I need help with medical claims...

Jack · Post by **Jack** » Sun Jan 29, 2006 10:48 pm

As always, I have a bunch of claims to fill out.

They all say "THIS IS NOT A BILL," but the papers that came with them say, "You must pay this amount" and are each in the hundreds of dollars.

My insurance company (the student insurance at school) has denied a lot of my claims, so if I don't pay the bills (I can't--they're in the thousands of dollars all together), will I be unable to see the doctor or does it vary from doctor to doctor?

The reason I ask is that I had an "encounter" with the lady who does the claims at the doctor's office and she was so mean to me that she made me cry in her office. She said that bill collectors will come to my place of residence and "hound" me (her word) for money and then said that if I didn't give her X amount of money right there, the doctor wouldn't see me anymore. I sent her a thank you card and told her Jesus loves her, because it felt like she was hard and cold-hearted. This happened at a specialist doctor, not my "normal" doctor, so I don't know if they can legally do that or not, refuse to see me because I can't pay it?

My "normal" doctor has never said anything to me about not being able to pay her, so I'm thinking it might just vary from doctor to doctor?

For the record, I've called the insurance company, and they are absolutely incomprehensible (and that's an understament). It's like they're speaking a foreign language to me.

Also, some of the forms ask for my mother and father's information like social security number and they won't tell me, so I've always left that part blank--could that be why they denied a lot of my claims?

I've never had any kind of insurance before, so I really don't know what I'm doing, even though I've been doing it for six months...

Charlene · Post by **Charlene** » Sun Jan 29, 2006 10:56 pm

Is there a social worker at school that can help with the paperwork?

I would write either "N/A" or "not available" or even "don't know" for the SSNs instead of leaving it blank. Then if some idiot calls and says "you mean you don't know your own parent's SSNs?" you have a chance to explain.

Insurance forms are no fun even when you feel good, and of course they always come when you're upset which makes it that much worse.

Keep copies. And keep copies of all the bills too.

Redwolf · Post by **Redwolf** » Sun Jan 29, 2006 10:57 pm

If I were you I'd start by calling my insurance representative, and asking how those forms need to be filled out. Ask them to explain to you why the claims were denied. If the procedures you've had are covered expenses and it's just a matter of filling out the forms differently, I'm sure they'll be happy to tell you. If they AREN'T covered expenses, than I'm afraid you will be responsible for the bills...but most medical offices will work with you on a payment plan.

If they need your parents social security info and such, then you may need to persuade your folks to part with that information...if they don't want to get billed by the school for your medical bills!

Redwolf

Congratulations · Post by **Congratulations** » Sun Jan 29, 2006 11:05 pm

I don't much about nothin, but I would agree that you should write something in every field of every form. That's what I've always been told to do, anyway.

Jack · Post by **Jack** » Sun Jan 29, 2006 11:09 pm

Charlene, this might sound petty, but I really can't afford to make copies of all of them. I've went through (literally) hundreds, mabey even thousands, of pieces of paper in the last six months all that have to do with medical bills. The cheapest copier I've found is 10c per copy, and if you do that over months with lots of paper, it adds up. I could ask to use a faculty copier, but I really doubt they'd allow me to do it in as large a volume as I'd need to with all the papers, and besides I don't have the energy/strength/time to copy all of them. The ones that I can keep I have in a big gray folder, though.

I have a counselor and I've also seen the office manager at my school's clinic. And they have helped me a great deal with all the different forms actually, but I'm still confused and have questions nobody seems to be able to answer.

Redwolf, a lot of the tests and procedures that I've had to have done are not things that normal college-aged people need done, so they're not covered on the student insurance, or they are only covered a small amount (I've gleaned this much from the conversations on the phone). I know that, and I also know that I owe different doctors a lot of money, but what I worry about is if it's legal for them to refuse to see me? Is it? I can't find an answer to that.

I don't mind owing money, I just don't want to get in a spot where I need to see a certain kind of doctor and they won't see me because I don't have the funds?

