insurance question

  1. Okay, today my husband get's his EOB from his insurance. He had gone to the chiropracter for his back problems. Well, before he went to the chiro, he asked me to check with insurance (of course, I'm a nurse and would "understand that stuff") and when I checked with insurance, I was told that our family deductible was met, so he would have 26 visits, or whatever but wouldn't have to pay the deductible. Well, I called today, asking why he WAS charged the deductible and was told that there wasn't any documentation about the previous conversation and that they are "really sorry" but since he is the primary insuranceholder, he ALSO has to meet a deductible. ***** He wouldent have GONE if he knew he would have to meet the deductible. He would have waited until his finances were better!!! Does anyone know-can we fight this?
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  2. 8 Comments

  3. by   renerian
    Yes there usually is a per person deductable and a family deductable.

    renerian
  4. by   robynrn2b
    Right, I understand that--but when I called I specifically stated that it was for my husband---who carries the insurance--and that the two kids deductibles were met---and asked if that would satisfy the family deductible----and was told YES it would. I specifically asked how much of it he would have to pay and was told that information too--NO DEDUCTIBLE
  5. by   TCW
    Robynrn2b,

    The call should have been recorded. Do you know who you spoke with? Do you know the day you called? I would appeal the decision of the insurance company in writing. If you know who you spoke with & when you called (approx.) then if the calls were indeed recorded then you could request that the insurance co. pull the tapes for the day you called and have them listen to them. If it turns out you were given incorr info then they can do a pay by exception. If all else fails, you can write a letter to a higher up at the insurance co.

    I work for an insurance co. and see this thing all the time. The call should have been documented by whomever you spoke with. If you were given WRONG info I would definately not give up the fight. !@#*! insurance companies--I only work for one b/c it pays the bills while I'm in school. Good luck.

    Tonya
  6. by   emily_mom
    I also had the same problem with going to the chiropractor. They said they would pay but then they didn't count the visits b/c they are not office visits...just adjustments. And they don't pay for adjustments. Bastards! So, they paid like $1.36 for over 250 in bills....SOBs!!!!!
  7. by   ptnurse
    That is just lousy. Like most I have had problems from time to time with insurance companies. I always keep a list of who I talked to the date and what they said. On any pending visits I ask for a precertification letter. It is just not hard to find someone at an insurance company that does not know what they are doing. Sorry for your trouble.
  8. by   deespoohbear
    I wouldn't go down without a fight!!! Insurance companies are out to screw you no matter what. They change the rules mid-stream to fit THEIR needs. About 10 years ago, I ran into a problem with an insurance company. I was going to have surgery and got everything pre-certified. After the surgery, the insurance company tried to deny the claim, saying the surgery was unnecessary. I came unglued. After a few phone calls and a brief conversation with an attorney friend, I found the magic words: "I have contacted an attorney, and the state insurance board." The doc, the hospital, and the anesthesia person all had their money in a matter of days. The squeaky wheel gets the grease, and if I were you I would squeak LOUD and often. And record EVERYTHING!!! Good luck!!!
  9. by   TCW
    just another tip from someone on the inside...the squeeky wheel does get the oil, but it doesn't hurt to be polite, get someone on your side and touch base with the insurance co. as often as possible. If you are gonna pursue it make sure you do just that. Don't follow up with it every so often, but rather make it a point to be on top of your case.

    It's ridiculous you have to do all this, but I think you have a fighting chance.

    Tonya
  10. by   robynrn2b
    Thanks for all the response. Unfortunately, I did not document who I spoke with but I could figure out the date for sure. I learned the hard way to DOCUMENT the name. My husband says, well I guess I have to pay it. I told him NO, I will at least fight this. What do we have to lose? I thought that most of those calls were recorded so I will check!

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