[dwater]

My partner has been employed with the same large international company for 8 years. She had an elected procedure done that is required by law to be fully covered by insurance. She had 3 calls leading up to the procedure with her health insurance company each time asking them if they were certain it would be covered 100%. I thought that this was overkill but she was worried to the point of being paranoid about it. They assured her each time she would not have to pay any money at all for anything.

The procedure was in December. After the procedure she received a 6-figure bill, which she then had to follow up with hours of phone calls back and forth to the insurance company, hospital, and doctor's office. They sent her a revised bill for somewhere around $8,000, and then another revised bill for around $4,000.

The insurance company says it's because the doctor coded the procedure incorrectly. The doctor says the hospital coded it incorrectly. She has had to file an appeal with the insurance company, and the only reason it looks like it will work out is because the insurance company records all phone calls and was able to get records of her original calls before the procedure asking if it would be fully covered. She has still been told to expect that they will deny her first appeal and she'll have to appeal a second time in order to get it covered. This has been causing her immense stress for the past 4 months as she does not have enough money to pay even the $4,000 bill out of pocket.

My experience is that your experience actually is extremely uncommon in America today. Most people who have to interact with the health care system beyond annual checkups have to deal with something like this.

[pxeboot]

She is lucky she is getting that even partially covered if she only got a verbal agreement. My insurance policy has a clause that anything they say over the phone is not a promise to pay. You have to call AND get something in writing to even be eligible for a dispute later.

[jimmy1]

I am fortunate to have had the experience of growing up with a rabid Greek mother who would get to the bottom of any shenanigans with any sort of insurance agency, bill collector or anything. I now have my own experience. Yes the first time was stressful, but reading your story, trying to put myself in your partner's shoes this would not have ended up causing me any stress, especially if I knew the law is on my side. I certainly wouldn't paid any bill until it was all sorted out. I also have experience where a medical charge that was suppose to be covered as a legitimate procedure was not and charged off onto my credit (because again, I refused to pay). I was easily able to negotiate with the credit reporting agency to remove this negative mark on my credit. (Negative marks due to medical bills affect your credit much less than say missing a credit card payment, IIRC, I was still able to obtain credit cards, get loans, and generally had decent overall credit).

My father currently undergoing treatment for lung cancer. He has medicare and supplemental coverage through Humana. Bills are still in excess of 150,000, so I definitely understand the other side of it.

[pnutjam]

My previous employer had my insurance totally wrong. According to everything I signed at open enrollment, I had a $6k deductible and $6.6k Out-of-pocket max. This was for the family, no individual deductible.

When I go to the insurance site, it lists me with a $2k individual & $4k family deductible. It says my OOPM is $7.5k. Of course I hit my deductible this year, so I'm getting billed an extra thousand.

My employer and insurance company both swear it's the other one's fault and even filing a complaint with the state insurance commission doesn't seem to have helped. :(

[sjg007]

In the future the way to avoid this is for the hospital/doctor to submit a prior auth request. Then you have it in writing.