008, -1/+2I can verify that. Anyone get the "Usual and Customary Fees" shpeel on emergency services? It sucks.
        • blast_flame, on 02/06/2008, -4/+1Yes and I am not defending the currant American healthcare system but universal healthcare is not the answer.
      • sk11, on 02/06/2008, -1/+2"Some men aren't looking for anything logical. They can't be bought, bullied, reasoned or negotiated with. Some men just want to watch the world burn."
    • eFiniTi, on 02/06/2008, -10/+4You want to know sickening? Try letting our ***** politicians run our health care.

      Sure our current system isn't excellent, but national health care is a horrible idea. What happens when you receive bad health care from your current provider? Switch. Now what happens when you receive bad, mandatory health care from the government? You keep paying taxes for it and hope you can afford a better service.

      What about those of us that are cool with our health care providers and don't want government health care? I hope we're not going to be forced to pay for ***** we don't want or need.
      • kingmanic, on 02/06/2008, -1/+4No matter what you do a dip ***** bureaucrat will run your health care. It'll be worse then the politician because a politician has to worry about optics. A bureaucrat worries about nothing. So it's either a corprate paper pusher or a government paper pusher. The only difference is the 66% the corporate one skims off the top of what you spend and the 20% the government one wastes by being inefficient.
        • blast_flame, on 02/06/2008, -1/+1If their was real competition and not so much government involvement then that would not be the case.
      • InfiniteNothing, on 02/06/2008, -1/+1If doctors are in control of health care and you don't like your health care, just get a different doctor. I don't see why the government would get a say.
      • Luminoth, on 02/06/2008, -1/+2Does wishing a long term, expensive medical condition not covered by your insurance upon you and your family make me a bad person? A little perspective goes a long way in these sorts of issues.
      • dood, on 02/06/2008, -1/+3"What happens when you receive bad health care from your current provider? Switch."
        That doesn't make any sense. Let's say your health care provider just told you you have some form of treatable cancer, and your insurance company will not pay to have it treated. You can't just switch to another insurance carrier -- they're not going to treat you, either, because it's cancer or because it's a preexisting condition, or any number of other reasons.
  • borez, on 02/06/2008, -10/+5cough...NHS..cough
    • chicagospur, on 02/06/2008, -4/+8Go into an NHS hospital with a cough, come out with MRSA.
      • borez, on 02/06/2008, -0/+2I actually laughed out loud
      • borez, on 02/06/2008, -6/+1FYI: MRSA = 25 per million population

        Citation: http://www.statistics.gov.uk/StatBase/Product.asp? ...

        Pure press *****
        • chicagospur, on 02/06/2008, -0/+1Over 2,000 deaths relating to MRSA in 2005 alone. No figures yet for 2006 and 2007, but they are going to be higher, based on the trends shown on the site. There are no numbers for people who contract MRSA but don't die.
          When you go to hospital, you are supposed to get cured, not contract another disease that will potentially kill you.
          • borez, on 02/06/2008, -2/+1You break your arm, they'll fix it for free. The rest is up to you quite frankly.

            There's a lot of hypochondriacs in the UK ( who don't know which side their bread is buttered on ), that's all I have to say on this subject thx
        • docbob84, on 02/06/2008, -0/+0Check out a hospital some time. You know the rooms they don't let anybody, including nurses and docs, without a gown and face mask? They're called isolation rooms. About 80% of them are isolated for MRSA, trying to keep the hospital staff from getting contaminated. Unfortunately the staff are busy and don't always wash their hands religiously. The result for you? Yes, maybe only 25 in a million have MRSA among healthy people. A LOT more (I've seen up to 25 PERCENT in the hospital I work with) of people in the hospital get it, and in a forty year career chances are pretty great that a nurse or doc will get it. It is a problem, it is caught in hospitals. It's not going to become a plague, but it could well get to a point where the average inpatient is kept in the hospital two more days than they would have, just because they got a staph infection. I know it's not related to insurance, sorry for the comment abuse, but PLEASE make sure you WATCH your docs or nurses wash their hands (the alcohol stuff is even better) before they touch you if you ever stay in the hospital.
      • Luminoth, on 02/06/2008, -0/+3Oddly enough, it's becoming a larger and larger problem in the US as well. The practice of prescribing antibiotics for everything under the sun combined with people's complete lack of the ability follow simple, finish your medication instructions (as well as the rampant germophobia that seems to be taking over) probably has much more to do with the problem than anything NHS related.
    • mikehrp, on 02/06/2008, -1/+2Over my dead body. Literally.
  • richfarr, on 02/06/2008, -8/+10Health insurance in the US makes me sick. It seems to me that the best insurance is no insurance. At least then when the bill comes there is a real reason to not pay it. Plus, if you dont have health insurance and decide to pay the bill out of pocket, you will be charged a quarter as much as they bill the HMO's if you call and ask for a I have no insurance discount !
    • Akairenn, on 02/06/2008, -4/+3Quite. The only reason I have insurance at this point is because I get it dirt cheap through my job. Before that? Uh, yeah. Spend thousands of dollars per year, instead of a couple of hundred (yeah, the yearly checkup, dental checkup, eye exam and couple of boxes of contacts aren't that expensive). All on the off chance that I get sick - but not too sick, because at that point, I'd be boned anyway. Yeah, no thanks. And they wonder why so many people between 18 and 30 choose not to buy into the insurance scam.
    • bxblox, on 02/06/2008, -2/+4Unfortunately, paying out of pocket isnt a reasonable option in the US. Medical procedures will cost more than many people make in a lifetime ,without insurance. If you're diagnosed with disease and have no insurance just consider yourself dying.
      • pendrachken, on 02/06/2008, -3/+1why? hospitals are REQUIRED to treat life threatening conditions, hell you can get surgery performed and make payments on it ( I personally know a guy that had both of his knees replaced and payed the hospital 25$ / month! ) not to mention if you make only a moderate income the average bill reduction after speaking with the hospitals patient advocates is 60-90%. when I didn't have insurance I paid 3$ for my 30$ allergy shots.
    • ScottAbram, on 02/06/2008, -0/+3richfarr, you must not follow the subject closely. Uninsured and "self-payers" pay at a significantly higher rate than the insurance companies. Read here for just one article of many that confirm this: http://www.jhsph.edu/publichealthnews/press_releas ... Tax write offs are one reason hospitals reason hospitals overcharge cash payers (who the hospitals mostly rightly assume cannot afford to pay even at most favored insurance rates), so the inflated charges make better bad debt expense deductions on their taxes. I have long argued to friends and family that the uninsured/cash payer should get "most favored insurance" rates from hospitals. That would be a decent "first step" to making health care affordable to a larger segment of Americans.
      • pendrachken, on 02/06/2008, -1/+2oh so wronge, see my post just above you...
    • docbob84, on 02/06/2008, -2/+3The wonderful part of free market healthcare is, even though they are non-profit, most hospitals do NOT have to provide every service if they know you can't pay. You come in after a car accident with no insurance, yeah, we'll fix you up. You come in with kidney failure and want a kidney? Well... in my opinion, that's evidence of natural selection right there. Why should I pay for a several-hundred-thousand dollar operation out of my pocket if you can't be bothered to get health insurance? A hospital's not going to eat the cost of the operation that would give you maybe thirty more years to live; they're going to eat the cost of hospice care for your remaining week or so.
      • alwilson, on 02/06/2008, -0/+1"You come in with kidney failure and want a kidney? Well... in my opinion, that's evidence of natural selection right there."

