Health insurance - pedda bokka

[simha2727]

How did you chose the hospital if it’s out of network ? Hospital select chesukunapudu they will verify kada ?

[budgetpadbhanabam]

2 hours ago, Srin said:

DB,

 

mee amulyamina salahalu kavali plz 

 

March lo we had baby, so baby wife pregnancy time lo  low deductible plan teesukunnam $500 deductible (max out of pocket $1500), hospital lo join avakamundey deductible amount $500 pay chesam

 

ivala Cigna lo login ayyi chustey pedda bokka kanipinchundi $13,700 pay cheyali ani and aaa daridrudu out of network anta (he is assistant surgeon anta), ma ob-gyn vadey $4000 bill vesadu in network and deductible met ayyai kabatti i paid $0 to my ob-gyn

 

veedu evado asalu ela vachado teliyadu bill matram Cigna portal lo undi. Ilanti situation lo how to get this sorted out. Insurance ki adigitey they told he is out of network and members benefit plan limits the payment to maximum reimbursement charge, claim is out of network meaning the allowable for out of network on the procedure is what was subjected to the deductible and the provider may bill you for the balance ani eee sodi cheppadu 

 

Ipudu Nenu ela fight cheyali with the provider insurance vadu clear ga cheppadu its your responsibility ani 

 

evarikina ilanti situation vastey inta pedda bokka bill vastey how did u overcome 

 

Konchem mee viluvina salahalu ivvandi

 

 

bro if the procedure happend after dec 31st 2021 they cant send you bill if they are out of network when you go treatment from a innetwork hispital. its a law also i was duprised ni out if pocket max entha? after reachind deductable what is your co insurance usually minimum 10% untadi

[Srin]

7 hours ago, Swatkat said:

Wait for experts bro too much asalu. Usual ga aetna or united health care isthadhi ma company. Nenu uhc teskunna. Cigna popular ah ?

Cigna is good insurance company chala mandi uisng

[Srin]

7 hours ago, sarvayogi said:

are you FTE or contracting?

Ma wife is full time to a compnay and valla compnay through ney insurance teesukundi, first baby apudu same plan and now same plan kani eee pedda bokka asalu never expected, anni deductibles meet ayyai anukunna, ma first baby ki we were in NICU and we just paid deductible $500, bill came up to $50k, manam insurance undi kabatti only $500 tho ipoinid kani ee second baby ki idi unexpected asalu aa suregeon specialist ela vachado emo 

[Srin]

7 hours ago, rolex said:

There will be multiple parties involved in pregnancy like obgyn, anesthesia, pediatrician, hospital, blood works etc. check if your obgyn and delivery hospital is in network. If these 2 are in network you can do an “appeal” with Customer service. Tell your story and mention that these are not under your control.. They will open a appeal request and re consider your bill.. they might reconsider..

Yeah labor lo join aye mundey we checked all hospital is in network and OB-GYN kuda, hospital bill a $10K bill chesadu , inusrance a pay chesindi anuko but still $10K tho $13k vadu anta thopu turumkan nak artam avadam ledu, moreover he is assisitant surgeon

[Srin]

7 hours ago, no01 said:

nee hospital n dr both in-network kada? usually Anesthesiologist ki separate bill untadi...which covers but still you need to a some part. Ee surgeon deniki vachadu? was it a complicated delivery which involved C-section? still your in-network Dr's should be able to do it right? and hospital admin's usually check ur insurance details..how did they end up calling somebody else who is not covered? did they gave u headsup? talk to your hospital billing and tell them what this is mess ani....they will re-send the claim with some adjustments.

Hospital and OB-GYN both ate in-network. C-section planned and no complications it is very smooth, 

nenu adey anukunna OB-GYN and Hospital both in network inapudu y we care all ani kani ila vache sariki mind out ipoindi. asalu maku emi cheppa ledu like some xyz will be coming ani, manam em anukuntam in-network a kada vallu chusukuntaru ani kani ila evadu paditey vadu mana consent lekunda too much 

 

ninna just cigna lo login ayyi cigna tho matlada and they said i have to pay $13k ani, moreover inka vadu(assistnat surgeon ) bill papma ledu, cigna lo claim processed May 21 ani undi, its more than 60 days nenu raadu anukunna kani cigna cheppindi u will get the bill ani, am surprised em cheyalo

[Srin]

7 hours ago, dkchinnari said:

asalu delivery how did u chose this hospital? is someone recommended..vallu before check chestharu kadha?

 

 

OB-GYN vallu shcedule chesaru for inducing and this is the hospital in the county near to us and it is in-netwrk. First baby kuda same hospital but first baby complications undey but never paid more than $500

[Srin]

7 hours ago, Pavanonline said:

in/out anedi hospital vallu munde cheptaru kada. Generally hospital is the one we deal with so first find out if there was miscommunication when selecting the hospital. 

https://www.cms.gov/newsroom/fact-sheets/no-surprises-understand-your-rights-against-surprise-medical-bills

see above article if its relevant to your case. Nenu recent ga emergency care out of network ki vella but insurance bill ekkuva raledu, in EOB I saw it was because of the new law above.

out of network max $1500 a kani cigna cheppindi idi, which curprises me

 

I can see a patient responsibility of $13,679.22 which $247.89 was subjected to the deductible. Based on this claims, the members benefit plan limits the payment to maximum reimbursable charge. As this claims was processed as out of network. Meaning on this claims, the allowable for out of network on the procedure is what was subjected to the deductible and the provider may bill you for the balance. This was processed accordingly based on your out of network coverage

