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  • Health Care Reform needed - ASAP

    The perils of a poor man -

    As many of you know I have twins. The wife and I took them to get shots - the 12 month ones a couple of months ago - although my health insurance said they covered all immunizations 100%. They denied the claim because they said the doctor billed them as shots and not immunizations. This is 115 dollars per shot - times 3 shots - times 2 kids. For a total of 345 per kid or 690. So when talking to the insurance company I find I have a limit on these immunizations of $500 per child. Of course, 1 year olds get 12 month shots - 15 month shots - and 18 month shots.

    They the insurance company said they would cover them if they were rebilled under immunization shots. We called the doctor - and since we are long term patients - they gave us the hook up. Out of pocket we have to pay 15 bucks a shot. My insurance company despite what they have posted - says they don't want to pay any immunizations to the doctor. So we are just going to pay out of pocket - it's a lot cheaper in the long run.
    Turning the other cheek is better than burying the other body.

    Official Sport Lounge Sponsor of Rhode Island - Quincy Jones - Yadier Molina who knows no fear.
    God is stronger and the problem knows it.

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  • #2
    And most of the candidates want to keep insurance companies in the look when it comes to health care reform, idiots.
    They are a company, as has been stated here many times a companies first responsibility is to it's shareholders, and that is fine, but that is exactly why they shouldn't be involved with federally funded health care for America. Fuck them.
    Every penny we have to give to them in profit is money taken away from health care services for Americans.
    Be passionate about what you believe in, or why bother.

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    • #3
      Originally posted by Schwahalala View Post
      The perils of a poor man -

      As many of you know I have twins. The wife and I took them to get shots - the 12 month ones a couple of months ago - although my health insurance said they covered all immunizations 100%. They denied the claim because they said the doctor billed them as shots and not immunizations. This is 115 dollars per shot - times 3 shots - times 2 kids. For a total of 345 per kid or 690. So when talking to the insurance company I find I have a limit on these immunizations of $500 per child. Of course, 1 year olds get 12 month shots - 15 month shots - and 18 month shots.

      They the insurance company said they would cover them if they were rebilled under immunization shots. We called the doctor - and since we are long term patients - they gave us the hook up. Out of pocket we have to pay 15 bucks a shot. My insurance company despite what they have posted - says they don't want to pay any immunizations to the doctor. So we are just going to pay out of pocket - it's a lot cheaper in the long run.
      Schwah...PM me, I have billed for a pediatrician for years.

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      • #4
        Don't give up! Call them every day. Eventually they'll get sick of you.
        Former 2017 OFFICIAL SPONSOR of Braves' Fill-In Matt Adams,
        Jesus is . . .


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        • #5
          Originally posted by Schwahalala View Post
          The perils of a poor man -

          As many of you know I have twins. The wife and I took them to get shots - the 12 month ones a couple of months ago - although my health insurance said they covered all immunizations 100%. They denied the claim because they said the doctor billed them as shots and not immunizations. This is 115 dollars per shot - times 3 shots - times 2 kids. For a total of 345 per kid or 690. So when talking to the insurance company I find I have a limit on these immunizations of $500 per child. Of course, 1 year olds get 12 month shots - 15 month shots - and 18 month shots.

          They the insurance company said they would cover them if they were rebilled under immunization shots. We called the doctor - and since we are long term patients - they gave us the hook up. Out of pocket we have to pay 15 bucks a shot. My insurance company despite what they have posted - says they don't want to pay any immunizations to the doctor. So we are just going to pay out of pocket - it's a lot cheaper in the long run.
          Tell them you'll get your lawyer involved if they are not fulfilling their end of the defined benefit you are entitled to.

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          • #6
            Every insurance company does everything they can to keep from paying.

            It's possible that there is 1 code incorrect on their claim, and they are denying the entire visit because of it. If they billed one shot with the diagnosis code for the disease instead of the vaccination, it could throw things off. It could also be that they are billing the admin fees for an injection instead of vaccination. But more than likely the insurance is hoping you'll take their denial without checking on it.

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            • #7
              Originally posted by Iowa_Card View Post
              Tell them you'll get your lawyer involved if they are not fulfilling their end of the defined benefit you are entitled to.

              I am not saying this is bad advice---it might be the very best thing to do.

              But it is a symptom of what is wrong with the healthcare system in the usa. Too many insurance executives and lawyers getting too much money--not enough being spent on healthcare.

              Too many people intimidated into not fighting the often hopeless fights.
              v


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              • #8
                Originally posted by AWSmith98 View Post
                Every insurance company does everything they can to keep from paying.

                It's possible that there is 1 code incorrect on their claim, and they are denying the entire visit because of it. If they billed one shot with the diagnosis code for the disease instead of the vaccination, it could throw things off. It could also be that they are billing the admin fees for an injection instead of vaccination. But more than likely the insurance is hoping you'll take their denial without checking on it.
                Coding mistakes cause more problems with insurance than anything else. Keep after them and you will eventually win.
                Adapt, Improvise, and Overcome..... The only way to live.

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                • #9
                  Schwa...who's your provider?

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                  • #10


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                    • #11
                      Originally posted by Jack Daniels View Post
                      Schwa...who's your provider?

                      United Health Care -
                      Turning the other cheek is better than burying the other body.

                      Official Sport Lounge Sponsor of Rhode Island - Quincy Jones - Yadier Molina who knows no fear.
                      God is stronger and the problem knows it.

                      2017 BOTB bracket

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                      • #12
                        Originally posted by Schwahalala View Post
                        United Health Care -
                        Ugh...they are the absolute worst. Did you happen to take them in on 11/7/07? They had a system wide problem on that date.

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                        • #13
                          Originally posted by AWSmith98 View Post
                          Ugh...they are the absolute worst. Did you happen to take them in on 11/7/07? They had a system wide problem on that date.

                          No January 1 of this year.
                          Turning the other cheek is better than burying the other body.

                          Official Sport Lounge Sponsor of Rhode Island - Quincy Jones - Yadier Molina who knows no fear.
                          God is stronger and the problem knows it.

                          2017 BOTB bracket

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