        Your comment is proof that you are a self-serving scumbag. You don't care about civilized society, you are only concerned about your own well-fair even if it's at the expense of others who are less fortunate. There are many deserving people who can't get or afford the extreme costs of insurance. According to your post, you are okay with them going off somewhere to die just so you can save a few pennies.
  • Senturion, on 02/06/2008, -10/+61#10 You're the only country in the civilized world without some form of universal health care.
    • pintomp3, on 02/06/2008, -5/+16#11 you would actually pay less through taxes than you do for premiums if you had uhc.
      #12 bean counters decide if you should get a procedure instead of your doctor.
  • prestige, on 02/06/2008, -11/+34Thank God, I'm Canadian. I can't imagine what it is like to bargain over health coverage. I hope nation-wide health care comes to the USA soon.
    • mmmmmbiscuits, on 02/06/2008, -15/+6No complaints here. I can get an MRI or CT scan with only 24 hours notice on an outpatient basis, and within an hour in an emergency. I hope access to 20th century technology comes to Canada soon.
      • Alex2, on 02/06/2008, -0/+6You can google 'False Creek Surgical center' if you want to pay for a MRI and same day service.
      • Rikkochet, on 02/06/2008, -0/+7I can get an MRI in a few months (sooner if it's critical) for free, or I can pay 1500 bucks and get one in a couple hours. That sounds like a reasonable system.
        Then again, it seems like I hear a lot of "***** the poor, they're just lazy" from the US middle class on Digg. Kind of sad.
        • kingmanic, on 02/06/2008, -0/+5It's the delusional part of the middle class who has the idea "I'm one good idea from being a billionaire" stuck in his head. Most of the rest either are too over worked to raise their voice or too in debt to take time to voice an opinion.
        • zacharytelschow, on 02/06/2008, -4/+1According to government statistics, the "poor" work an average of 16 hours per week in the United States. When other citizens are putting in 40 hours, yes, I would qualify this group as lazy.
          • masterofshadows, on 02/06/2008, -0/+2I work 40 hours a week in a dead end job, the job market here is horrible and i cant afford to move. I am considered poor. I just broke both of the radial heads in my arms, if i didn't know someone who could put the immobilizers in for free (family friend) the procedure would have cost me over 10 grand. No poor person can afford that, heck most middle class people can't afford that. And when you live so close to poverty you can't afford to even pay the premiums that insurers want, let alone the copays. The myth that "The poor" are just lazy is a myth. there are lazy poor people but a lot of them are hard working people down on their luck.
      • TomK88, on 02/06/2008, -0/+7I wonder where the misinformation about Canada's health care system comes from? Sure, some non-emergency things take quite awhile but anything that is threatening your life will be dealt with swiftly. You RARELY hear about a story in Canada where somebody died because of Canada's health care system.
        • kingmanic, on 02/06/2008, -0/+3Indeed. Most things that take a while are non-life threatening issues that require specialists. Even then it was 3 weeks for a stomach specialists for my mother. 1 week for a joint specialist for my dad. 4h for an x-ray. the month+ long waiting lists are rare.
        • jmusal, on 02/06/2008, -0/+1The same can genuinely be said about the current system in the US. Despite what you may hear from the sensationalist-media, it is a very rare case where a patient will die as a result of a determination by their insurer. I cannot say that it has never happened, but neither can the advocates of the Canadian health care system.
          The truth of the matter is, in the US at least, that the uneducated consumers are the ones who suffer most. To use a cliche acronym, RTFM.... The patients who truly understand and follow the process greatly reduce the chances of an unjust denial.
          Those of you who are criticizing private insurance in the US, and advocating a "national healthcare system" will be very disappointed to find that the most likely way the government will "achieve" this is to mandate enrollment into private insurance or state operated Medicaid.
          Like it or not, the private insurance is here to stay, and as a consumer, your best bet is to be educated, read your materials, and follow the policies. This will help to ensure that you receive the necessary test, procedures, and care, and do not fall victim to loopholes, paperwork, and bureaucracy in general.

