Quantcast

Subscribe to:
POZ magazine
E-newsletters
Join POZ: Facebook MySpace Twitter Pinterest
Tumblr Google+ Flickr MySpace
POZ Personals
Sign In / Join
Username:
Password:
Welcome, Guest. Please login or register.
July 23, 2014, 06:48:23 PM

Login with username, password and session length


Members
Stats
  • Total Posts: 631615
  • Total Topics: 47812
  • Online Today: 283
  • Online Ever: 585
  • (January 07, 2014, 02:31:47 PM)
Users Online

Welcome


Welcome to the POZ/AIDSmeds Community Forums, a round-the-clock discussion area for people with HIV/AIDS, their friends/family/caregivers, and others concerned about HIV/AIDS.  Click on the links below to browse our various forums; scroll down for a glance at the most recent posts; or join in the conversation yourself by registering on the left side of this page.

Privacy Warning:  Please realize that these forums are open to all, and are fully searchable via Google and other search engines. If you are HIV positive and disclose this in our forums, then it is almost the same thing as telling the whole world (or at least the World Wide Web). If this concerns you, then do not use a username or avatar that are self-identifying in any way. We do not allow the deletion of anything you post in these forums, so think before you post.

  • The information shared in these forums, by moderators and members, is designed to complement, not replace, the relationship between an individual and his/her own physician.

  • All members of these forums are, by default, not considered to be licensed medical providers. If otherwise, users must clearly define themselves as such.

  • Forums members must behave at all times with respect and honesty. Posting guidelines, including time-out and banning policies, have been established by the moderators of these forums. Click here for “Am I Infected?” posting guidelines. Click here for posting guidelines pertaining to all other POZ/AIDSmeds community forums.

  • We ask all forums members to provide references for health/medical/scientific information they provide, when it is not a personal experience being discussed. Please provide hyperlinks with full URLs or full citations of published works not available via the Internet. Additionally, all forums members must post information which are true and correct to their knowledge.

  • Product advertisement—including links; banners; editorial content; and clinical trial, study or survey participation—is strictly prohibited by forums members unless permission has been secured from POZ.

To change forums navigation language settings, click here (members only), Register now

Para cambiar sus preferencias de los foros en español, haz clic aquí (sólo miembros), Regístrate ahora

Finished Reading This? You can collapse this or any other box on this page by clicking the symbol in each box.

Author Topic: New insurance and billing...  (Read 5960 times)

0 Members and 1 Guest are viewing this topic.

Offline J.R.E.

  • Member
  • Posts: 7,094
  • Joined Dec-2003 Living positive, since 1985.
New insurance and billing...
« on: April 11, 2007, 07:52:08 AM »
Good Morning ,

Beginning this year ( January 01,07 --our company switched over from Cigna to Aetna. I just received a bill from Quest Diagnostics. Apparently , Aetna doesn't cover all of the cost of the 3 month blood tests.

I figured something like this was going to happen, But I am at least prepared. I wasn't quite sure what my out of pocket would be, until now.

Just to give an idea of the cost ; (these were my blood tests were done on Jan 11th.)


Amylase-------$46.22

Cholesterol---$31.75

Lipoprotein,direct,HDL-----$42.25

Triglycerides ----------------- $ 31.75

Prostate, specific AG--------$100.65 ( that was an expensive one)---once a year


CBC,PLT,DIFF--------$33.00

T- CELLS; ABS CD4 COUNT-----$192.46

Comprehen Metabolic panel-----$49.50

Virus -1 quant---------$ 279..50



Grand total-------$807.08 


The amount I have to pay after after Aetna's share is ----- $183.19


I had a feeling that after we switched to Aetna, that I would have to be responsible for some of the costs. It still pays to have insurance. With Cigna, there was no charge for the blood test....


Ray





Current Meds ; Viramune, Epzicom, 40mg of simvastatin, 12.5mg of Hydrochlorothiazide.
Metoprolol tartrate 25mg



http://forums.poz.com/index.php?topic=40802.0

http://forums.poz.com/index.php?topic=45159.0

http://forums.poz.com/index.php?topic=39722.msg495621;topicseen#msg495621

http://forums.poz.com/index.php?topic=46806.0

http://forums.poz.com/index.php?topic=39414.msg491701#msg491701


 In October of 2003, My t-cell count was 16, Viral load was over 500,000, Percentage at that time was 5%. I started my first  HAART regimen  on October 24th,03.

