insurance warning! Wait until you hear this one!

[Guest guest]

Most of you who've read my postings know that 2 weeks after my surgery I had to

be rushed via ambulance ordered by a visiting nurse from my hospital to evaluate

me after my severe spasms.  She assured me that everything was handled with my

insurance comany, Humana, the correct way.   My mother had called, my boyfriend

called and I called and were all told everything was done correctly.  I called

Humana for some questions on 12/10 and the rep told me that I was just sent 2

separate bills; one was huge and that she sees that it was a mistake; that they

had penalized me 50% for no precert.  When I got the $6000 bill I called anyway

and was told it was under review.  Today the same rep called me and said that I

indeed owed the money because I had no precert.  She added that there were no

records of any calls made by anyone but me!  I called the nurse from my hospital

who had handled everything and she said this happens everyday.  That both she

and

the hospital's billing office callled Humana for the precert and were both told

that a precert was not necessary.  The nurse told me they kept careful records

of who they spoke with and the dates etc.and would write me a letter with the

info and email it to me tomorrow.  I just spent an hour drafting a letter to

dispute this whole thing.

Back in September they did the same thing to me.  I was upset that my primary

doc didn't order an MRI right away.  My doc insisted they need a precert.  I

called Humana and a rep told me I didn't need one.  Fortunately my doc got one

anyway and had a confirmation number for it because when I got home from surgery

I had a $600 bill stating that I was penalized 50% because I had no precert.  In

this case I provided the confirmation number and had the decision reversed.

Obviously this is showing some kind of pattern.  Lesson to all of you:

1. no matter how much pain or meds you're on, make the calls, take accurate

records to document who you spoke with, the date and a reference number;

confirmation number if you get one.  Keep these in a place you won't loose them.

2. If they tell you that you don't need a precert don't believe them.  Insist on

one anyway or insist they send an official document (if time allows) stating

such.

3. remember all calls are recorded: be careful what you say; but know that an

attorney can suppeonna records and feel free to remind them of that if they give

you trouble.

4. The provider can still put a collection on you even if you think the

insurance company owes the money.  I know this because I've dealt with people's

credit for 15 years and have seen it often; if it goes to collection, it will

not come off your credit report; best case it shows as a paid collection and

your score still suffers. So keep the provider in the loop and send them copies

of your dispute documentation.

This is such an agravating thing to do to people in pain.  My back muscles have

tightened from the anger and stress it's put me in.  Hopefully I've helped some

of you avoid a similar situation.