          Now, please proceed to bury this. :-)
          • TomK88, on 02/06/2008, -0/+1I'm sure most people that are insured are fine. However, what about the people who aren't?
          • funk49, on 02/06/2008, -3/+1Walk into Children's Hospital LA on any given day and you'll see how some people in the US who have zero health insurance are treated. Poor immigrants that can't speak English are seen by the world's best doctors for $0.00. The ER basically serves as a doctor's office for migrants and it's estimated that 80% of the hospital is without coverage. Disclaimer: CHLA is a non-profit hospital.
          • brufleth, on 02/06/2008, -0/+1@funk49
            Many of those people will be forced to pay for the care they receive for as long as it takes to pay off the coverage. It usually isn't free. People in the US without insurance might get stabilizing health care but they aren't going to get the care they may actually need. Just enough to get them up and out of the hospital. If things are really bad they might have to make the decision "how healthy can I afford to be."

            FYI, Children's Hospital LA doesn't have the best doctors in the world. It might have very good doctors but that's a glamorous exaggeration. Also, "non-profit" doesn't mean what you think it means. It doesn't mean they are a charity.

            You're also talking about a weird sub group. Most people without coverage aren't migrants who don't speak English. The US system fails people every day who have lived here their whole lives and have paid insurance premiums for decades. The fiscal motivation simply isn't there to help sick people if it is cheaper to deny them coverage.
      • brufleth, on 02/06/2008, -0/+2No, no you can't. Well maybe you can in your area but often times it takes quite a while (if considered non critical) to get an MRI even in the states. Oh and that's really only if you already have insurance by the way. Otherwise all a hospital has to do is stabilize you.

        Don't fool yourself into thinking you have special care either. The US consistently ranks low in quality of health care. Parroting BS propaganda helps nobody. We in the US over pay for sub standard health care that can utterly fail you when you need it most.
    • nydwarf, on 02/07/2008, -0/+1Actually we have access to 21st Century medical technology asshat.
  • scrumpy, on 02/06/2008, -2/+10You forgot to mention - "You're cheaper.. dead"
    Same with workers comp.
    • brufleth, on 02/06/2008, -0/+1Insurance companies make money collecting premiums from healthy people. If you get sick enough to start costing them more than they make off you it is in the companies best interest to cut their losses.
      • foxter, on 02/06/2008, -0/+1So which part of insurance is that? If I don't get sick, I pay them money for nothing. If I do get sick, they deny me coverage and still take my money.

        Oh, screw that man! I'm going to cut my losses writing this comment...
  • Ericular, on 02/06/2008, -1/+18That exact situation happened to my wife and I after she delivered our son. There were a couple specialists that were on-call and came to the delivery room after the baby had some complications. Insurance denied the claim for the specialists as being "out of network". I called them on it and they tried to tell me we should have planned ahead for this and had a referral ready. What BS. I had to finally get the hospital to call and bitch the insurance company out before they'd pay the claim.

    They intentionally deny claims they know are valid, especially in price ranges where they think you'll just pay it to avoid the hassle. Don't let them get away with it!
  • aaronw, on 02/06/2008, -3/+8It's the point of *any* company, not just (health) insurance ones (except for some non-profits I suppose) to make money and to return the investment of the shareholders. There are plenty of companies that are "guilty" of this.
    • jgzman, on 02/06/2008, -2/+7If a company's business plan requires the regular, premeditated defrauding of its customers, the business deserves to fail miserably, and the officers hanged.
      • brufleth, on 02/06/2008, -1/+1Insurance companies will cut their losses if they can on someone costing them more than they pay in premiums. This isn't sneakers or cars we're talking about. You can't test drive an insurance company and often times your insurance company is picked by your employer. It isn't defrauding just as it isn't defrauding when your DVD player breaks after the warranty expires.

