a reply to: Sharparrow
I don't know who would be the local representative to go to ? We are talking about 4 different entities that need to be addressed. Why all four ?
Because all four of them are deeply involved in the ObamaCare / Govt Marketplace offering. They all have to work together, but they are not. They
are being extremely defiant and passing the buck to the patients.
It gets even better. My daughter is sick and her father wants me to take her to the doctor. I am of course very reluctant because of all the issues
that have happened on our insurance. Her father feels she may have strept, but I don't think it is strept...I've been caring for her and watching her
but she has just started running a fever so I give in and agree to take her to the doctor. I took her yesterday. Due to the insurance fiasco I have
already described in this thread I haven't even been able to choose a primary care doctor for either of us so I know we are likely going to visit an
urgent care facility.
I called my insurance company the night before to be sure where I was taking my daughter would be covered and if the types of services would be
covered. I was told over the phone that yes it would be covered as long as I went to the facility I asked about over the phone, because they were "In
Network". My cost would only be $5 CoPay and on my plan this particular type of visit does not have a deductible. I did the work involved to be 100%
certain I was covered before taking her to be looked at.
I get to the facility and while I am being signed in I ask the lady at the desk the same question, do you cover my insurance...just to be double sure.
She tells me yes. So she continues to sign us up/check us in. Then proceeds to tell me the cost is going to be $125 for my deductible. I
immediately correct her and tell her that no, this plan does not have a deductible for this service (some services have it, others do not, visits to
PCP, Women's Yearly, or Urgent Care do not have it, they simply have no co-pay or a small co-pay), that i called and researched into it before coming
into their office today so that I would be prepared for what I actually will owe. She refuses to budge and just repeats that I will owe $125 to be
seen. So i say fine, we are calling the insurance right now to clear this up and I call.
The insurance representative confirms over the phone that I should only be paying $5.00 and no more for the visit. The check in clerk at the doctor
office won't sway and keeps talking about the deductible. The insurance rep tells me to ask them to speak with someone else in the office who can
actually help, so at the same time the clerk calls someone else up. So a new lady enters the sign in cubicle and stands there to listen to what is
occurring but doesn't really do anything. The clerk still won't budge so the insurance rep asks for their phone number and calls the office direct
and speaks with the clerk for about ten to fifteen minutes. The clerk is busy typing a bunch of stuff into the computer and finally when she gets off
the phone, she has changed it to the $5.00. But is still trying to imply I am going to get billed for the deductible.
I also mention to her that if they do a strept test on my daughter, and have to send it to a lab that they have to use the lab that is "In Network"
and covered under my insurance. I looked this up the night before as well and I know who the lab is. She tells me I have to discuss this with the
So when me and daughter get called back by the nurse who does the weight/temperature check in I also mention choosing the "In Network" lab as well,
but she also tells me to bring it up with the doctor.
We get placed in the room to be seen by the doctor. He internally in that office does a flu test and strept test. I discussed the lab concern with
him, but he tells me they are doing it right there right now so they won't be sending to a lab.
My daughter is diagnosed with flu and the doctor tells me to simply continue doing the treatment I had already been doing for her. We get prescribed
nothing because we all know the flu simply has to run its course...we can simply treat the symptoms. So just as I thought she doesn't not have
You may be wondering why the hang up on the lab... Because twice now on two different doctor appointments, the doctor offices have sent lab work to a
lab that isn't on my insurance plan. The first time it happened, it was an appointment for my daughter several years ago at her pediatricians office
which we had gone to since her birth. I was on an employer health insurance plan at that time (not govt marketplace). The dr office without my
consent sent it to a lab that was not on the insurance. I fought the bill for months with the doctor office and they finally reversed it, but not
before they had someone outside of their office continually call and harass me about the past due balance even though the bill was in dispute from the
start. I swiftly removed both of my children from that doctors office after that visit because they could no longer be trusted.
The second lab incident happened in Feb 2017 on my new marketplace plan that Ive explained all the fiascos I am going through right now... Lab work
sent to a lab that doesn't participate on the plan by the doctors office without my consent. I handed them my insurance card at the start of the
doctor visit. This doctor office agreed to participate in the plan, they are "In Network". But along with coding things so it won't be covered, they
also submit to a lab that isn't "In Network".