Health Insurance?
My mom is not happy with the insurance company. This is my dads railroad insurance.
Answers:
Call the insurance company and inquire as to the reason for rejection, find out why then call your union and ask them for help. If the surgery was determined to be voluntary the insurance company may reject it. How long has your mother had this insurance? If not long (less than 18 months) they may have rejected the claim b/c of waiting periods.
Also, was the surgery inpatient or outpatient? If inpatient the hospital may have determined that the surgery could have been performed outpatient and rejecting forthat reason. If inpatient you probably needed pre-admission certification, did she get that with the insurance company?
DO you have a referral policy? If yes, the surgery would not be covered unless there was a referral from her primary care physician.
Was the providing hospital a member of the participating insruance companies network? IF not they may reject the claim on that basis.
You have not gathered all the information yet, and I doubt that you can find a better insurance provider then what you've got with your dads railroad job...I assume it's a union job.
You need to call the union and the insurance company and start asking questions. DO NOT PAY ANYONE ANY MONEY until you have a resolution that you're satisfied with.
Beware of HIPPA (health insurance patient protection act) in my opinion its just an excuse for the providers (hospital, doctors and insurance company) to be lazy if YOU call you'll get "I cant help you I can only talk to your mom b/c of hippa"
SO GET YOUR MOM ON THE PHONE AND HAVE HER AUTHORIZE THEM TO LET YOU HELP and start asking questionsl, like the ones above.
There has to be more to this--if she followed procedures, the insurance company would pay the bills. $5,000 is not a lot for any surgery, maybe this is the residual she has to pay. No new insurance company will pay a previous bill, so I'm not sure why you are looking for a new company. Your mom needs to understand why the insurance isn't paying. Do they have a required pre-approval? Did she go to a non-preferred provider? These will hurt you with any insurance.
I think your mom should find out exactly why the operation wasn't covered. She might want to go to the insurance commissioner in her state if she feels the insurance company should have covered the surgery. I would not accept the insurance company's decision without a fight.
why wouldn't they pay for it ? I would think they would have to. maybe the doctors office might be able to help her ? sometimes they can resubmit the billing codes that are used to make it covered ? they might pay the second time ? she might want to think of getting a supplementary secondary insurance policy to to supplement the railroad insurance policy she already has. AFLAC offers such a policy. I'm sure many other companies have this. she should compare plans/fees to determine what she needs.
Kat:
As an insurance broker for over 25 years, I simply wanted to mention that the responses from Still, Kathryn, Mildred and Club are excellent, and filled with many worthy suggestions. The common thread in these four responses is that there is some digging to do on your part, and not to accept on face value that your mother owes $5000. My educated guess is that it will be less than that once you do what has been suggested by these knowledgable individuals.
OK, the LOW monthly payment means it's not "the best". And any recommendation you get over the internet is likely to not help her out at all.
If her health insurance won't pick it up, likely the hospital isn't IN NETWORK.
You need a LOCAL INDEPENDENT AGENT who can get you a variety of quotes with different companies that have a lot of IN NETWORK providers in your area.
Cheap payment and great health plan means squat if your mom has to drive 500 miles to be in an in network hospital.
could this be what is left over from what the insurance already payed. alot of people dont realize the insurance never was and never will be ment to cover the whole bill. there will always be out of pocket expences to be payed by the policy holder. because it is only $5000, and you have "low monthly payments", it sounds like your insurance covered what it should have.
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