        Insurance companies make money. That isn't evil that's just what they do. You can't expect them to be charities.
        • jgzman, on 02/07/2008, -0/+1I don't expect them to be charities. I expect them to cover my medical expenses. If it's costing them money, that's too bad. They should have had a better business plan.
          If a company claims to provide a service, and then fails to provide it, that is at best breach of faith, and at worst breach of contract.
    • bxblox, on 02/06/2008, -1/+9The only difference is a health insurance company will tell you your heart transplant isn't necessary, while your heart is failing and your doctor tells you it is. Most of us dont have a problem with them making money, the only problem I have with them is they'll charge for a service for as long as you don't need it and then when you do they just say "***** off."
    • kingmanic, on 02/06/2008, -0/+5There is a difference between "profiting" and "profiteering".
    • VinceNoir, on 02/06/2008, -0/+1OK... your point? Reading between the lines it sounds as if you're implying that they are justified in screwing their customers in order to help their shareholders. If that's what you're saying, I can only hope that you are stating it as a miserable and disgusting fact of business rather than great and wonderful approach.
    • bobartig, on 02/06/2008, -1/+1But there are plenty of companies that operate in an ethical manner. Health insurance companies should not get away with misleading customers with unnecessary billing. They should not even attempt it because it is fraud, which is illegal.
    • Kallius, on 02/06/2008, -0/+4Amazing how many people are quick to point out that when a person behaves unethically with a company, terms like "theft" or "fraud" are thrown around, but when a company behaves unethically with a person, it's "just business." That's what happens when corporations are granted all the rights but few of the responsibilities of a living, breathing person.
  • airwalkery2k, on 02/06/2008, -4/+7I like #3. "To get tested, talk up your symptoms."

    Basically, lie.
    • JamesBrown, on 02/06/2008, -0/+3why not? The insurance companies essential lie to us when they say they'll pay for our treatment. They lie, cheat, and swindle, taking our money and providing as little service as possible in return

      I have absolutely zero sympathy for insurance companies. Take them for everything they're worth
    • ttamshadbolt, on 02/06/2008, -0/+3not a good idea... the doctors job is to diagnose illness - and lying about symptoms is just a bad idea
    • brufleth, on 02/06/2008, -0/+1Meh, this isn't as invalid a suggestion as you might think. Far more often the problem is that people aren't being honest about how bad something really is. I know plenty of people who had chest pains they ignored until they had to go in for emergency heart surgery or who have severe back problems they shrug off and don't even mention to their doctors.

      Personally I ignore a lot of my health problems (allergies, joint problems, insomnia, etc) because I know it'd just end up costing me a fortune in copays for doctor visits and medication. Not to mention every time I go to get a prescription filled it ends up taking weeks to get my insurance company to actually agree to pay (usually gets bounced back to my doctor who has to respond to the pharmacy and insurance company, and yes this has happened with antibiotics which delayed treatment of a serious infection).
    • km85, on 02/06/2008, -0/+0Yeah it is funny they used colonoscopy as the example. If there's any procedure I would never want to get unless I absolutely have to, this would be it. Does the author even know what colonoscopy is? It's sodomy by a huge camera probe!
  • nathanaver, on 02/06/2008, -6/+27"To get tested, talk up your symptoms."
    NO! It's people like this that drive up the cost of medical care for everyone. You don't need a colonoscopy because your friend had colon cancer! What the hell is wrong with this person! Same goes for this: "If you want a special CT scan or MRI, your doc probably won’t authorize it unless it’s an absolute must." That's because it's expensive and a waste of money. Stop abusing the system!
    • howitzeral, on 02/06/2008, -4/+12Exactly right. I lost all respect for this article once I read that "tip". Lying to your doctor so you can get an unnecessary expensive test? Oh yeah, that's a good idea...
      • neguy, on 02/06/2008, -1/+4I so happy someone else understands this. Reading the comments on this story make me want to scream.
    • docbob84, on 02/06/2008, -6/+4Thank you! The worst thing in the world is a retired couple with access to the internet and WebMD or something similar. There are people who spend all day with nothing better to do than look up symptoms and discover they have some horrible (and almost nonexistent) tropical disease, when they haven't left the state in decades. People I'm sorry but if you don't trust your doctor you should A) find a new one, or B) go to medical school yourself. Don't second guess the doctor or try to trick him (second *opinions* are great, though, if from another MD). There's a reason they went through those extra twelve to fifteen years of school.
    • JamesBrown, on 02/06/2008, -1/+3***** that. I pay my premiums. I should get some service in return.