Regarding payment plans, I am only able to work 3 or 4 hours a week, because I am too sick. All of the money I have is used on food and stuff like deodorant (and hairbrushes!) and I've had to take out loans to pay for my books. I have no help from my family at all. So if I had some kind of payment plan, it would seriously have to be like paying a nickel a month.

P.S. Before anybody says anything to the effect of "Sell your computer" I think I should state that this computer is not really mine. The school I go to is a school for low income students and it gives each student a computer to use, and it only becomes mine after graduation. I just feel the need to disclaim that. I own nothing else of value to sell.

Charlene · Post by **Charlene** » Mon Jan 30, 2006 1:09 am

Cran, I didn't think of this before - but maybe you don't actually need photocopies. Just keep as much of the bill as you can - send in the bit that they need back with the payment and keep the rest with the details. Write notes on what you keep - paid so much on such-and-such a date with check number whatever, or money order, or paid by cash, etc. Just keep a paper trail, because insurance companies and hospitals just love to double bill. Ask the doctors if they can write off some of the charges. When my mother died, she had been in the hospital for 3 months, 2 of which were spent in intensive care. The only insurance my folks had was Medicare. The hospital wrote off literally 2/3 of the bill. (of course, that means someone else wound up being charged more to pay for it in the long run).

missy · Post by **missy** » Mon Jan 30, 2006 6:10 am

Cran:

(I'm sorry if I offend anyone that actually works in the insurance business........)

It's been my experience that insurance companies often refuse to pay for something on the first filing. If you call and talk with them and find out why (as stated, it could just be having to file something differently with a different code, etc.) you may get more paid for. I know it's a pain, and a lot of work, but it just seems that IS the way it works. I'm in the process of fighting over Noah's braces right now. It also helps to have the doctor's help in your fight.

I also think, due to your income level, etc., you need to talk to someone on the state or federal level about Medicaid. There's a good possibility that you should be getting some type of aid.

I realize it's a lot of legwork, and not something you feel you need to be doing right now, but it may be your only choice. Hopefully someone at the college can help you with at least the agencies you need to talk to so you aren' wasting precious time.

And, agree with whomever said to put "N/A" in the box - a blank area will always kick out a form; at least if something is there, they know you saw it and didn't fill it in.

Good luck - and I'll be saying a prayer or two for you........

Jerry Freeman · Post by **Jerry Freeman** » Mon Jan 30, 2006 6:15 am

If it says "This is not a bill" then it's not a bill.

It may be that the providers will accept what the insurance has paid and write off the remainder. Also, claims that have been refused by insurance companies can be appealed. Sometimes it takes more than one try to get an insurance company to pay up. You'll need to try to find someone there to help with this stuff. I would start by asking the people in the campus doctor's office who you can talk to or asking whatever counselors or social workers are there.

Best wishes,
Jerry

Tyler · Post by **Tyler** » Mon Jan 30, 2006 7:08 am

This really sucks Cran! We're going through something similar with our local health care provider over my wife's gall bladder surgery four weeks ago...and so far we've accumulated over $15k in bills. The sickeningly ironic thing is that, here insurance is so expensive that it's cheaper for us to pay out-of-pocket for this rather than buy insurance or take a cut in pay for an employer-sponsored plan.
Dealing with any healtcare provider, insurance or no, is a pain in the ass in this country.
Try for federal aid. If you dont make much, you might qualify.
We tried for federal aid when we were first married, back when I made quite a bit less (to the tune of less than $10) and they disqualified us because we made too much.

I wish you didn't have to go through this, because I know first hand that dealing with medical providers sucks bad, and in this day and age medical providers are one of the biggest bankrupters of the lower middle class.

What can I say, welcome to America.

Redwolf · Post by **Redwolf** » Mon Jan 30, 2006 8:54 am

I don't know all the legalities involved, and they probably vary by state as well, but yes...as far as I know a private practitioner can refuse to continue to treat a patient. Even private hospitals are generally only obliged to provide triage and to stabilize a patient before transporting him to a public facility.