[Srin]

7 hours ago, nokia123 said:

same hospital lo oka doc in network and inkokallu out of network...etta thelusthadhi manaki?

yeah adey kada, more over patinet consent kuda ledu and yes I agree complications untey am okay, it is a planned surgery and evado muku mokam teliyani vadu $13k bill papmpadam endi

[Srin]

7 hours ago, Android_Halwa said:

Wait for the hospital to send you the bill...someone from the hospital will reach out to you. Either by phone or mail..

baby delivery roju oka 5-6 claims unnai andulo OB-GYN($4k), hospital($10k), lab($110), ANESTHESIA($2k) and eee third person (out of network person $13k) andarivi in-network and deductible already met, kani veedu bill $13k ila undi 

all the below details are from Cigna Portal

Doctor profile: 

Jason C. Stanford

 Out-of-Network

123 Rockhill Dr,
Sanford, FL 32771-7745

Service Date & Type	Billed	Not Allowed	Covered Amount	Plan Paid	Not Covered By Plan	Applied to Deductible	Copay	Coinsurance	Total Patient Responsibility
Totals	$13,679.22	$0.00	$247.89	$0.00	$13,431.33	$247.89	$0.00	$0.00	$13,679.22
ASSISTANT SURGERY	$9,254.12	$0.00	$228.84	$0.00	$9,025.28	$228.84	$0.00	$0.00	$9,254.12
03/xx/2022	$4,425.10	$0.00	$19.05	$0.00	$4,406.05	$19.05	$0.00	$0.00	$4,425.10

[Srin]

7 hours ago, no01 said:

out of pocket max enti (both in and out of network)....ekkuva think cheyyaku..deal with hospital...vallu ichina codes thone insurance will bill. So they should be taking care of this. 

ninna ee claim chusinapati nundi mind out ipoindi, i will cal hospital and  see why a third person involved when the surgery is well planned in advance and the personcharging more than your hospital bill and OB-GYN ani, let me see 

[Srin]

7 hours ago, simha2727 said:

How did you chose the hospital if it’s out of network ? Hospital select chesukunapudu they will verify kada ?

Bro,

Manam anni chusukuntam kada(and yes everything is in-network), nenu 1 week nundey took care of all this deductible $500 ani and adi kuda over the phone pay chesa when hospital called for scheduling the time and everything is in-network kani eee third person bill is am a lot concerned. assisitant vadiki anta pedda bill enti. insurance chetulu ettesindi i need to pay the $13k ani 

[Srin]

6 hours ago, budgetpadbhanabam said:

bro if the procedure happend after dec 31st 2021 they cant send you bill if they are out of network when you go treatment from a innetwork hispital. its a law also i was duprised ni out if pocket max entha? after reachind deductable what is your co insurance usually minimum 10% untadi

am 100% sure we chose high premium policy meaning premium ekkuva pay chesi deductibles $500 and out-of pocket maximum $1500

 

kani insurance idi edo artam avadam ledu what they told

 

 

I can see a patient responsibility of $13,679.22 which $247.89 was subjected to the deductible. Based on this claims, the members benefit plan limits the payment to maximum reimbursable charge. As this claims was processed as out of network. Meaning on this claims, the allowable for out of network on the procedure is what was subjected to the deductible and the provider may bill you for the balance. This was processed accordingly based on your out of network coverage

[Allarinaresh10]

5 minutes ago, Srin said:

baby delivery roju oka 5-6 claims unnai andulo OB-GYN($4k), hospital($10k), lab($110), ANESTHESIA($2k) and eee third person (out of network person $13k) andarivi in-network and deductible already met, kani veedu bill $13k ila undi 

Service Date & Type	Billed	Not Allowed	Covered Amount	Plan Paid	Not Covered By Plan	Applied to Deductible	Copay	Coinsurance	Total Patient Responsibility
Totals	$13,679.22	$0.00	$247.89	$0.00	$13,431.33	$247.89	$0.00	$0.00	$13,679.22
ASSISTANT SURGERY	$9,254.12	$0.00	$228.84	$0.00	$9,025.28	$228.84	$0.00	$0.00	$9,254.12
03/xx/2022	$4,425.10	$0.00	$19.05	$0.00	$4,406.05	$19.05	$0.00	$0.00	$4,425.10

First Obgyn ni contact avvu only she can guide you. Because planned ani anukunnam kada why there was an out of network doctor/surgeon ani. 
 

Most probably your doctor answer might be at the time of surgery hospital lo aa doctor available lo unnadru.. so he/she participated anocchu. Then you might have less chances to get away. 
 

Last resort is to appeal for your claim to the insurance company. 

good luck. 

[Srin]

1 minute ago, Allarinaresh10 said:

First Obgyn ni contact avvu only she can guide you. Because planned ani anukunnam kada why there was an out of network doctor/surgeon ani. 
 

Most probably your doctor answer might be at the time of surgery hospital lo aa doctor available lo unnadru.. so he/she participated anocchu. Then you might have less chances to get away. 
 

Last resort is to appeal for your claim to the insurance company. 

good luck. 

Yeah naku adey cheptaru anipinstundi kani how do I appel the claim, inusrance vadu is telling this

 

I can see a patient responsibility of $13,679.22 which $247.89 was subjected to the deductible. Based on this claims, the members benefit plan limits the payment to maximum reimbursable charge. As this claims was processed as out of network. Meaning on this claims, the allowable for out of network on the procedure is what was subjected to the deductible and the provider may bill you for the balance. This was processed accordingly based on your out of network coverage