      It shouldn't be I pay them, they provide me nothing. And why should they decide what is or is not an "absolute must"? Shouldn't the patient and the doctor make that decision, not some pencil pushing accountant?
      • neguy, on 02/06/2008, -2/+1Health insurance companies follow the recommendations of the centers for Medicare and Medicaid when deciding what is covered. It is not purely a financial decision. If you want higher premiums keep spreading your ignorance.
      • zandernat, on 02/06/2008, -1/+1It's all al total scam designed to DESTROY your health and your finances for the profit of insurance companies and their doctor toadies. Learn about natural health care and stay away from AMA doctors unless you have a broken bone.
      • nathanaver, on 02/06/2008, -0/+2This notion of "I pay my premiums. I should get some service in return." is completely off base. When you buy insurance you are not buying services, you are buying assurance that if you actually need some services, the company will pay. Why don't you just be glad that you are healthy and don't need the service? Did you not read the article? This guy is advising the patient ways to get an expensive service even if the doctor doesn't think it's necessary. The insurance company had nothing to do with it. It's the same deal in countries with socialized medicine, if you don't need the service you don't get it because they are rationing care to save money. I'm sorry but anyone that thinks like this is a selfish, ignorant, LEECH on society. I hope that works out for you, you know, karma-wise.
    • InfiniteNothing, on 02/06/2008, -1/+3Ounce of prevention:
      In theory, catching things like colon cancer early will save money because it will be treated early rather than later when it's a much more expensive procedure.
      • neguy, on 02/06/2008, -2/+2You are making a generization that is not correct. Unnecessary test are not helpful they just cost money. Think about it like it was your money that paid for the test and my test, because it is.
      • nathanaver, on 02/06/2008, -0/+1This doesn't apply to colonoscopies. A colonoscopy costs ~$700 and has almost no benefit for a person under 50 unless that person has a family history of early colon cancer. At age 50 your doctor will probably recommend one and it will be covered. Until then, it is a waste of money.
    • zandernat, on 02/06/2008, -4/+1Why are you trying to play their games and work their system? This is such a slave mentality. It's all al total scam designed to DESTROY your health and your finances for the profit of insurance companies and their doctor toadies. Learn about natural health care and stay away from AMA doctors unless you have a broken bone.
  • Trav3133, on 02/06/2008, -10/+1Back in my motherland doctor pays you.
  • mattyoi, on 02/06/2008, -1/+25i remember working in the call centre for Health Insurance.. it was terrible.. I would be abused all the time, because there were all these secret little clauses that the consumer didn't know about. For eg This woman wanted to know why we didn't pay for ambulance fees, doctors etc for her deceased baby girl.. And the reason was that her baby was already dead when the ambulance got there. It was AWFUL. I had to quit
  • myAmygdala, on 02/06/2008, -5/+7Kucinich 2012
  • Alex2, on 02/06/2008, -3/+19Insurance companies don't want you to know about free healthcare in Canada.
    • eFiniTi, on 02/06/2008, -12/+3Omg conspiracy! Well good thing I'm already convinced I don't have to wait ridiculous long lines to get treatment..
      • kingmanic, on 02/06/2008, -0/+5You may want to live here a while, run some stats and not believe hear say. The waiting lists aren't long. They exist for only non essential things relating to specialists. It will resolve itself in 15-30 years due to boomers dropping dead. In 15-30 years the US will still have one of the most expensive and ***** up system in the developed world.
      • brufleth, on 02/06/2008, -0/+2This line is getting a little thin. You might be surprised to hear that you can end up waiting quite a while to see a specialist in the US too. In addition if you're sick enough to see a specialist in the US you might very well be too sick to work which can easily mean loss of work/income/insurance at which point that specialist you might get to see a little faster (still can take me a week just to see my PCP about a sinus infection) will bankrupt you.
  • bxblox, on 02/06/2008, -1/+9Health insurance is a casino..
    • InfiniteNothing, on 02/06/2008, -0/+1So is a lack of health insurance.
    • brufleth, on 02/06/2008, -0/+1...where the insurance company is the house and just like in Vegas, they always win.
  • t35t0r, on 02/06/2008, -10/+3The biggest secret the health insurance companies don't want you to know about:

    #1: Exercise, don't smoke, don't chew tobacco, don't do drugs, don't drink excessively, eat healthy
    • kingmanic, on 02/06/2008, -0/+4They'd actually prefer if you do those things because it drops the chance they'll have to spend on you while you still pay them.
    • sk11, on 02/06/2008, -0/+1Don't get unlucky, don't have bad genes, avoid contact with anyone or anything.
    • brufleth, on 02/06/2008, -0/+2And you can still get cancer, heart disease, arthritis, broken bones, sinus infections, pneumonia, and millions of other illnesses.

      You're not immortal. You can be an Olympic level athlete but even if you're in a sterile padded room you can still get plenty of severe illnesses.

      By all means, live a healthy life style, but don't think it protects you from getting sick (of course in can help). In fact, some illness can even be more detrimental if you're healthier. Read up on the great influenza of 1918. Fascinating stuff. It was more lethal to people in the prime of their lives. They'd drop dead within hours of showing symptoms sometimes because their immune systems reacted so violently it destroyed their lungs.
  • kingmanic, on 02/06/2008, -0/+5I feel really sorry for the people who need to go through this ***** to stay healthy/alive.
  • misterhat, on 02/06/2008, -3/+7Wow, I was about to pay off a 500 dollar bill for an anesthesiologist from my insurance company. ***** dugg.
    • misterhat, on 02/06/2008, -1/+3why am i getting dugg down? my insurance company claimed that the anesthesiologist wasnt covered because he was out of network when i really didnt have a choice. the article saved me 500 dollars.
  • mrogi, on 02/06/2008, -2/+0"Old folks must die" _Medical Insurance Company motto
  • Pinkertinkle, on 02/06/2008, -3/+3Holy crap, some of these are good suggestions but some of them are just exploiting the system and driving up the costs for others. Making up symptoms to get a colonoscopy? Not entirely ethical. Bringing in stuff you printed off the internet to convince your doctor? Good luck with that buddy, more likely to piss off your doctor. Your daughter starved herself into $110,000 of bills? Please raise my premiums so I can help pay for that.
  • mrivorey, on 02/06/2008, -7/+1Health insurance companies like to keep secrets. And they like to save money. Example: You have surgery, and weeks later you get a bill for using an out-of-network anesthesiologist. Ridiculous, right? You didn’t choose who put you under, so you shouldn’t have to pay extra. But your insurer sent the bill anyway, hoping you wouldn’t notice.

    Fighting back against this kind of trickery—and winning—is a lot easier than you think, says Kevin Flynn, president of Healthcare Advocates, a Philadelphia-based firm that helps patients wrangle with their health plans. We checked with Flynn and other insurance-industry insiders, lawyers, doctors, and regulators to uncover nine little-known ways to get the health coverage you deserve—for less.

