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Re: endo specialist/insurance
From: endo (anonymous@obgyn.net)
Sat Sep 15 16:55:31 2007
At Wed, 12 Sep 2007, D wrote:
>D
I have a PPO. There's a lady from the CEC and she is already appealing
it so I'm praying she can help. From what I understand she's a whiz at
dealing with these kind of insurance situations. I thought it was 60%
of whatever the drs did but now I think it is whatever the insurance
comp deems necessary. This country's healthcare needs to be revamped
completely.
Thanks for listening!!
Charissa
>What kind of insurance do you have? Is it a PPO? Insurance is a HUGE
>problem for anyone who has the misfortune to get sick. Every state has
>some kind of insurance board, they should be able to help you figure out
>the best way to appeal, and how to make a complaint if you don't get
>satisfaction. Here's the one for Illinois:
>http://www.idfpr.com/DOI/default2.asp
>
>When they say they'll pay 60%, what they mean is they'll pay 60% of what
>they consider to be "reasonable and customary" charges (after you've met
>the deductible) - you pay 100% of everything above that, as well as 40%
>of everything within their R&C limits. Another way they squeeze
>customers is if you have multiple procedures done, sometimes they'll try
>to say only the main procedure was "medically necessary" and refuse to
>cover the others.
>
>The way our healthcare system is now, if you can't afford it you can't
>have it. It's pretty scary! Insurance companies are in business to make
>money, and they do that by limiting care.
>
>At Wed, 12 Sep 2007, endo wrote:
>>
>>I had surgery w/ the CEC in atlanta Ga this past July and now I am
>>getting these hellish stmts from my ins co telling me I owe over $17,000
>>just for the Dr bill even though I pd $3500 already before surgery. This
>>doesn't include the hospital bill. It's not fair that insurance
>>companies won't pay for drs who give us the best care. Is this what
>>would happen if I had a rare form of cancer and had to travel out of
>>state to a specialist to save my life? I realize endo is not fatal but
>>it does limit your life. I just needed to vent...if any one has any
>>advice about how to dispute these charges, let me know. I have an email
>>into the CEC to ask if they could help me out by resubmitting the claim
>>or to word it so they would cover more of the bill. I was told that
>>they would pay 60% up to 10,000 then 100% after that. Yeah right!! :( I
>>am feeling much better but it's sad that insurance companies don't cover
>>for endo specialists very well at all.
>
>--
>Find an endo specialist in the ERC's EndoDocs group:
>http://groups.yahoo.com/group/EndoDocs/
>
>Try an excellent endo support group:
>http://groups.yahoo.com/group/erc/
>
>Info on pain management:
>http://www.painfoundation.org/
>
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