Skip to main content

Author Topic: Health Insurance Not Paying Your Doctor Bill? AMA

  • *****
  • Administrator
  • Sr. Member
  • Posts: 251
  • Karma: +14/-0
I have over 10 years dealing with claims that get denied by health insurance, both public and private, and getting them to pay so that you, the insured, don't have to. Ask me anything!
  • IP logged
Welcome to the Free Thought Movement.

M

MRCH

How common are insurance scams? If that's an area you know about as well.
  • IP logged

  • *****
  • Administrator
  • Sr. Member
  • Posts: 251
  • Karma: +14/-0
You are not allowed to view links. Register or Login
How common are insurance scams? If that's an area you know about as well.

Medicare has been a massive target for fraud in the past. Scammers have made millions off of them. They have brought that down recently with value based payment requirements. The state Medicaid programs are easy targets as well. Private insurers are profit-seeking, so they have dedicated staff to watch every dollar. It's harder to scam them and get away with it. Is that what you were asking about?
  • IP logged
Welcome to the Free Thought Movement.

M

MRCH

You are not allowed to view links. Register or Login
You are not allowed to view links. Register or Login
How common are insurance scams? If that's an area you know about as well.

Medicare has been a massive target for fraud in the past. Scammers have made millions off of them. They have brought that down recently with value based payment requirements. The state Medicaid programs are easy targets as well. Private insurers are profit-seeking, so they have dedicated staff to watch every dollar. It's harder to scam them and get away with it. Is that what you were asking about?
I see, yes, that's what I was wondering about. If you're uninsured in USA and have to go to the hospital, you're basically fucked? I've seen huge bills in pictures just for simple procedures. Never set foot on US soil, so I don't know about the details.
  • IP logged

M
  • ***
  • Full Member
  • Posts: 242
  • Karma: +3/-0
How do you get claims approved? Interesting stories? Any info on alternative treatments?
  • IP logged

  • *****
  • Administrator
  • Sr. Member
  • Posts: 251
  • Karma: +14/-0
You are not allowed to view links. Register or Login
You are not allowed to view links. Register or Login
You are not allowed to view links. Register or Login
How common are insurance scams? If that's an area you know about as well.

Medicare has been a massive target for fraud in the past. Scammers have made millions off of them. They have brought that down recently with value based payment requirements. The state Medicaid programs are easy targets as well. Private insurers are profit-seeking, so they have dedicated staff to watch every dollar. It's harder to scam them and get away with it. Is that what you were asking about?
I see, yes, that's what I was wondering about. If you're uninsured in USA and have to go to the hospital, you're basically fucked? I've seen huge bills in pictures just for simple procedures. Never set foot on US soil, so I don't know about the details.

You're fucked either way lol. If you are insured, then you are paying out the ass every month for coverage you may never even use. Even if you do have a chance to use it, you will have to pay a certain level out-of-pocket before coverage kicks in. At least as a self-pay patient (what we call uninsured) you have more control of your expenses.

Most hospitals have self-pay discounts. Some are better than others. A university hospital, for example, receives tax breaks as an education center for charitable write-offs, and is may discount by as much as 50%. A self-pay patient can work out a payment plan with the hospital, or allow the balance to go to a collection agency and have even more leeway -- at the expense of taking a hit to their credit.

Some doctors are fed up with dealing with the insurance companies and only see self-pay patients. If you can manage it, that's the least expensive way to go. However, if your situation is an emergency, such as a car accident, you won't have control over that. For Americans who have auto insurance, my advice is to up your "medical payments" or "personal-injury-protection" coverage on your auto policy to equal your health insurance deductible. These types of coverage are considered primary to health insurance, and will pay first in the event of auto-related injury. But the laws are different in every state, so talk to your agent first.

The country with the best healthcare system is France. America should adopt it.
  • IP logged
Welcome to the Free Thought Movement.

  • *****
  • Administrator
  • Sr. Member
  • Posts: 251
  • Karma: +14/-0
You are not allowed to view links. Register or Login
How do you get claims approved? Interesting stories? Any info on alternative treatments?

Most claims are billed and paid electronically without human intervention. Only 10-20% are denied, usually due either failure of the doctor to obtain prior authorization or the insurance company saying the procedure was not medically necessary. I file appeals all the time by sending medical records and simply asking for a review.

Sometimes the denial is due to a coding error. If you have a lot of medical bills, you would do well to go over every procedure with a fine-toothed comb. You can look CPT codes up online to see what they mean. Coders make mistakes all the time, and most people don't realize they are being billed or even sent to collections because of a data entry error.

The weirdest thing I saw was when dozens of schoolchildren were treated for exposure to mold at the school. They all went to the same hospital. Later, some of the parents filed separate lawsuits against the school. The health insurance companies held off on paying because they expected the bills to be paid by the school's liability policy. The hospital ended up writing off the balances in order to avoid bad publicity.

So-called "alternative" medicine has been in use for thousands of years, if not more, yet western medicine still call it alternative. The irony is rich. Look for chiropractors in your area who use muscle testing and nutritional response treatment. They won't take insurance, but you're statistically less likely to have your condition worsen or even be killed. In the U.S., 250K people die every year because of -- not in spite of -- medical treatment.
  • IP logged
Welcome to the Free Thought Movement.

i

iknownothing

Don't have it. Don't want it. UK has NHS but I pay for private healthcare ie pay as you go even though our taxes pay for the NHS I always get put at the end of the queue and stay there it seems like most things here the rich middle class suffer so the lower class that pay nothing but take as much as possible (and will vote in the socialist Labour party) can get all the freebies.