    Don’t pay if you don’t have a say.
    When you purposely see an out-of-network doctor, your plan usually makes it clear that it’ll cost you. But when you have surgery, the hospital chooses the anesthesiologist. If you get that annoying “out-of-network” bill, Flynn says, draft a strongly worded letter stating you had no say about the anesthesiologist—in-network or otherwise—and, therefore, won’t pay any additional fees. “If you don’t have direct control, you are not liable,” Flynn says, adding that this tack is likely to work every time, but few consumers know about it.

    You may be eligible for more coverage.
    Depending on your state, you could be eligible for more benefits than your plan is telling you about. Take Maryland, for instance. Health plans operating there must pay for expensive infertility coverage. But one state over, in Virginia, they don’t. It’s unlikely that your plan is trumpeting info about state-mandated coverage, though. It’s up to you to get the scoop. One good place to check is Families USA (www.familiesusa.org), a consumer group that keeps tabs on state rules, suggests Kevin Lembo, Connecticut’s official health care advocate for consumers. Another option: Contact your state’s insurance commissioner.

    To get tested, talk up your symptoms.
    Your insurer doesn’t want to pay for a colonoscopy if it’s not necessary. But if your best friend is diagnosed with colon cancer and you want the $675 test to put your mind at ease, here’s how to get one covered: Mention to your doctor that you’ve had some blood in your stool and a lot of gas lately—or simply that your bowel habits have changed. Your plan has to pay for the test if you have gastro complaints, health experts say. (Only 21 states require insurers to cover colonoscopies for general screening.)

    Stall first, answer questions later.
    When Wendy Decenzo became pregnant with twins, she wasn’t worried about health insurance. Her husband, Chris, had made sure to get a health plan that covered pregnancy well before they started trying. But when Wendy began going for prenatal visits, coverage was denied. Their plan, Blue Cross of California, wouldn’t say why. Instead, the insurer asked the Decenzos to sign release forms allowing the plan to view their medical histories, which the law says are private.

    Chris believes the company was looking for any info that the Decenzos may have accidentally omitted when they applied for coverage. If an omission were found, the couple might have been denied coverage. “It seemed like a fishing expedition in order to deny us,” Chris says. So they refused to sign, and three months later the plan started paying for the prenatal appointments, even going back and paying for earlier visits that hadn’t been covered. Flynn says lots of insurers try this trick, but since their review process usually lasts only 60 to 90 days, they often drop the inquiry after that. Sometimes, procrastination pays.

    Letters are your best bet.
    It may seem a bit inconvenient, but the old-fashioned letter is by far the best way to communicate with your health plan. “Don’t do anything over the phone. It takes forever and when you’re done there’s no record of it, so it didn’t happen,” says Rhonda Orin, a Washington, D.C.–based attorney and author of Making Them Pay: How to Get the Most From Health Insurance and Managed Care.

    Letters almost always get a response, adds Lembo, the Connecticut health care advocate. Some plans will answer e-mail, but many won’t. And to whom, exactly, should you address your mail? Experts recommend following your plan’s appeal process for letters and sending copies to your state insurance commissioner. Also, keep copies of every letter you’ve sent your plan and everything they’ve sent back. That way, when your insurer says, “We never said we’d cover that,” you can say, “I have it right here in writing.”

    Doctors can be good weapons.
    You just got four massage sessions, under doctor’s orders, for lower-back pain—but your insurer refuses to pay for them? Ask your doctor for help. He can tell the insurer he’s going to complain to the state board that regulates health plans.

    “Health plans may not fear you, but they do respect the board,” says James Moss, a retired Kentucky surgeon. He intervened on a patient’s behalf and, by pressuring the board, helped the patient win coverage. Another option: Say you’ll call your congressman and/or state Medicare office to lodge a formal complaint, Moss says.

    Caveat: Don’t actually contact your state board yourself if a claim is denied. Janice Weiss, a Jupiter, Florida–based attorney who fights health plans for consumers, says some of her clients who went this route ended up hurting their cases when the state agency ruled their claims invalid; that left them little recourse with their insurance companies. Instead, while working your plan’s appeals process, just suggest you may take the matter to your state.

    A little research can go a long way.
    If you want a special CT scan or MRI, your doc probably won’t authorize it unless it’s an absolute must. Persuade her with expert info from the American College of Radiology’s Appropriateness Criteria, says Anne Roberts, executive vice chair of the department of radiology at the University of California, San Diego. Used primarily by doctors but open to the public, it’s an up-to-date list of the types of imaging that are right for various conditions (Click here for a link to the radiology site.) Arming yourself with the info doesn’t guarantee coverage, but it’s a proactive step in the right direction.

    There are ways to get drugs cheaper.
    Doctors are often wowed by the latest and greatest drugs, which tend to be the most expensive. Make sure these newer, high-end meds are what you need before you leave the doctor’s office. Sometimes your insurance plan won’t pay for them at all; other times it’ll charge higher co-pays. In many cases, drugs have generic versions that are just as effective but cheaper than the newer ones. Always ask your doc (or the pharmacist) for generics. And if you really need a medicine that doesn’t have a generic version, order it by mail. Many plans have a less-expensive mail-order pharmacy option. Another prescription trick for people who have chronic conditions like allergies: Ask your doc to write you a prescription for two or three months’ worth of medication instead of one. Goodbye, extra co-pays.

