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  1. #1
    Join Date
    Jun 2004
    Location
    Olean, NY
    Posts
    1,455

    med insurance runaround

    Looking for any advise here. last July I bought a motorcycle. While I rode it back from the sellers house my back started to hurt. It was a one hour drive and I had to pull over several times. It has plagued me since, has steadily gotten worse to the point now that I can't ride in my work van for more than 30 mins without getting out.

    I have united healthcare, I think I chose the better of the two options they offer.

    I had an x-ray a few weeks ago, I was just told there is a 700 dollar bill sent to me. It came out of my 2,500 deductable from 08. The doctor said I have degenerative disk disease (basically back arthritis). He gave me prednisone and a week worth of pain killers. He said I have to sort of deal with it, and gave me a tens unit.

    Well the pain is way too much to just deal with, I went back and asked for an MRI (doc didnt think it was needed). He ordered it and I called my insurance co to see if it was covered.

    I was told it will come out of my deductible so basically I pay the two grand out of pocket, and it will reflect my deductible.

    I called the MRI place. they said I need to stroke them a check for nine hundred bucks just to get started (their payment plan is half now half later), though if I pay in full I get 25% off.

    The MRI place put me on with their insurance dept. The in house insurance people said that doesnt make sense, insurance is supposed to pay for it then bill me out of the deductable

    I can't understand whats going on here. I need the MRI, I just can't describe the pain in my back. The tens unit is useless and pain killers are seven bucks a piece on the black market. I could care less about my credit at this point

    I'm thirty years old and something has to be done here. Anyone had to deal with a situation like this?

    Is it really possible for a doctor to tell me I have degenerative disk disease just from an x-ray? I think he is wrong (but he is the second opinion)

    Shouldnt my insurance be paying, then billing me the deductable?

    I really, really don't want to be forced out of this line of work, nor do I want to become hooked on pain killers.

    Is this coverage as bad as it seems?
    Guinness for strength

  2. #2
    Join Date
    Dec 2007
    Location
    Frognot TX
    Posts
    836
    Med ins can be a royal PITA, UHC was one of the better ones I've ever had, but they were also very high priced.

    Usually when I would go in for something, the hospital or who ever would send UHC a bill for umpteen billion, and UHC would say they would only pay about 1/4 of the charge, and if it wasn't covered under your schedule that amount would come out of your deductable. Always watch the calender if it is going to be a big expense, because most policies run from Jan 1 to Dec 31.

    Yup, if your deductable is $2500, and it was paid up yesterday, you get to start all over again today.

    I went in for a colonoscopy and the doctor asked me if I wanted to do a CAT scan, I asked him how much, and he said not that much, ins usually takes care of it, so I went in the chick that was doing the paper work said my cost for the procedure was $140, so i paid it and they did it. About a month later, I got a thing from BCBS saying that the hospital wanted over $8,800 for the scan, but they would only pay $1,850, and I owed the rest.

    The hospital and I are fighting over this right now, and they can kiss my arse if they think I'm paying $1,800 for an elective procedure that I was told would be $140, I would have told them to forget it.

  3. #3
    Join Date
    May 2004
    Location
    Austin, TX
    Posts
    1,743
    United Healthscare is a bunch of idiots. They will cheat you out of every
    $ they can. We had them 3 years ago, many doctors would not use them.

    They would decline every claim they could, would have to argue each one
    to get them paid. They hope you will give up on claims, and pay them
    yourselves.

  4. #4
    Join Date
    Dec 2007
    Location
    Frognot TX
    Posts
    836
    They probably are jerks now, when I used them was about 10 years ago, and I had cancer, so I was stuck with them for about 5 yrs, then got BCBS, but they all suck

  5. #5
    Join Date
    May 2002
    Location
    Houston Texas
    Posts
    6,327
    First United Healthcare sucks plain and simple and you have to fight them for everything you want.

    Second I would suggest that you get a second opinion including one from a good Chiropractor.

    Does your company have an HR department or a person that handles your insurance? If they do have them help you out if they don’t talk to your agent and insist that they help you decipher your benefits. Your agent must help you understand and properly utilize your policy benefits. Remember you are paying for them and their job is to provide proper utilization just as yours is to provide your clients with proper use of their equipment.

    Do not be passive stand up for your rights demand to be treated with respect and provided with your due.

  6. #6
    Join Date
    Jun 2004
    Location
    Olean, NY
    Posts
    1,455
    Quote Originally Posted by classical View Post

    Do not be passive stand up for your rights demand to be treated with respect and provided with your due.
    Thanks guys. Now I'm starting to miss the union.
    Guinness for strength

  7. #7
    Join Date
    Dec 2000
    Location
    NW Ohio
    Posts
    516
    Typically a provider will submit the claim the the insurance company who will review it and issue an EOB or explanation of benefits. The EOB will state what they will pay for and what your out of pocket expense will be. I'm sorry to say that if you have not met your deductible no one is going to pay it. It will be your responsibility to pay it to the provider. As Catpower stated your deductible probably started over today.
    What the MRI company told you would not be the normal way a claim is handled.

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