: Insurance and billing morons

March 13, 2006

Holy Toledo. So.Last year the boys had their yearly bone marrow biopsies.

No problem. The insurance paid for all of ph's. Not all of 's they

refused to pay the doctor $88. Of course We've never seen a bill and with

moving the EOB from our old insurance may have gotten lost in transit. But

no worries b/c I have never seen a physician's bill. Today an EOB comes

from our new insurance that we DI NOT HAVE ON THE DATE OF THE BMBs denying

the coverage. Um yeah-that makes sense since we were not insured by them

at the time. So, I call the hospital and get one of the billing ladies.

Trying to explain that they filed with the WRONG insurance was a nightmare.

HELLO!? ANYBODY HOME!? So she finally gets it like the third time I

explain..and then goes into the computer and says, " OH we never sent a claim

to UHC. " Ummmmm yeah, they just automatically figured it out and sent us

the EOB.no one ever sent them anything..

So then she looks at the original claim filed and says the old insurance

company denied it. Okay.so then I ask her to look up and see if they

denied ph's claim. She did not understand.so I explain that I have two

kids with the same thing and they get their yearly BMBs done together.

OH... so she looks up ph's and says his was paid. So then I ask her if

she can see what was different in the two claims. and if they will re-file

or appeal it-- she says she can't do that. I need to do it. So I have to

get on the phone to the old insurance company and talk to them.

These are the things that make you wonder. Same exact disease, same exact

procedure and the insurance covers it for one, but not the other. The first

answer is always, " Well, they just did not cover it. " It throws them for a

complete loop when I say, " But they covered it on the other child. " Not

that it matters, you'd think they'd pay the doctor for his services-they

paid the bills and for the " surgery " as listed in the EOB-wouldn't think it

was normal to pay the doctor who did the surgery?

Off to make the frustrating call. It will work out in the end, I am sure-it

is just frustrating dealing with these issues on an almost daily

basis-stupid things that add up and take a toll.

Peace Be With You,

~Pattie~

Piedmont Triad, NC

Mom to , age 12 & healthy, , age 9, Shwachman-Diamond Syndrome

and ph, age 8, Shwachman-Diamond Syndrome

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