I've had United for a little over a decade, and overall I have to say it's been pretty good. My wife was hospitalized for about a month with our first born, racking up hospital bills over half a million USD. I think I paid about $3500 out of pocket. Then, a number of years later, the same child had her appendix removed. Again, terrifying bills, and about $3500 out of pocket.
That being said, after the second event, we had discharge orders from the surgeon that included very specific conditions for when we should bring her in. When some of those conditions presented, we brought her to her (in network) primary care physician, whose office is (incidentally) in our in-network hospital. The physician agreed with our having brought her in, and recommended a CT scan. My daughter was sent down the hall from her in-network pediatrician to the in-network emergency room where the CT machine was located. CT scan proceeded, findings were good, and my daughter recovered just fine.
So imagine my surprise when I get a bill for the CT scan. After many phone calls, emails, registered letters, etc. the final determination was that the ER was, at the time of the events in question, had been staffed by an out-of-network third party and thus would not be covered.
Now in the scheme of things, the CT scan was a drop in the bucket compared to everything that was covered, and I'm very thankful for how things worked out. But the principal of that situation really left a bad taste in my mouth. We had no reason to suspect that the CT scan wouldn't be covered, and were in no way advised as such. Doesn't seem right.
"After many phone calls, emails, registered letters, etc. the final determination was that the ER was, at the time of the events in question, had been staffed by an out-of-network third party and thus would not be covered."
I always wonder how a normal person is supposed to figure out stuff like this. I suspect these traps are set intentionally to squeeze more money out of people.
As of Jan 1, 2022, the No Surprises Act requires all healthcare providers that work in a hospital to be considered to be in network if the hospital is in network. And also, all emergency healthcare is considered in network even if the hospital or doctors or labs are not in network.
Because most people give up or forget after the first round of phone calls. It's more profitable to deny claims initially. Patient either forgoes care or pays out of pocket. Insurance company keeps the premium from customer.
I had an out of network emergency room visit with a kidney stone once while covered by a $1,000/month UHC platinum plan. When the bills arrived I stupidly paid them thinking it’d be easier to just file the claim for reimbursement from UHC on my own. After two years of
submitting forms, exchanging letters, and hours of phone calls, I just gave up. It’s hard for me to consider their business as anything but an outright scam.
When I moved to the US somebody told me to hold onto money as long as possible when it comes to health care.. Once they have it, they won’t give it back.
> We had no reason to suspect that the CT scan wouldn't be covered, and were in no way advised as such. Doesn't seem right.
I can’t understand how this is even legal. I know its a somewhat normal occurrence but you wouod think people could at least easily win a lawsuit and get them to sure-up their policies.
Its probably ignorance and not malice but it doesn’t really matter. It basically just amounts to a scam.
Emergency care (ER care) is required to be covered even if it is out of network.
So the CT scan should have been covered.
Also if this was post 2021 there is the no surprises act that applies as well. This is when you go to an in network facility and out of network providers are staffing it.
"My wife was hospitalized for about a month with our first born, racking up hospital bills over half a million USD"
The problem is here and it is not pretty good. A month of hospitalization should not cost half a million dollars anywhere in the world. Most of this is because of the multiple middle men involved including the biggest mafia: health insurance companies.
I don't mean in an insulting way but this is the thinking that keeps us americans getting scrfewed by these mafia.
What is and is not covered is set by your employer. That is the “plan design” they either choose entirely (for self funded plans) or pick a group’s plan to join (group plans)
The surprise third party provider bills are kind of a separate issue, in that it was a scam every insurance company did. we’re mostly protected by the “no surprises act” that went into effect jan ‘22
That being said, after the second event, we had discharge orders from the surgeon that included very specific conditions for when we should bring her in. When some of those conditions presented, we brought her to her (in network) primary care physician, whose office is (incidentally) in our in-network hospital. The physician agreed with our having brought her in, and recommended a CT scan. My daughter was sent down the hall from her in-network pediatrician to the in-network emergency room where the CT machine was located. CT scan proceeded, findings were good, and my daughter recovered just fine.
So imagine my surprise when I get a bill for the CT scan. After many phone calls, emails, registered letters, etc. the final determination was that the ER was, at the time of the events in question, had been staffed by an out-of-network third party and thus would not be covered.
Now in the scheme of things, the CT scan was a drop in the bucket compared to everything that was covered, and I'm very thankful for how things worked out. But the principal of that situation really left a bad taste in my mouth. We had no reason to suspect that the CT scan wouldn't be covered, and were in no way advised as such. Doesn't seem right.