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Your insurance company is cheating you be sure to ask for your refund.

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  • Your insurance company is cheating you be sure to ask for your refund.

    My wife is a Registered Nurse. This his how I know about this.

    Have you ever noticed when you visit a new doctor you are always required to pay on your first office visit even if you have insurance. Your money will be refunded but YOU have to ask for it.

    This is how the system works. Lets assume your office visit is $100. After you pay $100 the doctor files a claim with insurance. Insurance sends a $100 check to the doctor. The doctor has already been paid so by law he is required to send that check back to the insurance company. Doctor is NOT required to notify the patent.

    The patent must call the doctor to see if they have received the insurance payment yet. When they say, YES we received the check and it was returned to the insurance company then you need to call the insurance company.

    You call the insurance company and they give you the run around. After being on hold for an hour, transfered several times, talked to several different people they tell you the check will be in the mail soon but it never comes.

    2 months later you call the insurance company again, same run around as before, this time they tell you something like the check was mailed to the wrong address. Company policy is not to send another check until that check returns.

    2 months later you call the insurance company again, you get more lame stories why the check is delayed. The insurance company acts like it makes them MAD that you called to ask for your refund. They may even tell you that you do not get a refund don't call again.

    You call the insurance company every 2 months finally after 14 months you finally receive your $100 refund check.

    This is very typical and Blue Cross Blue Shield is the worse company of them all.

    If you don't know to call and ask for your refund check the insurance company is NOT required to give you a refund so they get to keep the money.

    My wife was on the phone yesterday again for over an hour trying to get another refund from Blue Cross Blue Shield. This pisses me off I think everyone needs to know about this to get their refund.

  • #2

    Every insurance group I've dealt with (Blue Cross, Aetna, United Health Care, Medicare, TriCare, etc.) have constantly bombarded my mailbox with an unending stream of written statements showing charges, payments, disallowed charges, patient's copay/deductibles, and on & on...

    Granted, it's not the easiest thing to decipher all the accounting rigamarole, but it is all there.
    Lynn (Huntsville, AL)


    • #3
      Insurance will ruin this country.


      • #4
        if it were not for insurance, costs would be a lot lower. It's basically a big game of rising costs/rising services/re-rising costs, etc.

        It ends up being beneficial to somebody, sometimes even beneficial to the patient, if the insurance co cannot find a way to make your problem a "pre-existing condition" for which they will not pay.

        And if you can escape from the sink of diseases and infections known commonly as a "hospital" without GETTING one of the diseases or infections on top of whatever you were in there for.

        of course, if not for insurance, service, in terms of available means of care, etc, would be a lot lower as well......

        yes, there is an unending stream of paper dealing with who pays, who is supposed to pay, what was done, or supposedly done, etc, etc. So much info that it is possible to lose track on sheer volume, sometimes.
        Last edited by J Tiers; 07-09-2011, 11:50 AM.

        Keep eye on ball.
        Hashim Khan


        • #5
          I think ALL billing and payments MUST go through the patient or other "responsible party". It should be totally illegal for the doctor, hospital, or other provider to give a bill to anybody except the patient et al. AND it should be totally illegal for the insurance companies to get ANY information except from the patient. Doctor gives multiple copies of a STANDARD form bill to patient. Patient mails ONLY that bill to insurance company(ies): nmo other paperwork is ever to be required or allowed. Insurance companies pay patient based on stated coverage and bill ONLY - absolutely no communication with any other parties. (This means absolutely NO coordination of benefits.) And a VERY short fuse on making the payment - like 3 to 5 days only: payment must double for EACH extra day they take. And patient then pays doctor et al. ALL patients, including new ones, must be allowed 20 to 30 days to pay bill to allow for the process. Only exception to this would be if patient claims to have no insurance. Then immediate payment could be required.

          One more thing, written estimates should be required before any non emergency medical service. I know this one is tough, but I think it could be done. Perhaps they could have several possible contingencies in them to allow for the possibilities.

          Advantages: No arguments as to who should pay first. Every insurance company pays their full amount and pays it FAST. Patient can complain that bill is too much and I don't have any insurance. Dr. or hospital is then under pressure to cut their rates. Patient can actually make money on a Dr. visit if he/she has multiple policies. Absolutely nothing wrong with that. But I doubt that many will buy extra coverage just to make money when they are sick. Besides, with the cost of the coverage, they would probably just break even or even loose money that way.