    An advocate can help you win.
    Imagine being turned down for coverage after running up $125,000 in medical bills. That’s what happened to the parents of a daughter with anorexia just before they sought help from Kevin Flynn, of Healthcare Advocates. For $400, he took over the fight with their insurer and—after a year’s worth of combat—won.

    Flynn is a patient advocate, part of a growing industry that makes its money from helping you. Some advo-cates help you interact with your doctor, while others specialize in insurance disputes. Most of all, firms like Flynn’s keep the letters going out on your behalf, saving you time, energy, and headaches. “The insurers know that advocates know the laws, the regulations—things a regular consumer might not know. That makes them nervous,” Flynn says.

    Advocates can even get policies changed. One of Flynn’s clients, who had rectal cancer, was having trouble getting his insurance plan to pay for a new radiation therapy. The insurer claimed the treatment wasn’t ready for prime time, but Flynn found six studies showing its usefulness for the disease, got the coverage—and got the insurer to rewrite its policy.

    To find an advocate, contact the Patient Advocate Foundation, says Laura Weil, interim director of Sarah Lawrence College’s Health Advocacy Program. Another helpful resource is the Society for Healthcare Consumer Advocacy. Also try checking with the medical association for a particular condition, like the Multiple Myeloma Association or the National Association of Anorexia Nervosa and Associated Disorders; many of these groups keep lists of advocates. See the links below for help:
  • scamper22, on 02/06/2008, -0/+4u know, all this could be solved if the government ran a non-profit health insurance company to provide good competition.

    it would remove the profit motive/scamming and be fiscally responsible.
    • funk49, on 02/06/2008, -0/+1Right...that would require that the government operated it somewhat like a business and the problem with that is the fact that most of the idiots in our government don't have experience in running a business.
  • zandernat, on 02/06/2008, -2/+2Insurance is a total scam. Stay away from "doctors" unless you have a broken bone. Learn about natural health care. "Oh, I'll ask my doctor about it" No, your doctor does not give a rats petout about you and has never studied nutrition. Your health is his COMPETITION. You learning to heal yourself puts him out of business.
  • CheeseburgerBro, on 02/06/2008, -0/+2O, Canada.

    I sure do appreciate not having to evaluate my decision to seek medical care based on financial concerns.

    Um -- instead I evaluate my decision based or whether or not I have nine hours to spare, sitting in line. In Soviet Canuckistan....aw, forget it.
  • t4m5t3r, on 02/06/2008, -0/+0profit, profit, profit, Profit will come before life everytime, if they have to kill for profit they will and are doing so, realy no surprise,

    you and you family will die before "they" loose profit!!!

    thats just a fact! and to think, WE LET THEM DO IT!!!!
  • timusca, on 02/06/2008, -0/+1I'm going into surgery on Monday, so I'm glad I read this... somehow, I have a feeling Blue Cross will rape my wallet every chance they get.
  • MarsSentinel, on 02/06/2008, -0/+1solution: get the insurance asshats out from between patients and doctors. the model is broken. doctors post prices, you shop around. insurance is a scam.
  • MadceltUK, on 02/06/2008, -0/+1While the UK's health service isn't perfect, it's a hell of lot better than this....
  • stackered, on 02/06/2008, -0/+1If these are secrets then how did you know? Huh? Huh?
  • dawnlikethesoap, on 02/06/2008, -0/+0you know, i heard that circumcision on newborns isn't covered because it's considered "cosmetic".

    That's ***** up.
    • km85, on 02/06/2008, -0/+0umm... circumcision is what's ***** up! If you really want to mutilate your baby's genitals, pay for it yourself.
    • angelkinz121, on 07/14/2008, -0/+0Yes it is.... all you people on this website don't know *****!!!! IT's pissing me off! A circumcision is covered!
  • Jemo, on 02/06/2008, -0/+0Having a Cleft Lip/Pallet, I have been denied coverage time and time again. I'm as healthy as a horse, but because of my medical history I would be a liability to their system.
  • Pancake, on 02/06/2008, -0/+1funny cause i just got a call from my insurance company. after preapproving me for a knee surgery (couldnt walk for 3 months), i got the surgery. 15grand. now they say they wont cover a dime and wont give a reason. im going to fight this tooth and nail till i at least get SOME kind of coverage. i dont get why i was preapproved and then they backtracked on their coverage after the fact. makes me sick.

    anyone have tips on what to do in this situation? anybody else gone through this? its all new to me and i'm lookin for help. thanks.
    • angelkinz121, on 07/14/2008, -0/+0Call your health insurance company and ask them about the authorization, If it was approved or denied and why. It may be to late now... depending on what went on because you and your dr have 30 days to file an appeal. Once you find out what is going on call your dr's office and have them file an appeal w/ all of your medical records,and a certificate of medical necessity stating why you needed the surgery. And then the appeal will be looked at. The provider should have done this own there own already with out you even being aware of it, to try and get it covered. Depending on your health insurance company the dr may be able to get a retro authorization if the original was denied in the first place. The thing people dont realize is you have to sometimes double check your dr's work to make sure that they do what they are suppose to alot of the times they do stuff w/o the ok to do it. Most of the time its because they dont submit enough documentation, to say you need something done. I would contact your health insurance company first and see why it is being denied. Before you take the next step of action, you can also file an appeal yourself, but its better if the provider does it because they have all of the medical documentation that you need, the problem now is you might be out of the filing limit. If it is something like the authorization was denied, and the dr did it anyways you need to fight with the provider, if you cant file an appeal anymore.
  • aduck, on 02/06/2008, -0/+1I was just about to pay a $1500 bill for going to an out-of-network doctor when the insurance company told me he was covered. Apparently "covered" does not mean "In-Network". They haven't owned up to it, but maybe if I write a letter something will get done.

