Health Insurance

[Bandit]

I am starting to see a pattern with blue cross and it is starting to piss me off. they are supposed to pay 50% of claims if i go out of the network and so far they pay nothing when i went out of the network. Otherwise they pay 80% for in network claims.

I have also noticed a trend with them contracting doctors that do not use the hospitals that they contract in a different network . so, you find a great doctor in your network, but you cannot use that doctor at the hospital that the doctor uses if you should need the hospital. That is a scam to force people into some kind of cattle call. You pay for an individual PPO plan but they in reality are forcing you into an HMO group service.

My dentists secretary also let me in on some of the crappy HMO plans. She told me my dentist dropped all HMO plans because the insurance kept calling them & telling them not to give the best service, the best meds, not to xray, and to pull teeth instead of fixing teeth. Um, that is a problem.

If I can only afford to pay $700 every two months for one of their best PPO plans which makes me not able to afford the doctor visits, the meds, the deductible & the out of pocket, which in return means I will be once again in debt, then what in the hell is the point of buying insurance if I am going to be bankrupt due to lousy insurance?

I could at least be paying some of the medical bills that insurance refuses to pay if I drop the insurance. My point being, if I am going to be in debt for the rest of my life to massive medical bills that will bankrupt me again because health insurance & health care in the USA sucks, then what is the point of having insurance?

I have also learned from some other inside medical people that blue cross does not always pay for things in personal plans unless they are accute, which means they sell you full coverage but you only get what coverage they feel like paying.

Oh yes I know...we talk about this all the time. But I have never been this angry about how the system is out to screw people.

[Flamingo]

Managed care insurance came into existence to control the skyrocketing costs of doctors, hospitals and medical procedures that were beyond the reach of the average person. Without it, no one could afford to go to the doctor with a major problem, have to go to the hospital, be admitted, etc., etc. People go to the hospital one time and the bill is over $25,000. The average person just does not have that saved for medical purposes or other purposes.

There are many different kind of HMO and PPO plans all having various deductables. New on the market in the past several years are HRA's where you pay less for the plan but pay a higher deductable and the plan starts paying for services (i.e. 80% or so) after that deductable is met.

Don't blame managed care on the problems. A recent article in our local paper mentioned that a doctor's office is the most profitable office there is. Also, if you did not have that insurance and had to have major surgery, that is how large majority of folks end up filing bankruptcy - high medical bills they cannot pay due to lack of insurance or noncoverage by insurance.

[Bandit]

Managed care insurance came into existence to control the skyrocketing costs of doctors, hospitals and medical procedures that were beyond the reach of the average person. Without it, no one could afford to go to the doctor with a major problem, have to go to the hospital, be admitted, etc., etc. People go to the hospital one time and the bill is over $25,000. The average person just does not have that saved for medical purposes or other purposes.

There are many different kind of HMO and PPO plans all having various deductables. New on the market in the past several years are HRA's where you pay less for the plan but pay a higher deductable and the plan starts paying for services (i.e. 80% or so) after that deductable is met.

Don't blame managed care on the problems who is paying for 'FULL COVERAGE. A recent article in our local paper mentioned that a doctor's office is the most profitable office there is. Also, if you did not have that insurance and had to have major surgery, that is how large majority of folks end up filing bankruptcy - high medical bills they cannot pay due to lack of insurance or noncoverage by insurance.

none of that matters to the consumer. if the person is in debt to medical bills it does not matter if it is 10,000 or if it is 500,000. Yes I blame the united states managed health care system as the richest nation in the world for giving the worse medical attention, charging the most & scamming its people.

It does not matter if tou pay in the premium or in the deductible or the entire bill out of your ownpocket. If I did not have that insurance I could be paying a portion of the bills. Either way, the medical bills do not get paid & we do not get taken care of.

I think you missed the point. It does not matter if you have la ti da managed insurance when they refuse to pay the 10,000 outpatient hospital bill that they say they would pay 50% of...you end up bankrupt anyway!

[Bandit]

The only time people get decent health care or they used to, is when you work for an employer taking the shots for you.

Blue Cross admitted to me that the care people get through an empolyer is regulated by government so it is 100% better in paying and the difference between that & self pay they said is, night and day.

[DisneyGirl]

I'm sorry Bandit. It really stinks that on top of feeling bad you now have to deal with fighting the insurance company. I have Blue Shield here in CA and it's okay. You have to make sure you only see certain doctors that belong to one medical group and work out of a certain hospital. It's a real pain sometimes. But I'm thankful for what we do have and that my husband's employer pays for a big part of it.