They put sewage processing plants and airport lanes right over the most affluent houses whereas the proles and their free houses don't get plagued by either.
  • IP logged

  • *****
  • Administrator
  • Sr. Member
  • Posts: 251
  • Karma: +14/-0
You are not allowed to view links. Register or Login
Don't have it. Don't want it. UK has NHS but I pay for private healthcare ie pay as you go even though our taxes pay for the NHS I always get put at the end of the queue and stay there it seems like most things here the rich middle class suffer so the lower class that pay nothing but take as much as possible (and will vote in the socialist Labour party) can get all the freebies.

They put sewage processing plants and airport lanes right over the most affluent houses whereas the proles and their free houses don't get plagued by either.

I'm curious what is it really like with the NHS? Say you want a routine checkup that includes blood lab work. Do you have to get put into a queue? How long would it take? What if you have an appendix that is about to rupture?
  • IP logged
Welcome to the Free Thought Movement.

s
  • ****
  • Sr. Member
  • Posts: 305
  • Karma: +3/-0
Health Insurance Not Paying Your Doctor Bill? AMA
#9: July 18, 2020, 02:25:20 AM
You are not allowed to view links. Register or Login
I have over 10 years dealing with claims that get denied by health insurance, both public and private, and getting them to pay so that you, the insured, don't have to. Ask me anything!
you worked in Collection Adjuster? OMg  daughter lives with me so much work going to India ,she's always working to adjust their stupid bungling
Back in the day I filed an iatragenic claim on God ,he flubbed up ,at least he thought he was God ,knife slice bar room incident, lost part of a digit, SOB perp military trained was great knew where you bled the most. Anyway I collected out of court. So God 0 me 1.  Stay Safe
  • IP logged

  • *****
  • Administrator
  • Sr. Member
  • Posts: 251
  • Karma: +14/-0
You are not allowed to view links. Register or Login
You are not allowed to view links. Register or Login
I have over 10 years dealing with claims that get denied by health insurance, both public and private, and getting them to pay so that you, the insured, don't have to. Ask me anything!
you worked in Collection Adjuster? OMg  daughter lives with me so much work going to India ,she's always working to adjust their stupid bungling
Back in the day I filed an iatragenic claim on God ,he flubbed up ,at least he thought he was God ,knife slice bar room incident, lost part of a digit, SOB perp military trained was great knew where you bled the most. Anyway I collected out of court. So God 0 me 1.  Stay Safe


Lots of menial work is sent to companies in India in particular. I'm sure you weren't using that digit anyway, right?  ;D  Yeah, people get charged all the time for service they didn't receive because someone entered in a wrong code. Usually only the ones who are paying attention and call in about it get it corrected.
  • IP logged
Welcome to the Free Thought Movement.

s
  • ****
  • Sr. Member
  • Posts: 305
  • Karma: +3/-0
You are not allowed to view links. Register or Login
You are not allowed to view links. Register or Login
You are not allowed to view links. Register or Login
I have over 10 years dealing with claims that get denied by health insurance, both public and private, and getting them to pay so that you, the insured, don't have to. Ask me anything!
you worked in Collection Adjuster? OMg  daughter lives with me so much work going to India ,she's always working to adjust their stupid bungling
Back in the day I filed an iatragenic claim on God ,he flubbed up ,at least he thought he was God ,knife slice bar room incident, lost part of a digit, SOB perp military trained was great knew where you bled the most. Anyway I collected out of court. So God 0 me 1.  Stay Safe


Lots of menial work is sent to companies in India in particular. I'm sure you weren't using that digit anyway, right?  ;D  Yeah, people get charged all the time for service they didn't receive because someone entered in a wrong code. Usually only the ones who are paying attention and call in about it get it corrected.

At the time  had hand breaking his wrist- hit with bottle on that shoulder damn ! Stay Safe
  • IP logged

s
  • ****
  • Sr. Member
  • Posts: 305
  • Karma: +3/-0
Re: Health Insurance Not Paying Your Doctor Bill? AMA
#12: August 05, 2020, 11:44:45 PM
You are not allowed to view links. Register or Login
You are not allowed to view links. Register or Login
You are not allowed to view links. Register or Login
You are not allowed to view links. Register or Login
I have over 10 years dealing with claims that get denied by health insurance, both public and private, and getting them to pay so that you, the insured, don't have to. Ask me anything!
you worked in Collection Adjuster? OMg  daughter lives with me so much work going to India ,she's always working to adjust their stupid bungling
Back in the day I filed an iatragenic claim on God ,he flubbed up ,at least he thought he was God ,knife slice bar room incident, lost part of a digit, SOB perp military trained was great knew where you bled the most. Anyway I collected out of court. So God 0 me 1.  Stay Safe


Lots of menial work is sent to companies in India in particular. I'm sure you weren't using that digit anyway, right?  ;D  Yeah, people get charged all the time for service they didn't receive because someone entered in a wrong code. Usually only the ones who are paying attention and call in about it get it corrected.

At the time  had hand breaking his wrist- hit with bottle on that shoulder damn ! Stay Safe

Set up a dexcom on inlaw pricey but working fine his A1C was very high such a chump daughter has him on her leash now she monitors him on her phone cannot cheat anymore . Was always super high A1C zero carbs now and lol bitchin like a chump. Waist now 60 " omar makes his rags .Poor man  Stay Safe thanks
  • IP logged

 
SMF spam blocked by CleanTalk