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 Post subject: Re: sidelined - or "yeah - it was from falling off a horse"
PostPosted: Aug Mon 30, 2021 3:36 pm 
Member

Joined: Jan Thu 01, 1970 1:00 am
Posts: 1275
Location: Pasadena CA USA
ai6vx wrote:
... When I broke my collarbone, ER docs tried to charge $2K, insurance said "this in only worth $300, and we pay 50% out of network, so here's $150" ....


I had a similar thing happen many years ago. I sent the bill to the insurance company. They said that they only pay 80% of what doctors in my area charge and this bill was for much more. I wrote back and asked them to send me a list of the doctors in my area that they considered. They sent me a check for 80% of my original bill.


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 Post subject: Re: sidelined - or "yeah - it was from falling off a horse"
PostPosted: Aug Tue 31, 2021 3:21 am 
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Joined: Jul Sat 11, 2020 6:58 am
Posts: 259
Location: Ventura, CA
J. Hill wrote:
ai6vx wrote:
... When I broke my collarbone, ER docs tried to charge $2K, insurance said "this in only worth $300, and we pay 50% out of network, so here's $150" ....


I had a similar thing happen many years ago. I sent the bill to the insurance company. They said that they only pay 80% of what doctors in my area charge and this bill was for much more. I wrote back and asked them to send me a list of the doctors in my area that they considered. They sent me a check for 80% of my original bill.


Right now I'm stuck in the "We need to contact the local Blue Cross in your area and have them investigate why we are declining all of the billed amount". Supposed to take 10 days. Meanwhile the other bills are showing up. My pre-surgery EKG they covered 100% but 0% of the pre-surgery blood work. So much work to get this stuff straightened out.


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 Post subject: Re: sidelined - or "yeah - it was from falling off a horse"
PostPosted: Aug Tue 31, 2021 3:23 am 
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Joined: Jul Sat 11, 2020 6:58 am
Posts: 259
Location: Ventura, CA
RadioNut39 wrote:
First time I ever rode a horse was at the Griffith Park Stables, SFV,
CA. when I was a kid. Horses KNOW when you are a noobie. That
darn horse took me under a low tree branch to try and scrape me
off! :o Tore my shirt.

AFAIK, they still do trail rides out at Griffith park. The LA Equestrian center is there too - not sure if they have trail rides there

Quote:
Once on the beach, as the small group of, I suspect 'noobies', blissfully
rode along the edge of the waves...without warning the cowboy lets
loose a YEEHAW! :shock: and as the horses all took off as fast as they
could, I thought I heard him say: "Ride 'em, Cowboy"!

HAH! I hope they don't do that with a bunch of senior citizens! Broken bones guaranteed if any of them came off.


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 Post subject: Re: sidelined - or "yeah - it was from falling off a horse"
PostPosted: Sep Thu 02, 2021 1:18 am 
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Joined: Dec Sun 25, 2016 5:53 am
Posts: 350
I went recreational horseback riding once.
That's the story.

_________________
1970's Avionics Tech, USN Attack Squadron 147, "ARGONAUTS" A-7E A/C


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 Post subject: Re: sidelined - or "yeah - it was from falling off a horse"
PostPosted: Sep Thu 02, 2021 4:02 am 
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Joined: Apr Sun 01, 2012 9:55 pm
Posts: 13137
Location: Seattle, WA
Best of luck with your billing process. I personally think the financial parts are worse than the injury. They repair your broken wrist, but shatter your faith in humanity in the process.

I went horseback riding with my wife twice as a young man, and enjoyed it quite a bit, but then she and I got divorced. And that's that story.

_________________
Rodney -- KG7EPW
Measure it with a micrometer, mark it with chalk, cut it with a chainsaw.


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 Post subject: Re: sidelined - or "yeah - it was from falling off a horse"
PostPosted: Sep Thu 02, 2021 12:03 pm 
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Joined: Jul Tue 15, 2008 6:13 pm
Posts: 9549
Location: Gretna, Nebraska
If you really want a frustrating experience, try and find out how much your out of pocket cost will be for a planned medical procedure.
There are fewer things more complicated than the financial relationship between health care providers and insurers and it feels like neither one really cares very much about the patients needs.

_________________
http://www.vintagerestorationservices.com
Paul
...... how hard can it be?


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 Post subject: Re: sidelined - or "yeah - it was from falling off a horse"
PostPosted: Sep Fri 03, 2021 2:47 am 
Member

Joined: Jul Sat 11, 2020 6:58 am
Posts: 259
Location: Ventura, CA
Update:
Insurance: "They didn't bill correctly, their bill is $0.00"

me: "But my benefits statement from you says they billed "$2500, so why do you say it's zero?"

Insurance: "they need to re-bill. You need to call them"

me: "can you call them? I don't know what to tell them"

Insurance: "yes, we will call them"
Insurance the next day " We called them, they said they billed correctly and will not re-bill. that's all we can do, sorry. They're not in-network so we can't make them do the right thing. They will balance bill you."


I HATE insurance! I'm hoping my company's benefits dept can escalate this.


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 Post subject: Re: sidelined - or "yeah - it was from falling off a horse"
PostPosted: Sep Sun 19, 2021 5:02 pm 
Member

Joined: Jul Sat 11, 2020 6:58 am
Posts: 259
Location: Ventura, CA
8 weeks post surgery update.
- insurance still not paying for the bigger portion of the ER visit, and they've basically thrown up their hands about it saying that I need to deal with the provider and get them to re-code the bill.

- I still cannot pick up my thumb off the table if I lay my hand flat
- my wrist range of motion is still really poor, especially when trying to bend my wrist downward - it just stops at 25 degrees. PT guy says "you're stuck and not making progress". He's even tried 'taking me to 9 out of 10 pain level' to try and free up what's going on to no avail.
- Still aches


Fingers are at least useable and getting stronger. Hopefully all of this is just time and not that something is wrong.


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