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Double hernia surgery...

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Originally posted by: Engineer
I just love insurance.....two of the 5 claims have been 100% denied so far. State that they did not receive enough information from the provider. Insurance is a crock of shit. You pay your premiums and they do their damnest not pay a cent.
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You didn't know this beforehand?

No offense....but that is exactly their business model. Find any reason not to reimburse...higher margins that way.

One of the better benefits with my company is that they pay employee health insurance premiums in full...It's not a mind boggling plan ($5k deductible into 80/20), but it's free...
 
I have a handicapped teenager and he has AETNA. You need to keep calling them and keep records of who you spoke to and what they said. You also need to keep contacting the hospital and your doctors (keep records) and find out what's going on. Also try and find out which codes AETNA isn't accepting - docs and hospitals put in the wrong codes a high percentage of the time.

Be nice but persistent. Yelling and screaming just slows them down.

Hospitals and MD's get stuff to collectors really quickly these days, so soon you'll be dealing with them also. This is where your records will come in handy - the more information the collection agency has, the more time they'll give you to get the mess cleared up.

Also, when things are finally settled, be sure to get ALL of the parties to contact the credit bureaus that the bills are paid and everything is okay. Never send a check to any of the parties for payment unless you get written confirmation that all of the credit bureaus will clear your account.

Get all the help you can from your employer - don't give up, they can do a lot to get this cleared up. See if the hospital has a patient advocate, sometimes they can cut through the paperwork. Hopefully you are friendly with the insurance expert at your MD's office.

Whatever you do, do not trust that things will be okay.

Hope you are feeling better! :beer:

p.s. it can be really hard to find out from the MD/hospital EVERY doc that will be sending in a bill. Don't be surprised if you get a large bill in a few months from the Medical Shaving Professional or the Allergic Laundry Specialist or something like that. Those are both real examples BTW. Not the exact names but close.
 
princess ida is right. Some hospitals are really crap when it comes down to handling insurance claims and they don't give correct info to the Insurance Co.


Wish you the best recovery.
 
Originally posted by: princess ida
I have a handicapped teenager and he has AETNA. You need to keep calling them and keep records of who you spoke to and what they said. You also need to keep contacting the hospital and your doctors (keep records) and find out what's going on. Also try and find out which codes AETNA isn't accepting - docs and hospitals put in the wrong codes a high percentage of the time.

Be nice but persistent. Yelling and screaming just slows them down.

Hospitals and MD's get stuff to collectors really quickly these days, so soon you'll be dealing with them also. This is where your records will come in handy - the more information the collection agency has, the more time they'll give you to get the mess cleared up.

Also, when things are finally settled, be sure to get ALL of the parties to contact the credit bureaus that the bills are paid and everything is okay. Never send a check to any of the parties for payment unless you get written confirmation that all of the credit bureaus will clear your account.

Get all the help you can from your employer - don't give up, they can do a lot to get this cleared up. See if the hospital has a patient advocate, sometimes they can cut through the paperwork. Hopefully you are friendly with the insurance expert at your MD's office.

Whatever you do, do not trust that things will be okay.

Hope you are feeling better! :beer:

p.s. it can be really hard to find out from the MD/hospital EVERY doc that will be sending in a bill. Don't be surprised if you get a large bill in a few months from the Medical Shaving Professional or the Allergic Laundry Specialist or something like that. Those are both real examples BTW. Not the exact names but close.
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Thanks for the great reply! 🙂

I've contacted both the surgical center and Aetna (didn't get names though). Will try that next week to see if I can get things moving along. Surgical center didn't seem to have an issue with the non payment right now (they have not sent me a bill due yet and I was told that everything is OK as of right now).

AETNA did pay the surgeon as well as the anesthesiologist (was out of network but paid network rates after I called the 1st time) so at least some of it's out of the way. There are three more surgery center charges (either denied or pending) that I've started working on (called to see if I could assist in getting things moving along, etc). I'll call both back next week and see what is missing and get names this time.

:beer: to the great reply!!! 😀
 
I definitely "feel your pain," so to speak.

When I had my knee "rebuilt" as a result of a work-comp injury, about 6 weeks after the surgery, I started getting the bills from the surgery center, anesthesiologist, for lab work, etc. The only party the insurance company paid properly was the orthopedic surgeon...

I had to turn my pitbull...I mean my work comp lawyer loose on the insurance company to get them paid...

Mind you, everything was "pre-authorized" before the knee surgery was ever scheduled...it was just another example of inefficient insurance company proceses and another way for them to fuck with me...as they've done right from the original date of injury.

Your case is obviously different, but the methods of getting fucked with are similar. Don't let up on the insurance company.

DEMAND in writing what's being denied and why. You have the right to know every dime that's being denied or challenged.
 
Originally posted by: Engineer
I just love insurance.....two of the 5 claims have been 100% denied so far. State that they did not receive enough information from the provider. Insurance is a crock of shit. You pay your premiums and they do their damnest not pay a cent.

They ask me if I wanted them to ask the provider again for the information? WTF? No, I don't want you to pay the $12,000 worth of denied claims....just let it go!! (sarcasm).
Click to expand...

Another shining example how great the current medical system is.

and people don't want to change this?
 
Originally posted by: OILFIELDTRASH
what is a hernia? How do they occur?
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Tear in the muscles in either the groin or belly button area that lets your insides (intestines, guts, etc) start pushing to the outside (looks like a lump on the outside. Mine was as big as a baseball).