Often though, if you've worked out some kind of payment plan with their billing office and are making good on the payments, they will continue to see you.

Redwolf

Wanderer · Post by **Wanderer** » Mon Jan 30, 2006 9:01 am

Almost always when I deal with insurance, they cover most of it, and then don't cover some amount. They send a letter that says "this is not a bill" and "patient is reponsible for remainder" or words to that effect.

That just means that they're sending some money to the doctor, and saying "this is how much we're not paying". The doctor will either write off the remainder (sometimes) or send you a bill for it (sometimes).

I'm guessing that they can refuse to see you if you haven't paid them, unless you have a medical emergency and are going to a hospital. But, doctors are just like any other business...you can vote with your feet. If your specialist's receptionist treats you poorly, choose another specialist, and write a letter to your (former) doctor telling them why. I've done that before, when a receptionist was especially rude to me one day for no reason at all (I was establishing myselfing as a new patient, and hadn't dealt with this doctor before).

It sucks that you're having to fill out your own insurance paperwork. Many doctor's offices do that for you with the insurance that my jobs have provided, but student insurance may not be so user friendly.

Tiff · Post by **Tiff** » Mon Jan 30, 2006 9:07 am

makes me glad that i don't have to pay for that sorta stuff...

...don't even have to pay for perscriptions cause i'm still in full time education! no worries at all!

dwinterfield · Post by **dwinterfield** » Mon Jan 30, 2006 9:23 am

Wanderer wrote:Almost always when I deal with insurance, they cover most of it, and then don't cover some amount. They send a letter that says "this is not a bill" and "patient is reponsible for remainder" or words to that effect.

That just means that they're sending some money to the doctor, and saying "this is how much we're not paying". The doctor will either write off the remainder (sometimes) or send you a bill for it (sometimes).

I'm guessing that they can refuse to see you if you haven't paid them, unless you have a medical emergency and are going to a hospital. But, doctors are just like any other business...you can vote with your feet. If your specialist's receptionist treats you poorly, choose another specialist, and write a letter to your (former) doctor telling them why. I've done that before, when a receptionist was especially rude to me one day for no reason at all (I was establishing myselfing as a new patient, and hadn't dealt with this doctor before).

It sucks that you're having to fill out your own insurance paperwork. Many doctor's offices do that for you with the insurance that my jobs have provided, but student insurance may not be so user friendly.

I agree with all of this. One additonal thing to keep in mind is that many ocs are not necessarily good managers. One Doc that I see anually has always made a point of telling me to come directly to him if I'm unhappy with any aspect of nursing, billing, support staff. Good for him. I've never had a problem, but he's the only Doc who acknowledged up front that he's responsible for the performance of all the people that work for him.

dwinterfield · Post by **dwinterfield** » Mon Jan 30, 2006 9:23 am

Wanderer wrote:Almost always when I deal with insurance, they cover most of it, and then don't cover some amount. They send a letter that says "this is not a bill" and "patient is reponsible for remainder" or words to that effect.

That just means that they're sending some money to the doctor, and saying "this is how much we're not paying". The doctor will either write off the remainder (sometimes) or send you a bill for it (sometimes).

I'm guessing that they can refuse to see you if you haven't paid them, unless you have a medical emergency and are going to a hospital. But, doctors are just like any other business...you can vote with your feet. If your specialist's receptionist treats you poorly, choose another specialist, and write a letter to your (former) doctor telling them why. I've done that before, when a receptionist was especially rude to me one day for no reason at all (I was establishing myselfing as a new patient, and hadn't dealt with this doctor before).

It sucks that you're having to fill out your own insurance paperwork. Many doctor's offices do that for you with the insurance that my jobs have provided, but student insurance may not be so user friendly.

I agree with all of this. One additonal thing to keep in mind is that many ocs are not necessarily good managers. One Doc that I see anually has always made a point of telling me to come directly to him if I'm unhappy with any aspect of nursing, billing, support staff. Good for him. I've never had a problem, but he's the only Doc who acknowledged up front that he's responsible for the performance of all the people that work for him.