I have to do prior auths sometimes. Always get this line which makes me think what the fuck am I doing this for?
“Prior authorization is not a guarantee of payment. All final payment is subject to the members eligibility and benefits at the time of service”.
Not that it makes it better, but she was sent the same $139,000 bill 4 times. While the hospital and her insurance were still working out the insurance’s portion because things weren’t coded properly.
In the end she didn’t owe any of it, but only because she pestered the hospital and finally had them send her the itemized bill because they still hadn’t sent it to her insurance. She then sent it along to insurance and it got cleared up. So frustrating.
My family had to deal with that recently. Something was coded incorrectly that made our bill $10,000+ more than it should be. And it’s on the patient to catch these things, even though they’ve made this ridiculously complicated coding system.
For example, for a tear of the meniscus in the knee there are 43 different codes, depending on: Which knee: left, right, unknown, and just “knee” Type of tear: 12 different types And that doesn’t include noting whether it’s the first visit for this injury or a follow-up.
drives me nuts. provider can’t navigate the insurance system which is designed to be hard and you as someone who has no access to the software and have no experience or knowledge on how these work have to spend massively stressful hours upon hours to clear up. All the time wondering if this will be the one you can’t clear up. And in the end the insurance is going to be paying for the health outcomes of all that stress. I also love the we don’t cover this pretty cheap procedure that is highly effective but will cover massively expensive suregery that has iffy outcomes. Go on. do the surgery. you will have to live with the outcomes. Surely you can somehow gather the thousands for the cheap procedure yourself on top of your maximum out of pocket this year. big game of chicken. dare you take the surgery that will cost them hundreds of thousands?
I also found out when looking for my confusing code example that different insurers sometimes want something coded differently based on their definition of what a procedure entails
yeah you don’t even get some sort of usefull experience for each one you do as its mostly just a game of telphone where you are in between the insurer and provider. You would think the provider would be motivated but they charge so much more than they get that I think they view it as hey if they can just get 10% of the bill from you they break even and if they get more they are going to get ahead. Im so glad for the no surprise billing thing as it gives a somewhat better footing.
US healthcare is extortion.
Believe the headline, 100%. Our “healthcare system” is that fucked. It doesn’t really work. It saves lives and ruins them.
This must be an American thing.
