How the hell does this work??

[Vixen]

Is anyone here familiar with health insurance BS?
I just got a gigantic sized bill for my whole pregnancy stuff.
My prenatal care.. all 2k of it.. covered, lovely, wonderful.
my DELIVERY..... not covered.

So I am allowed to carry the baby and nurture the baby, but apparantly I am not allowed to HAVE the baby.

Does this make sense to anyone, and if so, please explain it to me??!?!

[Jorddyn]

Originally posted by Vixen
Is anyone here familiar with health insurance BS?
I just got a gigantic sized bill for my whole pregnancy stuff.
My prenatal care.. all 2k of it.. covered, lovely, wonderful.
my DELIVERY..... not covered.

So I am allowed to carry the baby and nurture the baby, but apparantly I am not allowed to HAVE the baby.

Does this make sense to anyone, and if so, please explain it to me??!?!

1. Insurance companies know people don't read fine print.

2. Insurance companies know that even if people do read fine print, they can make it so unintelligible that people will not understand the fine print.

3. Insurance companies know that even if you do read and decipher the fine print, it will take at least 10 months, so you will have already popped out the kid :D

Honestly, it's bullshit. I have no explanation for it other than insurance companies are out to make money in any way possible.

I'm sorry, it sucks :(

Jorddyn

[Warriorbird]

"insurance companies are out to make money in any way possible"

Check and make sure that's not pre-filing. Sometimes they can take up to six months to settle large size claims.

I hate insurance companies.

[The Ponzzz]

What state are you in?

NY has 100% coverage for PCAP if ya make less than 25k a year(30k married). Which means when yer pregnant, quit yer job and hope your spouse doesn't make over 11.99 an hour. But other than that, 95% is covered(and believe me that 5% is quite a big bill).

[Jorddyn]

Originally posted by Warriorbird
Check and make sure that's not pre-filing. Sometimes they can take up to six months to settle large size claims.


A quick (ok, you'll be on hold an hour) call to the customer service line should clear up why they were denied.

When I broke my leg, they denied my claim because the owners of my apartment complex told them that it didn't happen. Clearly, they would know better than the EMTs, the surgeon, my nurses, and me. It was all an elaborate ruse for me to get that nifty cast. (Sorry, tangent)

Jorddyn

[Celephais]

I remember (another) calvin and hobbes where his dad tells him it averages $250,000 (memory.. could have been $100k) to raise a kid to the age of 18. He then asks Calvin if that quarter million is a loan or a gift.

Barely out of the womb, and it's only just started.

Edit: I'm sure that stat is outdated... anyone have an updated?

[Edited on 9-6-2005 by Celephais]

[Warriorbird]

When I broke my leg, they denied my claim because the owners of my apartment complex told them that it didn't happen. Clearly, they would know better than the EMTs, the surgeon, my nurses, and me. It was all an elaborate ruse for me to get that nifty cast


Crazy. One more reason to be glad I'm out.

[Edited on 9-6-2005 by Warriorbird]

[Janarth]

Insurance contracts aren't that hard...

Read the insuring agreement, check the definitions if a defined word is used. After that, see what is excluded in the exclusions section. Done. GS's combat system is harder to figure out :p

Though, I don't often see health insurance contracts...

[Warriorbird]

:chuckles:

The definitions are sticky and pretty hard for a lay-person to grasp at times. It gets even worse when you start dealing with PPOs and HMOs.

[Vixen]

Thanks for the advice. Basically insurance company is saying the doctors office never filed those charges, and the doctors office is saying they did. After the "quick" phone calls I find out that they decided to deny it because the doctor who gave me my prenatal care, is not the doctor who delivered my son. (Who just happened to be out of town when I went into labor) So... that warrants ME paying the 3k just because my doctor decided to take a hike that weekend?

[Jorddyn]

Originally posted by Vixen
After the "quick" phone calls I find out that they decided to deny it because the doctor who gave me my prenatal care, is not the doctor who delivered my son. (Who just happened to be out of town when I went into labor) So... that warrants ME paying the 3k just because my doctor decided to take a hike that weekend?

Nope, but it gives them an excuse to deny the claim on the first go-round.

Insurance companies make a very small percentage of their profits by actually selling insurance. They make the rest of their money by holding investments. If they manage to deny all claims on the first round and drag out the payment, they get to keep their investments making money. It may not sound like a big deal, but imagine if they can delay all claims by a month. Nice float :D

Edited to add - Plus, some people see "denied" and simply pay the claims. Of course, your situation is different since your bills are high, but if they can get 1 in 10 people to pay for their own doctors visits, they're doing alright.

Jorddyn

[Edited on 9-6-2005 by Jorddyn]

[DeV]

That's really fucked up, Vixen. But at least you got an adorable little melon head out of the deal. :saint:

[Vixen]

He is adorable. My husband was looking over my shoulder actually and was like.. WHO LIMED MY SON!? hehe.

[Celephais]

You should go out and buy a watermelon or canteloupe and take a picture, your son will be the next internet phenome

[Ilvane]

Jani, call your insurance company. It WILL get paid. If you get told no, ask for a supervisor, and raise holy hell until someone there says yes.

I've worked for insurance long enough to know how to get around it, so IM if you want more ideas.;)

-A