          Under this system prices for medical care might actually come DOWN. Drs and hospitals would have to compete for your business.

          OK, rant mode off.
          Paul A.
          SE Texas

          Make it fit.
          You can't win and there is a penalty for trying!


          • #6
            Something I learned long ago about insurance.If you have a choice of deductible on office visits go with a higher deductible.The plan will cost you less money per year,take the money you save and deposit it in an interest bearing checking account.Use that money to ONLY pay the doctor's office directly.
            As an example my doctor charges $95 per visit under insurance coverage.Cash pay is $60,simple reason,no paperwork for his staff no fighting to get paid,two seconds and the deal is done.
            Now the real difference,going from a $5 co-pay plan to a $200 deductible plan saved me $480 per year.If I meet the deductible everything over $200 is paid at this point I'm still pocketing $280.
            Over the last 5 years I have met the deductible only once and now have a positive balance in the account north of $3k.
            I recently raised my hospitalization deductible and lowered my monthly premium even more.The extra cash is going in that same account and when it hits $10k I'll raise the deductible again at which point I'll let it ride until some point in the future when I start seeing the doctor more than once or twice a year.

            I should add this system of mine has been working fine for the past ten odd years.However my costs are now going up do to shrinking insurance premium pools brought on by the s----ty economy and the looming "Affordable Unicorn and Fairy Pixy dust Reform act",we passed the bill,now we are seeing what's in it.
            Last edited by wierdscience; 07-09-2011, 12:27 PM.
            I just need one more tool,just one!


            • #7
              Originally posted by vpt
              Insurance will ruin this country.

              How often do you see merry go rounds and teeter totters on playgrounds anymore? Slides are also on the way out.

              Grandson got sent home with a reprimand as while ago for 'running n the playground' When I called and asked, it was attributed to insurance regulations.
              My house insurance states that since my walnut tree is close to the garage, and drops walnuts, the garage windows are not covered.


              • #8
                Originally posted by vpt
                Insurance will ruin this country.

                will? will? hello?

                them & idiot claims lawyers

                just as bad this side of the pond too....

                the answer to insurance is... cheque in my hand in 14 days or you will be hearing from a debt recovery/bankrupcy service.


                • #9
                  Insurance companies and claims are the symptoms,lawyers are the disease.
                  I just need one more tool,just one!


                  • #10
                    Gary, as has been explained already, you should receive an EOB (Explanation of Benefits) for every visit. This will show the claim number, the amount paid, the amount not paid (your copay and any deductible) and the claim code.

                    There are no initial payments that slip under the wire...
                    "Twenty years from now you will be more disappointed by the things that you didn't do than by the ones you did."


                    • #11
                      living in a small country town going to a country doctor helps a lot, at least it does for me. OTOH, I have always paid only the co-pay on first visits. OTOH, I have always lived in small country towns even when I lived in Louisville Ky.
                      It's only ink and paper


                      • #12
                        Originally posted by gary350
                        My wife is a Registered Nurse. This his how I know about this.

                        Have you ever noticed when you visit a new doctor you are always required to pay on your first office visit even if you have insurance.
                        Huh? I have Blue Cross Blue Shield.

                        I go to the doctor's office, pay my co-pay ($20 or thereabouts), the doctor's office bills BCBS. If any of the rest of the bill isn't covered, the doctor's office sends me a bill that includes a full invoice of charges and payments.

                        Never once had a situation like you are describing.



                        • #13
                          Lawyers are responsible for almost ALL of our problems. Imagine the price of cars if there were more difficult means of bringing a lawsuit. Medical costs would plummet if the profession was not burdened with the costs of malpractice insurance You would even have room in the glove box when all the cautions and stupid warnings are eliminated from your owners manual . If you are not smart enough to jump a battery,or keep your hands away from an electric fan which MIGHT start at any time, let Darwin be the judge. It is difficult to imagine a situation where a reduction in frivolous lawsuits would not benefit the world. Sign me up for tort reform! Rant over, I think. Bob


                          • #14
                            Originally posted by wierdscience
                            lawyers are the disease.

