4 ms·
Once upon a time, I had a surprise bill for about $4,000 that health insurance decided should have been $700 for that procedure. I fought it and won. But it t
by cbanek 7y ago
Once upon a time, I had a surprise bill for about $4,000 that health insurance decided should have been $700 for that procedure. I fought it and won. But it took forever, almost a year of calling them and going back and forth - and this was actually decent corporate health insurance.
It took a lot of reading through the 600+ page plan document and finding loopholes. For example, I asked them that if they thought it should be done for $700, who would actually do it for $700? They couldn't list one provider that would accept the payment rate they thought they should pay. And since this was a reimbursement, and they had already pre-approved the procedure (knowing the price), I think I caught them already saying they would do it, but them not following through. There was a lot of going back and forth about in-network vs out of network, but again, no one in-network would perform the procedure. In the fine print of the plan document, it said if there are no in-network providers, the plan must provide you were in-network rates and deductibles for using an out-of-network provider.
So I told them if they can't find anyone who will accept what they are willing to pay, their figure is obviously wrong. It helped that with my health insurance, everything was supposed to be covered, 100% with no copay. So the fact that they tried to charge me for the $3300 overage was very out of line for them.
They never just said "no, we're not going to cooperate" it was more just endless stalling on their part. It was never really a blunt refusal, or if they tried that, I just proved how ridiculous their arguments were. I kept a lot of documentation.
I think in the end, they just relented because they were spending more dealing with me than actually just paying me my money. But it was certainly an uphill battle the whole way, and not one I would recommend to someone who isn't well versed in legalese.
- rntksi 7y agoThese stories are horrifying to me. I live in a less developed country than the US, other businesses may be crooked and all but at least the medical field is manageable.