Wednesday, May 23, 2012

Insurance and Billing Issues

I never realized how much extra time I would spend on the phone with the insurance company and doctor's offices relating to giving birth to Brandon.  There have been so many issues to date that I felt the need to share with everyone in case someone else has a similar experience and needs some advise.

Issue #1 - Brandon's birth date was put in incorrectly in the system for UHC (United Healthcare) which triggered a slew of problems.  They had his birth date as April 5 instead of March 28 which meant that all claims from when he was born were denied.  Yes, DENIED!!!  I initially tried calling the insurance company after finding out that they has the wrong birth date (they could have easily figured this out since I gave BIRTH on March 28) to change it and I was told that I was not authorized to update that information on the account and I would have to contact my benefits representative at work and they would have to do it.  Ridiculous if you as me.  Luckily, we have a wonderful HR person at Legendary and Cindy took care of this for me right away.

Issue #2 - Even after this was changed in their system, UHC did not automatically go back to the original claims and pay them.  I don't know what system they used but only about half, if that, were taken care of.  The rest I have had to call the doctor's billing offices and request that they resend the claim to the insurance company so they will pay it instead of trying to bill me (even though this has still happened on numerous occasions).

Issue #3 - Even after the claims have been submitted, on some of them the insurance company paid it as an out of network claim instead of in network.  GEEZ!!! This was an issue with the attending pediatrician for Brandon while we were in the hospital.  I guess he isn't considered in network but becuase he was the attending at the hospital during the birth they are supposed to pay it as in network instead of out of network.  This is important becuase it would have cost me an additional $700 had I not caught this.

Issue #4 - If you have blood tests run multiple times on the same day the insurance company will think they are getting double billed and will only pay one claim.  You then have to call the billing department of the hospital and have them resend the claim with a modifier.  Oh and BTW, the billing department at FWBMC has no idea what this means so you will speak with about 5 different people before finding someone that can deal with this. HEADACHE is all I can say.

Has anyone else had any similar insurance issues happen to them?  I feel like I pay enough in premiums and deductibles and I refuse to pay anymore that I have to.

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