                            Lawyers are a disease, a cancer of this planet. You are a plague, and we... are the cure


                            • #15
                              Ugh, What do you people expect when your health 'insurance' is run by a private, FOR PROFIT company? And then your hospitals are all for profit as well.

                              Except to get screwed over like no tomarrow, Because you have absolutely no choice!

                              Private companys should not be allowed to be the only choice when it comes to ANYTHING Critical to human surival. This includes: Health care, Prison, Water, Electricity and gas.

                              There is a prison in the USA thats refusing to take any more inmates. Is it full? Nope, the prision hasent gotten paid in awhile. So the cops are just releasing all the criminals now. Nowhere to put em.

                              Theres been judges arrested for taking bribes from prisons to give people longer sentences, and even to sentence innocent people... Juvie judges! What a wonderful way to insure theres lots of grown up criminals later (to be arrested and sentences and kept in for profit prisons) by abusing the children now!

                              Asprin cost $20 in the hospital. No, Not per bottle. Per PILL.

                              Insurance companys get a big discount on what they pay to the hospital as well. Hence even if they do pay out, they are not paying nearly what you think they have saved you, Except without them, you would be expected to pay exactly what the bill quotes.

                              Yea, the goverment is 'evil' and I would hardly trust them further then I could throw em, But they are not nearly as evil as FOR PROFIT companys.
                              Whens the last time the goverment even managed to stumble apon a profit?
                              Goverment is actualy about servicing the people, efficently as it can, Without all the money being funneled to a few people at the top. (At least, thats what its supposed to be)

                              You think chinese tools are bad, wait untill your insurance companys send ya to china to be worked on by chinese doctors using chinese EKG machines and chinese gas regulators on your anaesthetic.
                              Think thats bull****? Look up 'Medical tourism', People going overseas allready because its cheaper due to high deductables on thier plans. How long till your insurance companys say "You can get the proceedure in china, the worlds cheapest place, Or you can get it anywhere else.. And pay the diffrence out of your pocket"

                              And what about the HMO's CEO's? Some of em earn $12,000,000 a year.
                              Lets break that down. Lets say avg american paying $20,000 insurance per year. Thats 600 peoples payments. 600 people who have to now be denied any claim they will ever make, and most likey DIE PAINFUL DEATHS, Just so some CEO can have a few new beach houses this year. What did that CEO do to deserve beach houses? why he hired people who found new and exciting ways to denie your coverage under preexisting conditions, Or denie you all coverage because you lied, said you never smoked but they found someone who says you once tryed a cig in high school.

                              Here in canada, we let people have access to all the health care they need. Granny needs some new knees? we'll get right on that. Shes only got 10 years to live? Whatever, granny needs to walk or shes not gonna be living even that long is she? (My 80+ year old grandma got both knees replaced within about 4 months of complaining of excessive knee pain, Total cost to her: $0, Not counting gas to be driven to/from the hospital/doctors office a few times)

                              Bankrupt dude needs a 10 day stay? No problem. No cost.

                              Need a ride in an ambulance? Well.... Ok, We will charge you the insanely expensive fee of $1,000 + $9 a mile + all drugs you consume along the way.
                              Oh sorry, I was looking at a page for US ambulance!
                              Canada its $80. + $0 + $0.
                              While free is great, ambulances are a definate resource that should not be abused, so a $80 fee is great. Keeps people from using them for trivial stuff that does not need an ambulance, but the second you think you REALLY need to be in the hospital, $80 is really no obstical.

                              Btw, Flat $80 fee, ALSO COVERS AIR TRANSPORT!
                              Wonder how much air transport in the US costs. Judgeing by a quick google search, its around $15,000~20,000. Quite the hike from $80.

                              The only thing that really annoys me about our hospitals, is TV service is on little 14" CRT's, and theres no cable amps in the entire hospital, So the signal is horrable and fuzzy. And they DO charge ya a couple bucks a day if you want to watch.
                              And some hospital charges ya like $3 an hour parking, thats pertty crazy. (AFAIK the hospital itself doesnt even get the money, they just sold there parking lot, Really lame)

                              Can I spell it out any more clearly how badly you americans are getting screwed up the ass without so much compassion as a little lube?
                              Last edited by Black_Moons; 07-09-2011, 04:38 PM.
                              Play Brutal Nature, Black Moons free to play highly realistic voxel sandbox game.