Healthnet – “we can’t give you that information”

The last few years, I’ve become more involved in how my health insurance works. Before – I’d just go to a doctor – pay what wasn’t covered and move on with my life. But due to changes in my life, understanding what is covered and what isn’t has become a big deal.

This is where I’ve run into this nasty loop that occurs between myself, the insurance company, and the doctor/provider.  It looks like this:

Version 1:
Me: Will this procedure be covered
Doctors Office: You need to ask your insurance
Insurance Company: It depends on what your doctor does
Me: So basically, we won’t know if it is covered until afterwards?
Insurance Company: Your Doctor will know what is covered
Doctors Office: We don’t know what is covered – that is up to your Insurance. Please sign this document saying you are liable for all charges.
Me: I can’t get this done until I know if it is covered or not

Version 2:
Me: Will this procedure be covered
Hospital: Yes
Insurance: Yes
Me: Hi – why did I get charged for this?
Insurance: This doctor isn’t in network
Me: I thought this hospital was in-network
Insurance: Yes, but this doctor is not
Hospital: Next time, make sure that all doctors are in-network

Version 2.1:
Me: Will this procedure be covered?
Hospital: Yes
Me: How do I make sure that the doctors are in-network
Hospital: Well it just depends who is working that day
Me: So How do I make sure that they are in-network
Hospital: You will need to confirm with that doctor
Me: How am I supposed to do that if I’m fucking unconscious and a different anesthesiologist is working that day? Or when my wife is asleep after giving birth and you come in to do an ear-test on the the newborn?
Hospital: Well, we won’t know in advance who is working
Me: FML

Version 3:
Insurance: It is covered as long as the doctor uses the correct code
Me: Ok, which code is that
Insurance: I can’t tell you that
Me: Can’t, or Won’t.
Insurance: I am not allowed to give you that information

I’m sure there are more. Oh right – when the doctor does procedures that aren’t considered “preventative”, so they aren’t covered. Or when the doctor just uses the wrong code for it. Normally they just re-bill and it gets sorted out, but I had one doctor who REFUSED to resubmit the code.

Hrm, I’ll save my Doctor rant for another day.

 

 

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