telizas
09-18-2009, 01:04 PM
When I first looked into getting a pump, I sent my insurance info to both Animas and Minimed. I also called Medica and asked if there was a preferred pump under my plan. They instructed me to have the pump company contact them. Both Animas and Minimed said I was covered 80/20 on this type of item and I had a $2500 out-of-pocket maximum, that I had met approx $1500 of that and my out of pocket for the pump would contribute to this figure. Each pump was about $900, my cost. I have an FSA with about $2000 in it, so, cool beans, I could afford it.
Fast forward to today when we get a $700 check in the mail saying that this is all they will cover and my "Amount you owe" was over $6000. Nowhere on the EOB does it say that it is because Animas is out-of-network. I had to find this out by calling Medica. So they ****** up a few ways:
1. Telling ME it was covered 80/20, regardless of the provider, even though I asked SPECIFICALLY if they had a preferred provider.
2. NOT telling Animas that they were not the preferred provider
3. Not providing the reason on the EOB.
I am LIVID. Absolutely pissed off to the point of wanting to throw something. I called and started the appeals process, but I WILL be calling the Attorney General on this one... they know me quite well after Blue Cross tried to deny my newborn because she was born at 11:58pm and they denied the entire labor and delivery bill, when they got the bill for those two minutes.
OMG!! Why does this **** have to be so ****ed HARD. If Medica had said, WHEN I CALLED THEM TO ASK THIS VERY QUESTION, that their preferred prodiver was Minimed, I would have been A-OK with it. Now, two weeks into having the pump, I need to KNOW if this is going to be covered.
[insert lots of loud swearing here]
I don't need this right now. I am full-time in college at 33 with two kids and an unemployed husband. I'm plenty stressed already, thanks! GRRRRR!!
Fast forward to today when we get a $700 check in the mail saying that this is all they will cover and my "Amount you owe" was over $6000. Nowhere on the EOB does it say that it is because Animas is out-of-network. I had to find this out by calling Medica. So they ****** up a few ways:
1. Telling ME it was covered 80/20, regardless of the provider, even though I asked SPECIFICALLY if they had a preferred provider.
2. NOT telling Animas that they were not the preferred provider
3. Not providing the reason on the EOB.
I am LIVID. Absolutely pissed off to the point of wanting to throw something. I called and started the appeals process, but I WILL be calling the Attorney General on this one... they know me quite well after Blue Cross tried to deny my newborn because she was born at 11:58pm and they denied the entire labor and delivery bill, when they got the bill for those two minutes.
OMG!! Why does this **** have to be so ****ed HARD. If Medica had said, WHEN I CALLED THEM TO ASK THIS VERY QUESTION, that their preferred prodiver was Minimed, I would have been A-OK with it. Now, two weeks into having the pump, I need to KNOW if this is going to be covered.
[insert lots of loud swearing here]
I don't need this right now. I am full-time in college at 33 with two kids and an unemployed husband. I'm plenty stressed already, thanks! GRRRRR!!