Just found out my medical insurance is not a PPO!?!?!

[10" Red Devil]

Hello and if anyone has any advice or another forum I can visit to get advise it would be greatly appreciated! I just found out that I am being billed for 4 doctors visits I have had in the past 2 months. Turns out that the PPO I thought I had is really an HMO or what they call a Network. So now I have bills totaling $1,000 that I have to pay. I cannot afford this I am already paying on a student loan and a car which does not really give me much left over with my meager graphic designer salary. Im so mad, I mean none of the receptionist clued me in when I was visiting the doctors, they agreed it was a ppo. Is there anything I can do, or am I screwed!

Thanks for any and all suggestions!

[clavery]

If you didn't have a referral from your primary care physician (PCP) they will probably deny the claim. Do you have a flexible spending account that you can apply the expenses to? You still have to pay for it, but it come out of tax-deferred dollars, so it costs you less.

I'd call the medical plan and tell them you were informed that the plan was a PPO and you didn't need referrals. They will probably deny it anyway, but it's worth a shot. Also, see if the doctors are in the network. If they are, and even if you didn't get a referral, they may agree to the PPO rate and charge you less.

Cheryl

[spamin76]

There really is not much you can do. You can fight your insurance company, and try to appeal, but I do not think that will solve anything(I know, I work for one for 9 more days).

You can try to call them and tell them your PCP referred you out of network and try to get them to pay it as if it were in network... but...

Unfortunately, most insurance companies feel that staying in the network is ultimately the patient's responsibility.

[fishtanker]

If the docs were out of network then you really have no case.

If they were in network, then have your primary doc write you a referral for the specialists and then resubmit the claims.

[10" Red Devil]

Apparantly these docs are out of network. I still have not received all the bills, but I know I have at least 2 more doc bills coming and one was a nuerologist. I am feeling like such cinnimon toast right now!

I do have a flexible spending account apparantly. How would I use this to help?

Thanks!

[10" Red Devil]

One bill is $394 for a half hour visit where the doc asked a coupla questions and then immidiately prescriped a med. Amazing how that can total $394!!

[clavery]

Originally posted by 10" Red Devil
Apparantly these docs are out of network. I still have not received all the bills, but I know I have at least 2 more doc bills coming and one was a nuerologist. I am feeling like such cinnimon toast right now!

I do have a flexible spending account apparantly. How would I use this to help?

Thanks!

Submit the expenses to your HMO and get the "explanation of benefits (EOB)" denying the expense. Then submit the EOB to your Flexible Spending Account (FSA) and they will cut you a check from your FSA. You will have to pay the medical provider directly, but the FSA will reimburse you up the full cost of what was denied or whatever you've elected to contribute into the plan.

[spamin76]

Well now you know for next time...

Sorry, this really sucks, but this kind of thing is far from a rare occurence.

[10" Red Devil]

Originally posted by clavery
Submit the expenses to your HMO and get the "explanation of benefits (EOB)" denying the expense. Then submit the EOB to your Flexible Spending Account (FSA) and they will cut you a check from your FSA. You will have to pay the medical provider directly, but the FSA will reimburse you up the full cost of what was denied or whatever you've elected to contribute into the plan.

Sorry I dont quite understand, are you saying the FSA will pay the bill, does this mean I will have to pay the FSA or is it a case of what they will pay or not pay?

Thanks.

[bradwent]

Also, go back to the Docs office and talk with them and explain the situation. See if they can cut you a deal since you will most likely be paying out of pocket. Let them know you made a horrible mistake and need to pay them but can't afford that kind of bill. You never know and the worst case is they say no.

[Hoggn]

Originally posted by 10" Red Devil
Sorry I dont quite understand, are you saying the FSA will pay the bill, does this mean I will have to pay the FSA or is it a case of what they will pay or not pay?

Thanks.

A FSA is something that you have to contribute to throughout the year. It is voluntary on your part. Tax free money to use towards medical stuff but if you don't use it all you lose it at the end of the year.

[examiner]

The FSA is *your* money....if you haven't been putting *your* money into the FSA, there is nothing there to take out..it's typically done through payroll deductions...

You can usually only join the FSA at certain points during the year, typically at the start of the calendar year.

I don't mean this in a snotty way...but it's September...if you haven't already tapped into your FSA to pay some type of medical bill, it probably means you don't participate in the FSA. The FSA is one of those "use it or lose it" accounts...means you must spend the money you put in the account before the year is up or you lose it to the government.

[clavery]

Originally posted by 10" Red Devil
Sorry I dont quite understand, are you saying the FSA will pay the bill, does this mean I will have to pay the FSA or is it a case of what they will pay or not pay?

