Remember how I said last week that I recently had a health insurance claim victory after being on the phone with them on and off for 15 months and that the next claim I submitted (same service, different date), they declined.
Yeah, I take everything back.
Turns out: these people still don’t know how to do their job, because I thought we had worked everything out. They’re now claiming that the initial reimbursement was issued in error and they want that money back and they also won’t reimburse any of my other claims.
I won’t bore you with all the details but what this comes down to is this whole thing about in-network and out-of-network providers. I think that’s one of my biggest pet peeves about the healthcare “system” in the U.S. (and we already have a PPO plan for that reason).
We had multiple instances in the past where certain services by a provider were covered in an inpatient setting, but then not covered in an outpatient setting. I don’t understand why insurance won’t cover the same doctor in different circumstances.
(This is a rhetorical question, I understand why, but I don’t ‘comprehend’ it, if that makes sense.)
If you receive care in an in-network facility by an out-of-network provider, shouldn’t you be able to continue care with that provider in an outpatient setting? Why would they make you go to a different provider for aftercare? Working with a doctor/counselor is hugely a matter of trust and comfortability and the fact that they don’t allow you to continue working with the person that you’re already comfortable with is just ridiculous. It disrupts the whole process of continuing care and recovery.
I was told that we could get a partial reimbursement if I upgraded to a higher health care plan. BUT the catch: The next tier up would be an increase of almost $200/month and a $350 deductible on top of that, which, if I do the math, makes NO SENSE WHATSOEVER (the monthly out-of-pocket costs are <$200 right now). Why would I pay higher premiums AND a deductible before I get any benefits? I can’t see a scenario where that would make sense (although I guess, maybe it would if we anticipated higher annual expenses than we currently do.)
Right now, I am just furious because they make us choose (once again) between the provider we feel comfortable with and covering any of the expenses.
Does this kind of sh*t get you all riled up too?
Can I ask how much you pay for health insurance every month?