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Started By
Message
Why is medical billing the way that it is?
Posted on 1/9/26 at 11:57 am
Posted on 1/9/26 at 11:57 am
Got an ultrasound to monitor my fatty liver (paging Mingo). I had an ultrasound that discovered it incidentally January 2024. Had a follow up October 25.
The one in January with the same plan and provider was $50 out of pocket. They adjusted it down from $600ish dollars down to $50.
Same procedure same plan same provider insurance denied this latter one and now my provider wants the full $600.
WTF?
The one in January with the same plan and provider was $50 out of pocket. They adjusted it down from $600ish dollars down to $50.
Same procedure same plan same provider insurance denied this latter one and now my provider wants the full $600.
WTF?
16
Posted on 1/9/26 at 11:59 am to jlovel7
Don’t be fat. Simple solution
Posted on 1/9/26 at 11:59 am to jlovel7
What insurance plans cover have drastically changed in the last 5 or so years. That's how they work you over. Your deductible or copay might not go up, but then they start cutting out what they're going to cover.
Sometimes it's also they refuse to appropriately reimburse the provider and the provider no longer takes the insurance for the service.
I also recommend appealing anything your insurance denies coverage on. Someone, somewhere can often code something incorrectly and it'll frick up whether its covered or not.
Sometimes it's also they refuse to appropriately reimburse the provider and the provider no longer takes the insurance for the service.
I also recommend appealing anything your insurance denies coverage on. Someone, somewhere can often code something incorrectly and it'll frick up whether its covered or not.
Posted on 1/9/26 at 11:59 am to Mingo Was His NameO
quote:
paging Mingo
You responded pretty quickly there.
I think you should log off and workout.
Posted on 1/9/26 at 12:00 pm to jlovel7
quote:
Same procedure same plan same provider insurance denied this latter one and now my provider wants the full $600.
Ask your insurance if the indications for coverage have changed? And if so, what changed.
Posted on 1/9/26 at 12:01 pm to Mingo Was His NameO
So, Mingo, have you discovered a way to remove visceral fat from livers and pancreases?
If so, please share.
If so, please share.
Posted on 1/9/26 at 12:02 pm to jlovel7
If the doctor is in the plan and the work is deemed medically unnecessary, the provider is usually contractually barred from collecting. You need to read the claim determination by your insurer.
If the insurer is within many plans, your amount due should be discounted.
If the insurer is within many plans, your amount due should be discounted.
Posted on 1/9/26 at 12:03 pm to real turf fan
quote:
So, Mingo, have you discovered a way to remove visceral fat from livers and pancreases?
Is your contention you can’t reverse non alcoholic fatty liver disease?
Posted on 1/9/26 at 12:12 pm to jlovel7
quote:
Why is medical billing the way that it is?
Have a baby, or have your wife have one like me.
We received bills from 15 different Dr's who I had no idea who the frick they were.
Posted on 1/9/26 at 12:20 pm to jlovel7
quote:
Why is medical billing the way that it is?
Posted on 1/9/26 at 12:28 pm to jlovel7
I'm in the same boat. I've spent a few hours on the phone with my insurance, PBM, and pharmacy over the last week. Not one person could tell me why the glucose monitors and insulin pumps I was paying $25/$50 copays for last year have suddenly become $1000/month. Never hit a deductible, same insurance, same supplies, it's like there was an insurance fairy that changed how stuff worked overnight.
Posted on 1/9/26 at 12:30 pm to Mingo Was His NameO
quote:
Don’t be fat. Simple solution
Classic Mingo
Posted on 1/9/26 at 12:35 pm to jlovel7
The health insurance racket is built off of shite rolling downhill.
Unfortunately, you the customer, are at the bottom of the hill. You would like to think that there would be someone that is a consumer advocate, but it's not going to happen unless you're already broke.
Unfortunately, you the customer, are at the bottom of the hill. You would like to think that there would be someone that is a consumer advocate, but it's not going to happen unless you're already broke.
Posted on 1/9/26 at 12:38 pm to jlovel7
With the way the insurance money racket goes, someone ought to create a Zero Premium plan, but you pay 100% of the negotiated costs for services with no deductibles since you are out of pocket for everything.
You can save monthly on not having to pay a premium.
You can save monthly on not having to pay a premium.
Posted on 1/9/26 at 12:44 pm to jlovel7
quote:
Same procedure same plan same provider insurance denied this latter one and now my provider wants the full $600.
Ask for no insurance cash price.
Posted on 1/9/26 at 12:44 pm to jlovel7
But mah capitalism and Trump
Posted on 1/9/26 at 1:11 pm to jlovel7
I'm of the opinion, given that it is virtually impossible for the average person to figure most of this shite out in real time, that your provider should be required to determine if your insurance covers a service/procedure before it is done. If they fail to tell you that it isn't covered they should be required to write off the cost. Too often they lead people to believe their insurance will cover something when they know damn good and well it won't.
This post was edited on 1/9/26 at 1:12 pm
Posted on 1/9/26 at 1:26 pm to ClemsonKitten
quote:
But mah capitalism and Trump
Jesus fricking Christ (I am writing it out in this case).
How bad is your TDS you fricking Socialist / Commie?
The current system is called OBAMAcare you idiot.
You know who started this shite? OBAMA.
Go over in the corner and jerk off to protest videos and let the adults talk.
Posted on 1/9/26 at 1:34 pm to Mingo Was His NameO
are you always this miserable
Posted on 1/9/26 at 1:40 pm to lsucoonass
quote:
are you always this miserable
As long as people remain this fat and lazy, I will remain this miserable.
Ball is in your court
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