[Bandit]

I'm sorry Bandit. It really stinks that on top of feeling bad you now have to deal with fighting the insurance company. I have Blue Shield here in CA and it's okay. You have to make sure you only see certain doctors that belong to one medical group and work out of a certain hospital. It's a real pain sometimes. But I'm thankful for what we do have and that my husband's employer pays for a big part of it.

I bought good health insurance to keep me out of BK. And $350 bucks a month premium does not cover much of anything. This is their 4th best(?) plan.(?) I cannot afford 500 dollars a month for the traditional.

they do not tell the truth up front. they do not let you combine the doctor in the network with hsopital out of network for the 50% they say they will pay.

I have been doing some heavy research on them and they do people dirty on ridiculous whims. I paid a premium that includes 50% payment for out of the network & 80% in network. The doctor I wanted was in the network but because he only works out of two hospitals that are not in the network, They denied the entire claim to both the doctor and everyone involved. Do you have any idea how many doctors they have contracted this way? Almost every one of them. It is more like a an HMO but you pay PPO prices.

Now I am stuck with another 10K when my total out of pocket is only supposed to 3,000 for the year in network and a max of another 3,000 out of network! Fortunately that all went into the BK.

PPO is a lie because you may as well get a cheap HMO plan that does not help people or, have no insurance at all. This does not end at the medical field either. It is now effecting housing, auto and every other insurance on the market. They make billions but do not pay all the valid claims while uppity is enjoying the profits.

I am finding a lot of complaints and suits against blue cross where the fed does get involved for them not paying.

You dont have be sorry. I could be a lot worse off. I have learned to deal with certain things without medical help. I told my mother the other day that I may as well start planning my next BK on medical bills because high premium insurance sure isn't paying.

Having employer insurance is the only way & those who pay out of pocket do not stand a chance unless you are a multi millionaire...then you can even buy your way out of prison.

Can you tell my blood pressure is boiling?

[AMISLANDER]

Getting dental work done before my dental is dropped next year. I plan not to need stupid tooth repairs due to funny jokes that cause me to hit my teeth on tables anymore.

[Bandit]

Getting dental work done before my dental is dropped next year. I plan not to need stupid tooth repairs due to funny jokes that cause me to hit my teeth on tables anymore.

LOL! What happened? You already know my story about 7 broken teeth.
Did someone play a bad prank?

One of my lifelong friends is a truck driver. there was a load of metal pipes on the truck in front of him that came loose. One of the pipes came thru his trucks windsheld and hit him in the mouth. He lost every tooth & has had false teeth since 25 years old.

Make sure your dental covers the claims before. They do not like to pay for more than one root canal or one filling per year.

[AMISLANDER]

LOL! What happened? You already know my story about 7 broken teeth.
Did someone play a bad prank?

One of my lifelong friends is a truck driver. there was a load of metal pipes on the truck in front of him that came loose. One of the pipes came thru his trucks windsheld and hit him in the mouth. He lost every tooth & has had false teeth since 25 years old.

Make sure your dental covers the claims before. They do not like to pay for more than one root canal or one filling per year.

oh, yeah...I had taken my girlfriend out for her birthday & I was laughing at something & I laughed so hard I somehow hit my mouth on the table & knocked out an itsy bitsy filling that actually was getting yellow...I had my dentist's office submit the claim & it came back that after my deductible (plan runs October to October), they will be paying a WHOPPING $50 on a $365 tooth colored replacement that's about the size of a cracker shaving....

I am not laughing anymore, but maybe this is how the tooth fairy flies...I want to get my teeth whitened (trying out those crest strips first) and I would not have been able to whiten that cap/filling...now I'm going to have to see if the dentist will make it whiter so no matter which way I go, strips or in office laser, it will be compatible.

I did the laser whitening over 15 years ago & it really worked well, for me...I've heard pros & cons over it now...& not sure which way to go at this point, but thought I'd try the crest strips before spending a bundle that I don't have....ugh!

[Flamingo]

I bought good health insurance to keep me out of BK. And $350 bucks a month premium does not cover much of anything. This is their 4th best(?) plan.(?) I cannot afford 500 dollars a month for the traditional.

they do not tell the truth up front. they do not let you combine the doctor in the network with hsopital out of network for the 50% they say they will pay.

I have been doing some heavy research on them and they do people dirty on ridiculous whims. I paid a premium that includes 50% payment for out of the network & 80% in network. The doctor I wanted was in the network but because he only works out of two hospitals that are not in the network, They denied the entire claim to both the doctor and everyone involved. Do you have any idea how many doctors they have contracted this way? Almost every one of them. It is more like a an HMO but you pay PPO prices.

Now I am stuck with another 10K when my total out of pocket is only supposed to 3,000 for the year in network and a max of another 3,000 out of network! Fortunately that all went into the BK.

