INSURANCE: The Ultimate Gambling Casino
Okay, I promised you I'd share a little bit about what I have learned these last 2 years. I hope this helps someone out before we all end up in the county home. Insurance is a good thing. I am not saying I'm not glad to have it, but there are some things you need to know. I'll just "pick a place"and start. "Yes, we accept CIGNA" and "Yes, we are contracted with CIGNA" mean 2 different things. Most doctors offices will "take" any insurance payment they can get. A lot of plans nowadays offer the "go wherever you want, see whoever you want" option, but the doctor's office does not always play along. The doctor "accepts" CIGNA payments, but is not CONTRACTED with them. What does this mean? It means that CIGNA will pay them a little bit and they will take that. But there is no room for a write-off so the balance is my responsibility. Now did they tell me that? I guess I did not ask in the right terminology. When an insurance company is CONTRACTED with the doctor's office, it means they know what the doctor is going to get paid and the doctor knows and he accepts their deal and knows he will get his money. HE has to write off a certain amount (that those poor suckers who don't have insurance have to pay.....) Then you have a nice little balance that is bearable. I got the bill from the emergency room physician. Insurance paid nothing. The doctor is not CONTRACTED with CIGNA, you see. Now the ER is, and the Radiologist is. But the doc is not. See, they're all different entities. So when you take YOUR 2 year old who has fallen down the steps and cannot move her arm and is screaming in pain, make sure you whip your card out and have them make a fast call to see if the emergency room doctor is CONTRACTED with your insurance company and if he's not, have them call the next guy on the list to see if he is contracted and will he come in at 8:00 pm on Superbowl Sunday night. See, I just didn't think about doing that. I wanted to know if Annalynn needed a cast. and I wanted to know fairly quickly. Guess I over-reacted. Now I find it hard to understand why I can have my insurance pay a certain amount and then the doc has to write off the other $200, but my sis, who DIDN'T have insurance has to pay the whole thing. If they can "write off" $200 for me, why can't they do it for her??? OH WAIT, it's the same reason that I pay $5.97 for that roast because I have a KROGER PLUS CARD and my sis pays $26.85 for it because she never took the time to fill out that little piece of paper. ROLL THE DICE BABY!!!!!!!!!!! See what ya get!!! YEEE HAWWWW!!!!! NEXT BLOG: "TIME IN A BOTTLE.........."
posted by patty @ 8:28 PM
2 Comments:
I had the same thing happen to me last year at doctor Ratnayake at the off hours clinic. They not only told me that they accept Cigna, but it went so far as for me to stop them before taking x-rays, and ask them, "are you sure Cigna will cover this?" After a couple minutes of verifying this, they assured me that they would.
Guess what? 3 weeks later I got a bill for the whole thing! After assuming it was a clerical error, I called the clinic with my query.
They told me that, well, they don't take Cigna. Huh? What? Am I losing my mind? Did I imagine that I asked.....like 4 times?
Nope. I didn't imagine it. In fact, they remembered, and admited that they were at fault. Ok, whew! So I don't have to pay the bill? Oh, no, no. You still have to pay.
Huh? But...you...just....said....
"Sorry, sir, you don't expect the doctor to have to cover it, do you?" Ah, YEAH! I do! Or maybe the receptionist, or someone! Maybe the 10 of you could all pay like 20 bucks to cover your admitant SCREW UP!
Nope. Didn't happen.
I even went so far as to file a complain with the BBB. But guess whe they sided with? I'll give you a hint. It wasn't me. My mind still reeles a the thought of it.
So I bent over like a good little robot.
You have GOT to be freaking kidding me. Hmmmm.......so I guess next time I go to the ER, I shouldn't bother to ask anyway. I went to Ratnayake once. Same type of thing. sort of. They made me pay up front and then filed it for me and I'd get reimbursed. Well, it was not covered. So I was NOT reimbursed. I wanted to bend someone ELSE over........
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