Re: insurance- preexisting condition

[Guest guest]

i have united healthcare right now and went to a rheummy outside my network.

however, i asked if they accepted my ins. and they said yes, so i feel like i

was mislead b/c i now have to pay 2400. for one appt.! does anyone out there

have any advice as to how i can fight this? my ins. has denied it all b/c it is

outside the network and the doctor's office won't work with me. help!!

brooke

>

> From: " deebs87 " <dlohf@...>

> Date: 2006/11/09 Thu PM 04:42:07 EST

>

> Subject: [ ] insurance- preexisting condition

>

> Hello,

>

> In case anyone is changing insurance like I am:

>

> This is info I found in our BCBS booklet:

>

> Notice of Prexisting Condition Exclusion:

> Under HIPAA, a " preexisting condition " is a condition for which

> medical advice, diagnosis or care of treatment 6 month period ending

> on the enrollment date of a healthplan.

>

> Each healthplan may have their own preexisting condition exclusion.

> Contact your plan. I didn't see anything in the booklet for BCBS so

> my husband will check into it Monday. When we changed from United

> Heathcare to Cigna in 2004, Cigna didn't have the exclusion.

>

> If Exclusion exisits, the existence of a preexisting condition will

> be determined using information obtained relating to an individual's

> health status before enrollment.

>

>

>

>

>

>

[Guest guest]

You were mislead, by united healthcare. I am in debt

12,000 to one dr because of the same thing. And, she

was on my list. No way to fight..you lose. Trust me on

this. Tami

Tami -Dossey

[Guest guest]

----- Original Message -----

From: <joehatton@...>

>i have united healthcare right now and went to a rheummy outside my

>network. however, i asked if they accepted my ins. and they said yes, so i

>feel like i was mislead b/c i now have to pay 2400. for one appt.! does

>anyone out there have any advice as to how i can fight this? my ins. has

>denied it all b/c it is outside the network >and the doctor's office won't

>work with me. help!!

Sorry, , I think you're just going to have to pay it. I was told

(many times by other patients, the doctor himself, his staff) that a surgery

I wanted to go out of state for was going to be $4000. That's all, I was

suppose to pay and even signed a contract saying that. My insurance said

they'd pay a max of $5000 since he was out of network. I flew to another

state and had the surgery. The $4000 turned out to be a complete lie. My

insurance did pay for bits and pieces here and there, and it probably was

more than $5000 for those bits, but when it was all over and done with, I

was left with a bill for $38,0000. I spent the next two years fighting,

entirely on my own. Everyone I showed the paperworks/bills to, would say

" I've never seen anything like it, you shouldn't have to pay all that

money. " , but they wouldn't actually do anything to help me.

I finally hired a lawyer (and it took a ton of work to find her). After

looking my stack of paperwork over, and talking repeatedly to the clinic,

she said " either they are the most incompetant people ever or they're

committing fraud. " She finally got them to discount the bill down to $2000

more than what I had initially paid plus 2 years worth of payments. THe

lawyer's bill was another $3000. So all in all, I paid well over $10,000

for a surgery that was suppose to cost me only $4000. Add to that, plane

tickets, hotel rooms, car rental and food.

You could try hiring a lawyer, but the bill would end up being more than

$2400, and you're probably just have to pay the $2400 plus the lawyer's fee.

very sorry

Darcy

[Guest guest]

Hi :

I had United Healthcare at one time too - if I

remember right, they will pay for out of network

doctors, just at a different rate. Like instead of

80/20 with in network, they pay 70/30 for out of

network. If you had not yet reached your out of

pocket deductible, this can happen, but 2400 sounds

like way too much for a deductible to me. I think

that the out of network doctor should work with you a

bit more, like in payments or something, but for your

insurance to completely deny any cost sounds

unreasonable. I would try to fight it. The doctor

wants to be paid - they should help you with it too,

IMO. I hope that something works out with this -

Kathe in CA

--- joehatton@... wrote:

> i have united healthcare right now and went to a

> rheummy outside my network. however, i asked if

> they accepted my ins. and they said yes, so i feel

> like i was mislead b/c i now have to pay 2400. for

> one appt.! does anyone out there have any advice as

> to how i can fight this? my ins. has denied it all

> b/c it is outside the network and the doctor's

> office won't work with me. help!!

> brooke

> >

> > From: " deebs87 " <dlohf@...>

> > Date: 2006/11/09 Thu PM 04:42:07 EST

> >

> > Subject: [ ] insurance- preexisting

> condition

> >

> > Hello,

> >

> > In case anyone is changing insurance like I am:

> >

> > This is info I found in our BCBS booklet:

> >

> > Notice of Prexisting Condition Exclusion:

> > Under HIPAA, a " preexisting condition " is a

> condition for which

> > medical advice, diagnosis or care of treatment 6

> month period ending

> > on the enrollment date of a healthplan.

> >

> > Each healthplan may have their own preexisting

> condition exclusion.

> > Contact your plan. I didn't see anything in the

> booklet for BCBS so

> > my husband will check into it Monday. When we

> changed from United

> > Heathcare to Cigna in 2004, Cigna didn't have the

> exclusion.

> >

> > If Exclusion exisits, the existence of a

> preexisting condition will

> > be determined using information obtained relating

> to an individual's

> > health status before enrollment.

> >

> >

> >

> >

> >

> >

>

>

>

________________________________________________________________________________\

____

Want to start your own business?

