by Guest » Wed Jan 21, 2009 07:59 pm
I have Blue Cross of California Health Insurance. I was out of town and went into St Mary's Hospital in Reno NV. Not having a computer available to check out which Hospitals are in network or contracted with my insurance company my dad and I decide just to go in and ask them if they cover my Health Insurance plan. Before I can tell them which Insurance company I'm with they say we accept all Health Insurance companies.
Long story short, because I did not ask if they are contracted with my Insurance Company I am being charge as out of network for the full amount which is $2000.00 I have not had to use my coverage very often except a few times in my local city where I live. I didn't know to ask if there contracted with my company. I just assumed that when I asked if the covered or take my Health plan and they said yes that I was covered. They knew what I meant when I asked if they covered my Insurance. If they said we take your insurance but not under contracted rates I would have left. It was not a life or death situation. Because I didn't say contracted, all that meant was they bill my insurance instead of billing me.
Is this topical practice so the can get full price instead of contracted prices?
Seems like they would ask do you mean contracted?
What if any can I do about this.
My dad said that is BS they knew what you were asking. That's a scam. You don't carry Health Insurance to pay full price.
Live and learn. I know what to say now.
Long story short, because I did not ask if they are contracted with my Insurance Company I am being charge as out of network for the full amount which is $2000.00 I have not had to use my coverage very often except a few times in my local city where I live. I didn't know to ask if there contracted with my company. I just assumed that when I asked if the covered or take my Health plan and they said yes that I was covered. They knew what I meant when I asked if they covered my Insurance. If they said we take your insurance but not under contracted rates I would have left. It was not a life or death situation. Because I didn't say contracted, all that meant was they bill my insurance instead of billing me.
Is this topical practice so the can get full price instead of contracted prices?
Seems like they would ask do you mean contracted?
What if any can I do about this.
My dad said that is BS they knew what you were asking. That's a scam. You don't carry Health Insurance to pay full price.
Live and learn. I know what to say now.
Posted: Wed Jan 21, 2009 09:00 pm Post Subject:
Most health insurance policies are very specific as to which medical providers are in the approved network. It is up to the insured to make the decision as to which provider to use.
If this were an emergency situation, I don't think there would have been a problem.
I'm not quite sure about BlueCross BlueShield of California, but most BlueCross plans pay a reduced co-insurance amount for non-emergency treatment received from an out-of-network provider (usually 70/30 or 50/50).
Posted: Wed Jan 21, 2009 10:22 pm Post Subject: Out of network hospital
Thanks for quick response Insurance Maze. That's basically what St Mary's Hospital Billing told me.
I still say this is BS and they should ask you if your asking if we're contracted or not. Instead of keeping quite knowing what you meant when you ask if they cover your insurance. They just want your money knowing I would have left for Renown Hospital. They new they had a sucker and they took it.
Blue Cross has sent a grievance letter at this point.
Thanks again
Posted: Thu Jan 22, 2009 07:27 am Post Subject:
Maze, what the OP can expect in this situation? I've heard that the insurance company may consider the out-of-network visits if its an emergency situation or if you are referred to one by your primary care provider. I guess that implies that the insured is left with the bills to pay out of pocket if he chooses to visit out of the network doctor in normal situations.
Posted: Wed Jan 28, 2009 06:21 am Post Subject:
You are correct in that statement. Every health policy covers emergency expenses the same in and out of network while normal expenses vary greatly in and out of network.
Posted: Wed Jan 28, 2009 10:53 am Post Subject:
Hi,
Though I've never used my health insurance card at any of the health care units so far, but I guess I still remember what I was told while signing up with them.
I remember my agent telling me to show the health insurance card while I'd get admitted to any of the hospitals while it would be there responsibility to convey my admission to the carrier. Once this information gets conveyed my coverage gets in action.
From that time onwards I'd be covered for all the expenses associated with my treatment up till my coverage limit. Well, this is all smooth when I'm getting treated in a unit within the network. If under such circumstances the carrier is informed of my hospitalization 24 hours in advance under normal conditions or if its mentioned that I'd be getting hospitalized under an emergency then everything stands good.
A friend once told me that he'd be covered by his carrier for the hospital charges even if he's admitted to an out-of-network unit- the only difference being over there he'd need to pay for the initial treatment charges out-of-pocket. He'd then be reimbursed for the same after he submits the bills with his carrier.
Plasticmind
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