- Nov 17, 2019
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This might be able to go in Health and Fitness, but nobody reads that section.
Got a letter in the mail today from a major medical 'system' serving this area. We don't have small hospitals any more like we used to. They have all been absorbed by various national or regional corporate level medical systems.
Apparently they are in negotiations with my medical insurance company, also a major national system. They say my insurance company is slow to pay and often denies some claims.
They want me to call customer service at my insurance company and tell them to negotiate with the provider. How is that my duty? Or how is that what customer service is supposed to be doing?
But who is more at fault? When I look at my insurance company page, I see a number of claims for my recent medical event. Something like 30 or 40 separate items. Most have been paid (marked approved), but some have not. Those are either marked denied or only partially approved. But for some of those, there is a duplicate claim marked approved. When I call and ask, it seems they are simple coding errors and needed to be resubmitted differently in order to be paid.
On the hospital patient login account, I see the total of the two stays approaching $80,000.00 for a relatively simple procedure with a minor complication. No major specialized treatment. No ICU or any like it. About 7 days inpatient.
Back to the insurance company account and I see claims submitted for several thousand dollars where only a few hundred was paid as the 'contract amount'. Where did the rest of the bill go?
Are the providers overbilling knowing the insurance will pay a lesser amount?
Are the insurance companies underpaying knowing the hospitals are going to bill higher?
Got a letter in the mail today from a major medical 'system' serving this area. We don't have small hospitals any more like we used to. They have all been absorbed by various national or regional corporate level medical systems.
Apparently they are in negotiations with my medical insurance company, also a major national system. They say my insurance company is slow to pay and often denies some claims.
They want me to call customer service at my insurance company and tell them to negotiate with the provider. How is that my duty? Or how is that what customer service is supposed to be doing?
But who is more at fault? When I look at my insurance company page, I see a number of claims for my recent medical event. Something like 30 or 40 separate items. Most have been paid (marked approved), but some have not. Those are either marked denied or only partially approved. But for some of those, there is a duplicate claim marked approved. When I call and ask, it seems they are simple coding errors and needed to be resubmitted differently in order to be paid.
On the hospital patient login account, I see the total of the two stays approaching $80,000.00 for a relatively simple procedure with a minor complication. No major specialized treatment. No ICU or any like it. About 7 days inpatient.
Back to the insurance company account and I see claims submitted for several thousand dollars where only a few hundred was paid as the 'contract amount'. Where did the rest of the bill go?
Are the providers overbilling knowing the insurance will pay a lesser amount?
Are the insurance companies underpaying knowing the hospitals are going to bill higher?
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