Jump to content
×
Are you looking for the BariatricPal Store? Go now!
Sign in to follow this  
  • entries
    111
  • comments
    200
  • views
    21,305

Thoughts on Insurance

Sign in to follow this  
RavenClaw779

150 views

There was a forum question re; doctors "scamming" patients which got me thinking.

I have a commercial insurance background and stay on top of my medical insurance claims as I've had a number of denials over the years which were actually mistakes on the part of the carrier's claims adjustor.

 

Sadly, turnover in insurance companies is high. Burnout especially in the claims area is understandable due to the stress. Often the people hired have minimal experience in the field and no medical background. It really is in your best interest to know your policy and ask questions.

 

I don't think the United States needs universal health care, but we sure do need reform and oversight. Here are some great example from my own claims generating from the pre-surgical process:

 

*Basic Bloodwork

$832(Billed to BCBS); $104 (BCBS - Allowed)

- Required although I'd just had bi-annual labs with my primary two months prior.

 

*Medifast Nurse (15mins)

$82.22(Billed to BCBS); $22.93 (BCBS - Allowed)

- Didn't even include the Medifast product

 

*Pulmonologist (30 mins)

$263 (Billed to BCBS); $134(BCBS - Allowed)

- Wow; he asked the same questions already asked by another dept at the same facility and available online. Listened to my heart and lungs and told me that despite no flags for sleep apnea I had to go to sleep lab and have another "pre-surgical" appt with him.

 

This is why I love the Mayo Clinic. Their doctors are salaried and while their services are not cheap, they test because it's necessary not to gin up charges.

Sign in to follow this  


1 Comment


Recommended Comments

There was a forum question re; doctors "scamming" patients which got me thinking.

I have a commercial insurance background and stay on top of my medical insurance claims as I've had a number of denials over the years which were actually mistakes on the part of the carrier's claims adjustor.

Sadly, turnover in insurance companies is high. Burnout especially in the claims area is understandable due to the stress. Often the people hired have minimal experience in the field and no medical background. It really is in your best interest to know your policy and ask questions.

I don't think the United States needs universal health care, but we sure do need reform and oversight. Here are some great example from my own claims generating from the pre-surgical process:

*Basic Bloodwork

$832(Billed to BCBS); $104 (BCBS - Allowed)

- Required although I'd just had bi-annual labs with my primary two months prior.

*Medifast Nurse (15mins)

$82.22(Billed to BCBS); $22.93 (BCBS - Allowed)

- Didn't even include the Medifast product

*Pulmonologist (30 mins)

$263 (Billed to BCBS); $134(BCBS - Allowed)

- Wow; he asked the same questions already asked by another dept at the same facility and available online. Listened to my heart and lungs and told me that despite no flags for sleep apnea I had to go to sleep lab and have another "pre-surgical" appt with him.

This is why I love the Mayo Clinic. Their doctors are salaried and while their services are not cheap, they test because it's necessary not to gin up charges.

Share this comment


Link to comment

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

PatchAid Vitamin Patches

×