    The best part is I got a $144 NY State surcharge for using a doctor that wasn't covered by my insurance. Screwed both ways.
  • Imachick, on 02/06/2008, -1/+0On this matter, my heart goes out to you guys in the US. How you manage to live with this level of stress and inequality about your health is just beyond me. Really is an example of free markets being prioritised above citizen's lives. You can cuss me for being a commie of you like, but surely every citizen has right to be looked after, especially in a country as rich as yours.
    A few years ago (here in England) I was very ill with pneumonia. Hospitalised for 9 days. I've got full private healthcare with my job, but the wonderful National Health System was so good, that I didn't even bother to claim on my private policy. Total cost to me came in at a very reasonable £0.00. NHS FTW
  • oyouno, on 02/06/2008, -1/+0This is why Universal Health Care is the only way to go.

    Oh and it seems to be ok for our teachers and our MILITARY....but somehow not good enough for ordinary us citizens??????

    TOTALLLY SCREWED UP.

  • caponumen, on 02/06/2008, -0/+1LOL, Hillary wants to make this insanity UNIVERSAL.......
  • bioalchemist, on 02/07/2008, -0/+1What pisses me off is that insurance companies negotiate health care prices with providers. For example, your wife has a baby, and the bill is $4000. On the actual bill the hospital sends you, it shows that the insurance company gets a "discount" rate of, say $2000, and that is what they pay. Uninsured citizens, on the other hand, do not have the power to negotiate prices and always have to pay full price. How many uninsured people who filed bankruptcy to get out of health care-related debt wouldn't have had to if they'd been able to pay the same price as the insurance company? Pathetic.
    • wojtyk, on 02/07/2008, -0/+0Why the ***** does "negotiation" take place in the first place?
      It costs what it costs.
      When I go to McDonalds, I don't barter with the cashier over the price of a hamburger.
      Why should such a process exist in medicine? Or car buying for that matter.
    • angelkinz121, on 07/14/2008, -0/+0First of all health insurance companies don't negotiate money unless it comes to the member going to be billed some ridiculous amount of money, and most of the time its because they went out of network, and they aren't able to, read your benefits, and if you go in network like you are suppose to, the providers you go to, have a contract that they agreed to, to be paid for each service that they billed in the first place. And that is what they get! IF you have a $20 copay, your insurance company will pay up to the allowed amount of the contract, all but $20 and thats what you pay. If you are being billed by the provider more than that you need to call your health insurance company or look at the explanation of benefits, to see how much you are suppose to be paid. and a lot of times if you don't have health insurance you should probably go to the welfare office and see if you can get on medicaid.... and if you cant then call the dr's office and see if you can negotate a price. Most of the time they will try to help.
  • GovernmentSp00k, on 02/16/2008, -0/+0Best bet is to educate yourself, stay healthy and avoid as much of this Health Care insurers as you can so you won't need them.
  • parkernicky50, on 04/26/2008, -0/+0I read your post it is nice and informative. I liked it very much so i vote for it. Keep posting.If you have any new story about any health related topic, please share with me.
  • dudley9, on 05/25/2008, -0/+0http://www.genericsmed.com/
    http://www.generics.ws/
  • angelkinz121, on 07/14/2008, -0/+0I worked for Highmark and now I work for UPMC which are both very big health insurance companies in PA. Everyone thinks that it is the health insurance companies that bill you and it is not! It is the provider that you see, the dr's office, the hospital's where ever you may have went. The health insurance company doesn't get any of your money at all, the providers get your money. All your copayments and your deductibles, and coinsurance go to the providers. the only money that your health insurance company gets is your premiums. AND THATS IT! The health insurance company doesn't bill you for your visits. All you should get from them is your Explanation of Benefits, and that will tell you if you owe the provider anything, and you should look at these because the providers try to over bill you for things that they aren't allowed to. So my advice to you is contact your health insurance company if you have questions about a bill, and alot of times, they will call for you and talk to the providers, especially for older people they call. I don't think people should post things that they don't know what they are talking about, your giving false information, and its not helpful at all.
  • angelkinz121, on 07/14/2008, -0/+0I worked for Highmark and now I work for UPMC which are both very big health insurance companies in PA. Everyone thinks that it is the health insurance companies that bill you and it is not! It is the provider that you see, the dr's office, the hospital's where ever you may have went. The health insurance company doesn't get any of your money at all, the providers get your money. All your copayments and your deductibles, and coinsurance go to the providers. the only money that your health insurance company gets is your premiums. AND THATS IT! The health insurance company doesn't bill you for your visits. All you should get from them is your Explanation of Benefits, and that will tell you if you owe the provider anything, and you should look at these because the providers try to over bill you for things that they aren't allowed to. So my advice to you is contact your health insurance company if you have questions about a bill, and alot of times, they will call for you and talk to the providers, especially for older people they call. I don't think people should post things that they don't know what they are talking about, your giving false information, and its not helpful at all.
  • donna1234, on 07/24/2008, -0/+1 You have surgery, and weeks later you get a bill for using an out-of-network anesthesiologist.
    http://www.bluedune.net
  •  

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