Thanks.

A flexible spending account is an account that you set up to have pre-tax dollars funded into this account to cover uncovered medical expenses on a pre-tax basis. So you can submit your copays, coinsurance, and anything that is not covered by your insurance plan (but is not cosmetic in nature).

If you did not elect to contribute to an FSA during your benefits open enrollment, you can't elect to participate until the following open enrollment period or if you have a "qualifying event" to warrant opening an account mid-year, like marriage, birth or adoption of a child, loss of insurance coverage of a spouse (if you're covered under their plan) or loss of job of a spouse.

Does that make sense?

Cheryl

[10" Red Devil]

Originally posted by clavery
A flexible spending account is an account that you set up to have pre-tax dollars funded into this account to cover uncovered medical expenses on a pre-tax basis. So you can submit your copays, coinsurance, and anything that is not covered by your insurance plan (but is not cosmetic in nature).

If you did not elect to contribute to an FSA during your benefits open enrollment, you can't elect to participate until the following open enrollment period or if you have a "qualifying event" to warrant opening an account mid-year, like marriage, birth or adoption of a child, loss of insurance coverage of a spouse (if you're covered under their plan) or loss of job of a spouse.

Does that make sense?

Cheryl

Yeah it means Im screwed! Thanks very much for your expert advice. Thank everyone!

[Hoggn]

I think we covered FSA in its entirety...

[10" Red Devil]

Just called the doctors office and they cannot cut me a deal. I guess the only thing Im greateful for is that they are going to put me on a payment plan.

This just sucks because I am trying to get rid of a car bill of 3k and a student loan of 4k in order to get ahead and have some extra emergency money and maybe start contributing more towards retirement, but oh no, now back to living paycheck to paycheck!

Just sold my 1k terrestrial spotting scope to try and get a head, but now it seems like a drop in the bucket since I just went back up 1k in what I owe. I just want to have some emergency money so I dont have to keep borrowing on my gfs credit card whenever some stupid thing goes wrong with my car or otherwise.

[spamin76]

It's not a good spot to be in, but hang in there. Things will get better - might take some time, but you will manage to get it paid off.

[clavery]

Originally posted by kgallich
I think we covered FSA in its entirety...

Kgallich, but weren't you impressed with my explanation!!!!!!!!

Spamin, I think we should start a business helping folks manage their medical plans. I need a job, and you hate your HMO, so we could be the Robin Hoods of the medical insurance world. Take money from the big bad insurance companies and give it to the little people who pay premiums and support them.

What do you think?

Cheryl

[spamin76]

Sounds good to me!!

And I don't even have to work for this big evil company for a full two more weeks

[otolith]

One other thing to consider, usually a doctor bill that is submitted to the insurance company is much higher than what is actually paid out. You may want to ask your HMO what they would pay the doctor(s) directly for their service and see if it matches. Usually people who pay cash end up paying more than the insurance companies. Doesn't make a lot of sense, but you should look into it.

[spamin76]

People who pay cash have no negotiating power

[ecugman]

Originally posted by 10" Red Devil
Just called the doctors office and they cannot cut me a deal. I guess the only thing Im greateful for is that they are going to put me on a payment plan.

This just sucks because I am trying to get rid of a car bill of 3k and a student loan of 4k in order to get ahead and have some extra emergency money and maybe start contributing more towards retirement, but oh no, now back to living paycheck to paycheck!

Just sold my 1k terrestrial spotting scope to try and get a head, but now it seems like a drop in the bucket since I just went back up 1k in what I owe. I just want to have some emergency money so I dont have to keep borrowing on my gfs credit card whenever some stupid thing goes wrong with my car or otherwise.

Pay them whatever you can afford a month...nothing more. There is nothing they can do to you as long as you are making an effort to pay them regularly.

I went to the doctor (at age 10) and they ran mega-expensive allergy tests on me without my parents consent. The total came to over $2500. My parents were livid the were not consulted and fought it out with the doctors. After getting no where we consulted a lawyer friend and he told us to send them $1 per month. We started doing that and they "forgave" the bill.

Not comparing your situation as your charges seem to be legit, but don't stress too much...just pay what you can afford.

[dcoufal]

If the bills are from hospitals and not independents, you've got a 30% chance or so (at least around here) that they won't turn you over to collections as long as you pay $10-$15/month. Yes, it'll take many, many years to pay off the bills.....

Dwain

[BrianD]

Don't borrow from a credit card to pay the bill. Don't. The interest and fees aren't worth it. Just make whatever payments you can afford to make to the doctors.

[crp]

Check you plan again. Some plans will pay for out of network doctors but at a different rate and may charge a penalty.