Learn how on Small Business.

http://smallbusiness./r-index

[Guest guest]

thank you, darcy! i figured that is what i will have to do, but needed to hear

it from someone with experience! thanks again!

brooke

>

> From: " catstamp " <catstamp@...>

> Date: 2006/11/12 Sun AM 07:05:57 EST

> < >

> Subject: Re: [ ] insurance- preexisting condition

>

>

> ----- Original Message -----

> From: <joehatton@...>

> >i have united healthcare right now and went to a rheummy outside my

> >network. however, i asked if they accepted my ins. and they said yes, so i

> >feel like i was mislead b/c i now have to pay 2400. for one appt.! does

> >anyone out there have any advice as to how i can fight this? my ins. has

> >denied it all b/c it is outside the network >and the doctor's office won't

> >work with me. help!!

>

> Sorry, , I think you're just going to have to pay it. I was told

> (many times by other patients, the doctor himself, his staff) that a surgery

> I wanted to go out of state for was going to be $4000. That's all, I was

> suppose to pay and even signed a contract saying that. My insurance said

> they'd pay a max of $5000 since he was out of network. I flew to another

> state and had the surgery. The $4000 turned out to be a complete lie. My

> insurance did pay for bits and pieces here and there, and it probably was

> more than $5000 for those bits, but when it was all over and done with, I

> was left with a bill for $38,0000. I spent the next two years fighting,

> entirely on my own. Everyone I showed the paperworks/bills to, would say

> " I've never seen anything like it, you shouldn't have to pay all that

> money. " , but they wouldn't actually do anything to help me.

>

> I finally hired a lawyer (and it took a ton of work to find her). After

> looking my stack of paperwork over, and talking repeatedly to the clinic,

> she said " either they are the most incompetant people ever or they're

> committing fraud. " She finally got them to discount the bill down to $2000

> more than what I had initially paid plus 2 years worth of payments. THe

> lawyer's bill was another $3000. So all in all, I paid well over $10,000

> for a surgery that was suppose to cost me only $4000. Add to that, plane

> tickets, hotel rooms, car rental and food.

>

> You could try hiring a lawyer, but the bill would end up being more than

> $2400, and you're probably just have to pay the $2400 plus the lawyer's fee.

> very sorry

> Darcy

>

>

>

>

[Guest guest]

kathe-

the out of network deductible is 4000. isn't that crazy? and that's yearly!

they said i could pay it in installments over 2 years. i guess that's the best

i can hope for. thanks for the info!

brooke

>

> From: Kathe Sabetzadeh <lv2ryd@...>

> Date: 2006/11/12 Sun PM 05:58:59 EST

>

> Subject: Re: [ ] insurance- preexisting condition

>

>

>

> Hi :

>

> I had United Healthcare at one time too - if I

> remember right, they will pay for out of network

> doctors, just at a different rate. Like instead of

> 80/20 with in network, they pay 70/30 for out of

> network. If you had not yet reached your out of

> pocket deductible, this can happen, but 2400 sounds

> like way too much for a deductible to me. I think

> that the out of network doctor should work with you a

> bit more, like in payments or something, but for your

> insurance to completely deny any cost sounds

> unreasonable. I would try to fight it. The doctor

> wants to be paid - they should help you with it too,

> IMO. I hope that something works out with this -

> Kathe in CA

>

> --- joehatton@... wrote:

>

> > i have united healthcare right now and went to a

> > rheummy outside my network. however, i asked if

> > they accepted my ins. and they said yes, so i feel

> > like i was mislead b/c i now have to pay 2400. for

> > one appt.! does anyone out there have any advice as

> > to how i can fight this? my ins. has denied it all

> > b/c it is outside the network and the doctor's

> > office won't work with me. help!!

> > brooke

> > >

> > > From: " deebs87 " <dlohf@...>

> > > Date: 2006/11/09 Thu PM 04:42:07 EST

> > >

> > > Subject: [ ] insurance- preexisting

> > condition

> > >

> > > Hello,

> > >

> > > In case anyone is changing insurance like I am:

> > >

> > > This is info I found in our BCBS booklet:

> > >

> > > Notice of Prexisting Condition Exclusion:

> > > Under HIPAA, a " preexisting condition " is a

> > condition for which

> > > medical advice, diagnosis or care of treatment 6

> > month period ending

> > > on the enrollment date of a healthplan.

> > >

> > > Each healthplan may have their own preexisting

> > condition exclusion.

> > > Contact your plan. I didn't see anything in the

> > booklet for BCBS so

> > > my husband will check into it Monday. When we

> > changed from United

> > > Heathcare to Cigna in 2004, Cigna didn't have the

> > exclusion.

> > >

> > > If Exclusion exisits, the existence of a

> > preexisting condition will

> > > be determined using information obtained relating

> > to an individual's

> > > health status before enrollment.

> > >

> > >

> > >

> > >

> > >

> > >

> >

> >

> >

>

>

>

>

>

________________________________________________________________________________\

____

> Want to start your own business?

> Learn how on Small Business.

> http://smallbusiness./r-index

>

>

[Guest guest]

NEVER accept the info your doctors office...ALWAYS Call and verify that your

doc is currently in network. Most office staff have NO clue what insurance

specific plans they accept. I have called and been told they accept my ins

to learn that its a different plan than what I have. Please keep in mind one

insurance carrier can have many different variations of a plan.

Toni

Posted by: " joehatton@... " _joehatton@... _

(mailto:joehatton@...?Subject= Re:%20insurance-%20preexisting%20condition)

Sat Nov 11, 2006 5:07 pm (PST)

i have united healthcare right now and went to a rheummy outside my network.

however, i asked if they accepted my ins. and they said yes, so i feel like

i was mislead b/c i now have to pay 2400. for one appt.! does anyone out

there have any advice as to how i can fight this? my ins. has denied it all b/c

it is outside the network and the doctor's office won't work with me. help!!

brooke