Wednesday, August 13, 2008

Medical Bills, Insurance and Expensive Formula

Last year at this time we had our daughter, decided to move and got screwed by the company my husband worked for. He had told them he would work in September so we could have insurance coverage. They changed their mind and we lost insurance for September and part of October. Our new coverage began Oct. 11. In the meantime our daughter was diagnosed with a dislocatable hip. Treatment included fitting her for a harness that needed to be checked weekly for six weeks and then every other week for the last six weeks. It was diagnosed in MN and treated in WI. But because we had no insurance when she was five-weeks old and our first four appointments were not covered by any insurance. We didn't qualify for any assistance. So I called the billing department and asked if they had a discount. At the Children's Hospital there are three bills that we would receive -- one for the doctor, the facility and radiology. The doctor and facility bill we paid at each visit.

Anyway, I was able to get 40 percent discount for the facility, 10 percent for the doctor and 20 percent for radiology. By the fifth visit we had insurance. But guess what because my 2-month-old daughter had the condition before the insurance coverage it was considered pre-existing. In her short life it was already pre-existing. We had thought about waiting in August to treat it, but the sooner the better they told us. I still gave them my insurance card starting in Octboer and waited.

Turned out some parts of the last three or four visits (I lose track we were there so often for 12 weeks) were covered by insurance. I guess it depends on how they code the service. Of course it wasn't until March did I have everything figured out. Our last appointment was in early December. For whatever was considered pre-exisitng I still got a discount and insurance paid a portion of the rest. It would have been nice to just have one bill for each visit, but we had at least two and sometimes three. It consumed a lot of my time.

Be sure to ask for cash discounts even if you do have insurance, too. I used to go to a dentist that if I paid cash at the appointment I would get 10 percent off.

In January, as luck would have it my daughter had a huge reaction to milk-based formula. I switched her to Nutramigen right away. It is $25 for a 16 oz can of powder. I waited until our March appointment and asked the doctor to write a prescription for it. I waited because I didn't know how all this stuff worked.

Once I had the prescription I called the insurance and asked how to get the formula covered. They gave me a number for a place that is affiliated with them to order the formula. I don't remember why, but it didn't work out. I called the insurance again and they sent me to a medical supplier that did cover us. After I paid our deductible of $250, I was getting eight cans of formula for $64. And I filled out a form to have a portion of the previous cans purchased to be taken out of our flex spending account -- about $85.

It took forever for that to get cleared through insurance, too. In June we finally paid the deductible. Insurance sent letter about pre-existing to the medical supplier instead of our doctor. In fact at our June appointment I took the letter in and had the doctor sign it. It was a ton of work to figure this out, too. But we ended up saving a lot of money. And our deductible got met.

We have a follow up on my daughter's hip in December. We are waiting more than the 12 months, so it doesn't count as pre-exisitng. Of course, I'm sure something else will come out of it.

My advice with insurance is don't accept "no" or "I don't think so" as an answer. The more questions I asked the more infomation I got. Even if I was just re-stating what they said they went on to explain further. Actually, I find this true with most situations. As far as medical discounts, they won't give them unless you ask. They sure don't advertise "40 percent discount if you don't have insurance and pay cash."

1 comment:

Monica said...

I know I have been able to get a 10% discount for Samanthas speech when I pay in full our portion after ins pay the 80.


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