[notme]

While talking with ALASKA on another thread the subject of the complexity of health insurance came up. I was wondering how many people REALLY understand their insurance policies and exactly what you need to do when your doctor suggests a specialist or needed supplies.

I worked for a hospital for years and was really amazed at how many people were unaware of the hoops they needed to jump through to get their bills paid by the insurance carrier. Many times people with HMO's were sent to the hospital to have pre-surgery lab work done when in fact their insurance company didn't contract with the hospital lab and they should have gone elsewhere to get the lab work done. They would end up with a giant bill that they didn't expect. Also, patients would have surgery and the anesthesiologist would bill for his services seperately from the hospital bill and the insurance companies would deny payment because he was not a contracting doctor. (When have you ever had a choice who your anesthesiologist was?).

The insurance companies can change providers without informing us that changes have been made. I ordered my pump supplies this week from MiniMed and was told I could no longer get certain items from MiniMed and I would have to pay with credit card if I wanted those items. I called my insurance company to find out who the new provider was for these items and not a soul knew. They agreed that the contract with MiniMed was changed, but couldn't tell me who the new contract was with. Why can insurance companies make these changes without informing us? If MiniMed hadn't told me that the contract had changed, I could have ordered these supplies and been billed for these items later because they were no longer under my policy.

I was wondering how many of us have been "surprised" by insurance changes and how many people really understand the insurance terms of "out of pocket" "deductibles" "EOB's" and "contracting providers".

I really think some changes need to be made. Insurance companies make it as difficult as possible so we make mistakes and pay full price for services that should be covered at a contracted rate with our insurance companies.

Nancy