This is a long of a post, my apologies. I’m seeking advice on how to proceed.
For context, I have PPO insurance. In early April, I entered inpatient treatment at a mental health and addiction facility
I contacted the treatment facility, and gave them my insurance information. They reviewed, and got back to me, telling me I was in-network, and all I would be responsible for was my deductible and co-insurance max.
I wanted to do my due diligence, so I called my insurance and tried to verify the same. I got a customer service rep, who tried to look up the name of the treatment center in the Find a Provider tool. They could not locate it, and said they were out-of-network.
I call the treatment facility back, and tell them insurance did not concur. They tell me the insurance rep I spoke to did not know what they were talking about, they are in network. They mentioned they have been doing this over 50 years. I emphasize my discomfort, because I cannot afford to pay out-of-network rates. They provide their Tax ID code to help me verify. I still have this information.
I call my insurance back once more, and provide the Tax ID code. The rep does not know how to use this. However, we finally locate the provider, and they ARE indeed listed in the Find a provider tool as in-network I printed a PDF of the Find a Provider screen, where it says "In Your Network".
I decide to proceed, and the provider submits a pre-approval. I see it in my insurance portal before I depart. I then wired my deductible and co-insurance max directly to the provider. They require me to sign a Payment Agreement that I’m on the hook if my insurance won’t pay. I very nervously sign – not like I have an option if I want to go to treatment.
The program was 45 days. I stayed 40 days. Phones and laptops were confiscated, and I was refused access to them when I requested such to contact my insurance. We were told not to worry about insurance. Around a week in, my therapist told me my insurance had approved me for 33 days. As of writing this, I have a hard copy of this approval. I was able to rest a bit easy.
Come day 34, I ask for an insurance update. My therapist says they don’t have any update. I am denied the ability to call my insurance. On Day 37, I am told to call treatment finance, and given access to a phone. I call finance, and they state my insurance has denied my claim, and I need to discharge within 48 hours or pay $3000 a day. I say I will be discharging. They schedule my date to discharge on Day 40. I was not able to pick.
I exit treatment, and about three weeks later, and two claims (Day 1-33 and Day 34-40) finally show up in my insurance portal. They just say Claim Received though. Insurance tells me it will take 30-45 days to process. Insurance refuses to tell me how much was billed, or any information at all.
I wait 28 days, and finally the claim processes. (Day 34-40) Insurance fully denies the claim and won’t pay anything. I am liable for over $15K for just six days. I am still waiting on the other claim (Day 1-33). The EOB lists G22 (Your plan does not provide benefits for services that are not medically necessary) For some reason, the EOB states processing completed over two weeks ago. But the EOB was just released today. The $15K charge is blank in the Service/Product column so I don’t even understand how they arrived at that number. And it lists a single date of service. There is a few more rows for “Pharmacy Services”, “Professional Service”, “Hospital Discharge”. Those fees are far more reasonable.
My financial situation was not great prior to entering treatment, and this bill puts me in very uncertain territory. Frankly, I’m out of my depth and I intend to consult a lawyer to help me navigate the appeal process and other options I may have. Looking for advice on how to proceed.
This is the first time I’ve had a medical expense out of standard check ups. I pay my premiums. I am very demoralized - this entire process I have felt I’ve been kept in the dark, with no idea of what is happening. Neither insurance nor the provider would give me basic information about my own healthcare plan or what was being charged in treatment.
However, the good news is that I’m sober, and I don’t think I’m in an active mental health crisis anymore.
0 nhận xét:
Đăng nhận xét