PPO is a lie because you may as well get a cheap HMO plan that does not help people or, have no insurance at all. This does not end at the medical field either. It is now effecting housing, auto and every other insurance on the market. They make billions but do not pay all the valid claims while uppity is enjoying the profits.

I am finding a lot of complaints and suits against blue cross where the fed does get involved for them not paying.

You dont have be sorry. I could be a lot worse off. I have learned to deal with certain things without medical help. I told my mother the other day that I may as well start planning my next BK on medical bills because high premium insurance sure isn't paying.

Having employer insurance is the only way & those who pay out of pocket do not stand a chance unless you are a multi millionaire...then you can even buy your way out of prison.

Can you tell my blood pressure is boiling?

Bandit - appeal the matter - if you have coverage as you state, your doctor should be covered as in-network and the hospital he practices under should be covered as out-of-network. However, it is possible you may have had to obtain an authorization or approval ahead of time before you went to that hospital or your doctor had to obtain that for you. There are many doctors that practice only at various hospitals that may not be in-network with a particular health plan. The best thing to do with any insurance is to call the number on the back of your card before any procedure, admittance or surgery is done to check on your coverage. If you get an OK that all is fine, you are safe with that documented phone call (all calls are docoumented when they come into customer service). Here's hoping you get it all worked out...

I inadvertently was balanced billed by an x-ray provider for an x-ray of my wrist last year. Their charge for the x-ray was like $550.00. They contracted with my insurance company to pay only about $75.00 for those particular x-rays (look at the amount of their profit). They tried to bill me for the difference between the contracted rate with my insurance company and their standard cost for the x-ray of $550.00. You can get I flipped out but my insurance company took care of it immediately.

[Bandit]

Bandit - appeal the matter - if you have coverage as you state, your doctor should be covered as in-network and the hospital he practices under should be covered as out-of-network. However, it is possible you may have had to obtain an authorization or approval ahead of time before you went to that hospital or your doctor had to obtain that for you. There are many doctors that practice only at various hospitals that may not be in-network with a particular health plan. The best thing to do with any insurance is to call the number on the back of your card before any procedure, admittance or surgery is done to check on your coverage. If you get an OK that all is fine, you are safe with that documented phone call (all calls are docoumented when they come into customer service). Here's hoping you get it all worked out....

I have appealed & spent hours on the phone with them and I am still not done with them. They have good ears but they have better heads that shake sideways. I changed my plan from the best network (CHOICE that screwed me) to a lesser network (SELECT- so they can screw me some more). Assuming there is no BK for this, The only thing I could really do at this point is drop the coverage all together, start paying the medical bills that they said they would pay and use what is left over from not paying insurance to hire an attorney & fight them.

Or I could just drink some liquid plumber. Do you think they would cover that?

I also had the premium card that says you would get all generic perscriptions at $10 maximum per script. Guess what? It was cheaper for me not have inusurance & pay the smaller amount than the $10 copay, another reason I dropped their premium for that drug coverage & went with a deductible instead. My last script after my out of pocket & deductible was fulfilled saved me a whopping 8 pennies because they simply do not cover what they say after you have fulfilled your end of the deal. Am I supposed to appeal for 8 cents? The pharmacist understood exactly what I was saying & admitted he sees the problem with insurance all the time.

You know what else I have that they say? 100% coverage for anywhere I go out of my state. That is laughable. Seeing that I live on the border of 2 other states, perhaps I should try driving the distance just to see that their claim of 100% out of state actually means 0%. I still wonder about that & now that gas is down it would be worth the drive to use it. Somehow I really think they come up with these addies as gimmicks just to get you to buy it.

I get more insight from doctors secretaries and billing departments of hospitals on how they try to rip people off explaining that sometimes when tests come back negative they refuse to pay anything for he test because they feel you did not need that test since you were not really sick. Just when I think I have heard it all.

I inadvertently was balanced billed by an x-ray provider for an x-ray of my wrist last year. Their charge for the x-ray was like $550.00. They contracted with my insurance company to pay only about $75.00 for those particular x-rays (look at the amount of their profit). They tried to bill me for the difference between the contracted rate with my insurance company and their standard cost for the x-ray of $550.00. You can get I flipped out but my insurance company took care of it immediately.

Thank you for proving my point how insurance companies & doctors are indeed doing their best to rip the consumer off every chance they can. I am also familiar with those amounts for xrays. my last one for my foot was $900. They will probably pay 90.00. Though since the result was negative I will probably get stuck with the whole thing.

