Insurance issues

Well, I just got my first insurance summary since the injury and found out that the first Doctor I went to, who was in my insurnace company’s network, sent me to an imaging center who was NOT in my insurance company’s network and the MRI I got from that imaging center will end up costing me several thousand $$.

Thanks alot United Healthcare. I am so sick of the insurance system in the US. (I AM NOT A FAN OF OBAMA CARE THOUGH nor am I a fan of socialized medicine, there has to be a free market way to provide healthcare). How in the world am I supposed to know what imaging center is in or out of network. It should be that the in network DR is responsible for sending you to an in network imaging center. I make sure to go to an in network DR and in network Hospital for my surgery but the initial diagnosis by the in network DR determined that an MRI was needed for my injury after seeing the x-ray with either bone spurs or calcifactions and now the MRI is not covered???

I hate putting things off on other people like many in the United States do, but when you are hobbling around with an injury going from Dr to Dr and being told to go to a certain imaging center, you should feel safe with the idea that the in network Dr. that you chose - THAT TOOK YOUR INSURANCE INFORMATION - is sending you to an in network imaging center.

If the Dr. who is approved by United Healthcare to be in network decides that an MRI is needed then eiher United Healthcare should cover the cost of any referral to an imaging center or the Dr. should be responsible for sending their patients to the correct imaging centers. At a minimum the imaging center should tell you that they dont accept that insruance. Instead, nothing of the sort happened - the imaging center told me that I simply had not met my insurance’s deductable and I was responsbile for the difference rather than telling me that none of the cost would be covered by United Healthcare.

With that said I have posted the pictures of my X-Ray and MRI online since I might as well get my $$’s worth out of them. :-)

6 Responses to “Insurance issues”

  1. Hey Michaelz’s,

    Terribly sorry to hear about your insurance situation, what a bummer. Believe it or not my company is building a system right now that is working on fixing these types of issues. We process real time health insurance eligibility requests. Unfortunately, it was not soon enough for your own benefit but hopefully we can help out other future cases like this.

    It is really crummy b/c our system can pull your coverage and instantly tell you whether it is “in network” or “out of network” and thus whether or not you will have to pay for this procedure out of pocket.

    I understand your frustration with the doctor sending you to some one out of network but it is not his or her responsibility. And from my experience, this is one of the major problems we face in our country with Health Insurance. People have some type of insurance coverage and they really have no idea what that entails. The problem lies on both the individual and the insurance company. The individual thinking they are covered for everything and the insurance company not making it clear what their coverage does entail.

    So thats where we come in and hope to bring more clarity to help solve some of these exact problems we face. We have the technology its just a matter of building it.

  2. Wow
    Michaelsz
    Firstly I’m sorry for you, secondly I agree someone along the line should of given you the nod, you have enough on your mind with your injury, thirdly thousands of dollars! I can not believe the cost, going private in uk would only be a couple of hundred , finally the NHS gets a lot of stick here in the UK, but there’s good and bad reports if I look at the treatment hillie got it appears gold class, however banbam not so good service, in uk we call it a post code lottery , to you guys means zip code.

  3. I had a “rush” MRI and it was billed as $1000, but after negotiations with the insurance was only $500. I paid a part of the $500 as coinsurance. Basically what I’m saying is you should be paying about $1000. Anything more is a ripoff.

  4. I’d take ‘em both to Small Claims Court. And if you go to court in a boot or on crutches, that’s even BETTER!

    The Doc had all your insurance information, and should have told you — should have had a duty to tell you — that the MRI he’d prescribed would make your wallet disappear. And the MRI center should have told you the truth, too. People who buy stuff have the right to know the price — to THE BUYER — before the deal is final. They may settle with you before you get to argue it. If not, I think it’d be fun to try to make a common-sense appeal to a SCC judge about a patient/customer’s Right to Know, and right to be treated as fairly as a customer in (say) Walmart.

    If you do, and you get as far as a court appearance, make sure you bring ALL your documentation with you. From stories I’ve heard, it’s often the difference between success and failure in Small Claims Court. (It’s your responsibility, not theirs, to prove that you exist, that you went to the first Doc, that he sent you for the MRI, that you went, that you got a bill, that it wasn’t covered by your insurance. Don’t expect them or their lawyers to help you fill in the blanks.)

  5. I had a similar thing happen when I got my boot. Turns out, my insurance doesn’t cover it and they give me an Airwalker that they charge me $380 for. I can get it online for $89. If I had to choose, I would have spent $289 for a Vacco…

  6. Greetings! Very useful advice in this particular post!

    It’s the little changes that make the biggest changes. Thanks a lot for sharing!

    [WORDPRESS HASHCASH] The poster sent us ‘0 which is not a hashcash value.

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