Usually occurs by lifting too heavy of an object and causing the tear in the muscles of the stomach area. I caused mine by lifting and carrying large cases of hardwood flooring up a flight of stairs and then running (sprints) in the evenings. Just popped out (burns, looks bad).

Hernia: Wikipedia.

Basically what I had.
 
I have a mild "umbelical hernia" in my belly button. Not bad enough to justify surgery...yet, but the doc sez it could happen. I just have to be careful when I lift anything heavy...but with my FUBAR'd back...I rarely lift ANYTHING more than about 20-30 lbs.
 
As long as bragging rights are being exposed - I have a golf ball that developed in April after moving the household.
Doc is going to get it worked on the end of this month - I had an infection that needed to get knocked out first.

I was also told that carrying around a couple of kegs at your waistline makes one more susceptible to it - continually stressing the muscle.

BoomerD - right now, I can not carry a granddaughter and have to be carefull not holding the 2 month grandson to low.

Hopefully, my insurance will not have such issues.
 
Originally posted by: dmcowen674
Originally posted by: Engineer
I just love insurance.....two of the 5 claims have been 100% denied so far. State that they did not receive enough information from the provider. Insurance is a crock of shit. You pay your premiums and they do their damnest not pay a cent.

They ask me if I wanted them to ask the provider again for the information? WTF? No, I don't want you to pay the $12,000 worth of denied claims....just let it go!! (sarcasm).
Click to expand...

Another shining example how great the current medical system is.

and people don't want to change this?
Click to expand...

I don't think there are many people out there that don't want to change the system, they are just wary of the solutions currently being proposed, namely government control of the system.

I had bilateral inguinal hernia surgery about three years ago when I was 21. I was sore for about two weeks, but I was able to move around the house after 2 days and flew back to school after a week. The doc just gave me a bottle a vicodin and sent me on my way.

Hopefully you get the whole insurance issue solved soon.
 
Originally posted by: Common Courtesy
As long as bragging rights are being exposed - I have a golf ball that developed in April after moving the household.
Doc is going to get it worked on the end of this month - I had an infection that needed to get knocked out first.

I was also told that carrying around a couple of kegs at your waistline makes one more susceptible to it - continually stressing the muscle.

BoomerD - right now, I can not carry a granddaughter and have to be carefull not holding the 2 month grandson to low.

Hopefully, my insurance will not have such issues.
Click to expand...

Here's hoping for the best and wishing a speedy recovery. Strangely, I read around the net on hernia's (right after I developed the larger groin hernia) and discovered that not only can excess weight cause them, but losing weight quickly (I lost 50 pounds over about 2 months) can also contribute to getting a hernia. I developed mine right after losing the weight and running (sprinting).

Again, good luck and hope all goes well (including insurance, lol).
 
I will keep all the fellow guinea pigs updated as progresses - just like you have been nice enough to do.
 
Called both the insurance company and the clinic today (kept records):

Insurance Co:

Still waiting on information.
Sent clinic another letter on June 23rd re-requesting the required information.
Status changes automatically from pending to "rejected" after certain time.
Stated 3 way call possible to clinic if necessary.

Clinic:

Still waiting on insurance (no bills due yet).
Stated to wait until received a bill (I won't) to call them back.
Stated if I had received a bill, I could call insurance company and have them 3 way conference call to the clinic to discuss exactly what they need from the clinic to have the bill paid.



Me:

*sigh*
 
Insurance company finally paid another claim. They paid the largest claim of $11,900+.

So far, I've had to pay an additional $192 + 300 + 100 on top of the $1100 that I paid going in. There are two additional $579 charges that have been denied and I am waiting to see what happens with them.
 
Originally posted by: Engineer
Called both the insurance company and the clinic today (kept records):

Insurance Co:

Still waiting on information.
Sent clinic another letter on June 23rd re-requesting the required information.
Status changes automatically from pending to "rejected" after certain time.
Stated 3 way call possible to clinic if necessary.

Clinic:

Still waiting on insurance (no bills due yet).
Stated to wait until received a bill (I won't) to call them back.
Stated if I had received a bill, I could call insurance company and have them 3 way conference call to the clinic to discuss exactly what they need from the clinic to have the bill paid.



Me:

*sigh*
Click to expand...

So wait, the insurance company is waiting for a claim essentially from the clinic, and the clinic is waiting on the insurance in perpetuity. Hence no bill is due until the insurance pays, and the insurance won't pay until the bill is provided? Sounds like you're golden there!
 
Originally posted by: SunnyD


So wait, the insurance company is waiting for a claim essentially from the clinic, and the clinic is waiting on the insurance in perpetuity. Hence no bill is due until the insurance pays, and the insurance won't pay until the bill is provided? Sounds like you're golden there!
Click to expand...

At some point, the clinic, which has submitted records (twice) to the insurance company, is going to keep getting "denied" claims from the insurance company and then send me a bill. I've seen it happen before (with this same clinic) and have had to deal with it. I'm trying to deal with it ahead of time. It's getting better and so far, I've not been slammed with a full bill. Maybe the calls help...they certainly aren't hurting (I'm being very polite! 😛 ).

Edit: 2.5 of the claims have been denied. I though that claim #3 was paid in full, but the insurance denied $2,400 of the charges. What a crock of crap!
 
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