[Bandit]

oh, yeah...I had taken my girlfriend out for her birthday & I was laughing at something & I laughed so hard I somehow hit my mouth on the table & knocked out an itsy bitsy filling that actually was getting yellow...I had my dentist's office submit the claim & it came back that after my deductible (plan runs October to October), they will be paying a WHOPPING $50 on a $365 tooth colored replacement that's about the size of a cracker shaving....

I am not laughing anymore, but maybe this is how the tooth fairy flies...I want to get my teeth whitened (trying out those crest strips first) and I would not have been able to whiten that cap/filling...now I'm going to have to see if the dentist will make it whiter so no matter which way I go, strips or in office laser, it will be compatible.

I did the laser whitening over 15 years ago & it really worked well, for me...I've heard pros & cons over it now...& not sure which way to go at this point, but thought I'd try the crest strips before spending a bundle that I don't have....ugh!

I hear you. I searched for dental coverage and after reviewing all the plans, realized I would be better off paying out of my own pocket & be in debt because they do not offer much for those premiums & they leave you in debt anyway if you need a lot of work.

I tried those crest strips and yes they do work in making the teeth whiter, except for any fake teeth it wont change their color.

But they only go around the front & side teeth, not all the way to the back or on the inside, just the front side.

[PoorGrammyinBK7]

I bought good health insurance to keep me out of BK. And $350 bucks a month premium does not cover much of anything. This is their 4th best(?) plan.(?) I cannot afford 500 dollars a month for the traditional.

they do not tell the truth up front. they do not let you combine the doctor in the network with hsopital out of network for the 50% they say they will pay.

I have been doing some heavy research on them and they do people dirty on ridiculous whims. I paid a premium that includes 50% payment for out of the network & 80% in network. The doctor I wanted was in the network but because he only works out of two hospitals that are not in the network, They denied the entire claim to both the doctor and everyone involved. Do you have any idea how many doctors they have contracted this way? Almost every one of them. It is more like a an HMO but you pay PPO prices.

Now I am stuck with another 10K when my total out of pocket is only supposed to 3,000 for the year in network and a max of another 3,000 out of network! Fortunately that all went into the BK.

PPO is a lie because you may as well get a cheap HMO plan that does not help people or, have no insurance at all. This does not end at the medical field either. It is now effecting housing, auto and every other insurance on the market. They make billions but do not pay all the valid claims while uppity is enjoying the profits.

I am finding a lot of complaints and suits against blue cross where the fed does get involved for them not paying.

You dont have be sorry. I could be a lot worse off. I have learned to deal with certain things without medical help. I told my mother the other day that I may as well start planning my next BK on medical bills because high premium insurance sure isn't paying.

Having employer insurance is the only way & those who pay out of pocket do not stand a chance unless you are a multi millionaire...then you can even buy your way out of prison.

Can you tell my blood pressure is boiling?

I feel your pain! I don't have Blue Cross, but I have a PPO plan with another company. It is such a racket. I pay nearly $400 a month and have a huge deductible and out of pocket cap. I may as well not have any. They have paid NOTHING this year!

[Bandit]

I feel your pain! I don't have Blue Cross, but I have a PPO plan with another company. It is such a racket. I pay nearly $400 a month and have a huge deductible and out of pocket cap. I may as well not have any. They have paid NOTHING this year!

This is a problem. I know what you mean about them not paying anything to help you. It is set up as a win/win situation for the insurance company.

You pay a huge premium for what you can afford and then you still end up in debt with the deductible and out of pocket as they pay nothing to help you. What really gets me is if I had a bad accident like I did last year, I would not be able to pay the premiums anyway because I would not be able to work...so POOF....there goes insurance and I am right back into debt, especially if there are complications during the healing.

So if you are like me, you try so hard to stay out of debt with medical bills but the system has made it impossible, therefore it makes it unreasonable to be paying for a premium that will keep you in debt anyway if you actually make claims, that is if they will even pay for the claims.

I have been trying very hard to deal with this so I never have a BK again. iT is such a racket. I did figure one thing out...it makes no difference if you pay the piper in the premium price or in the out of pocket/deductible price. Either way when you start to actually use it, it puts you into high debt or you cannot go to doctors because of the copay.

I am wondering if I should just have magor medical? or have nothing & just deal with mounting medical bills & BK it every 8 years because insurance is not helping keep me out of BK.

My cousin pays 1,000 every two months for 90/10 and has only made one tiny claim in about 25 years for a perscription & dental cleanings once a year. They pay nothing because the deductible is $500 a year.

[Bandit]

Maybe I will be one to be in one of these types of class suits:

http://www.medicalnewstoday.com/articles/69446.php

900,000 doctors in the class? there is a big problem with blue cross blue shield.


I am already entered into a class suit against the 'not for profit' hosptial for overchargng me twice in the last 10 years.