 As of 6/4/14,  t-cells are at 423, Viral load <40

 Current % is at 13% 

  
 62 years young.

Offline mjmel

  • Member
  • Posts: 2,069
Re: New insurance and billing...
« Reply #1 on: April 11, 2007, 08:07:24 AM »
Thank you for posting those figures, Ray. I am on medical disability assistance. I had no idea the lab work is so expensive. WOW!

Offline Moffie65

  • Member
  • Posts: 1,755
  • Living POZ since 1983
Re: New insurance and billing...
« Reply #2 on: April 11, 2007, 09:25:44 AM »
Ray, that is interesting.....

I wonder just how close you are to qualifying for help from RW.  If you are personally not making a fortune, (please don't count your combined income) it might be time to start looking into signing up and maybe get some help.  What I am talking about is help with the co-pay.  I know here in Arizona, if a person is not above the income limits that we pay for co-pays for this type of expense for those that are self insured, or work insured. 

The reason for this is that it is recognized that many are functionally working and have insurance, but sometimes now the cost of meds and co-pays really causes one to go into poverty to keep up.  This would start a chain reaction that might cause the person to end up being on Ryan White for everything due to insurance or job loss.  Paying co-pays for people like you, keep you on the road to independence and that is the reason it is approved. 

I would suggest that you all look into this little known fact.  (not all states do this)

Love,
The Bible contains 6 admonishments to homosexuals,
and 362 to heterosexuals.
This doesn't mean that God doesn't love heterosexuals,
It's just that they need more supervision.
Lynn Lavne

Offline aztecan

  • Member
  • Posts: 5,382
  • 29 years positive, 56 years a pain in the butt
Re: New insurance and billing...
« Reply #3 on: April 11, 2007, 09:59:15 AM »
Hey Ray,

What Tim said regarding insurance assistance. Here in New Mexico, it isn't Ryan White but the ASOs who pay this through other funding, part of which probably comes from Ryan White, but that's another issue.

With my ASO, the rule is you are eligible for insurance assistance if you are on ARVs and earn less than 300 percent of poverty.

What Tim said about not counting your lover's income is important too. Since gay men cannot marry, your partner's income isn't considered with this program - and some others. (It is different for HOPWA, but that's another story.)

Anyway, its food for thought. I'm sorry you are being stuck with these co-pays. So far (knocks wood) mine are still fully covered.

HUGS,

Mark
"May your life preach more loudly than your lips."
~ William Ellery Channing (Unitarian Minister)

Offline J.R.E.

  • Member
  • Posts: 7,094
  • Joined Dec-2003 Living positive, since 1985.
Re: New insurance and billing...
« Reply #4 on: April 11, 2007, 10:05:26 AM »
Thanks Tim,

I just went online and paid that $183.19 bill to Quest. HOWEVER, after I paid that, something just didn't seem right to me. So I called Aetna....

I just got off the phone with Aetna, and they told me that my co-pay ( total  out of pocket should be only $50.00. That they ( Aetna)- are to pay that $ 183.19. At least that is the way I understood it, from the conversation I had. But apparently, Quest has not received payment yet from Aetna. OH BOY !!.... HERE WE GO... !!!!  :P :P


I then called Quest Diagnostics, and they told me that if/when Aetna sends them the money, that they would refund the $183.19

I really hate dealing with insurance issues. This stuff makes me crazy.

Meantime, I have a Quest diagnostics office , right across the street from me. I think I will go over there, with the information I have, and see what they have to say. Trying to talk, to these people on the phone, and understanding what they are talking about is almost impossible !!! I am sure you know what I mean !!!


Thanks for the RW information, but right now, I probably don't really need to use RW. I am not making a fortune, but I have been very careful of expenditures these past few years. I'll see what happens here first, with Aetna, and see how this resolves.


Thanks Tim-----Ray





Current Meds ; Viramune, Epzicom, 40mg of simvastatin, 12.5mg of Hydrochlorothiazide.
Metoprolol tartrate 25mg



http://forums.poz.com/index.php?topic=40802.0

http://forums.poz.com/index.php?topic=45159.0

http://forums.poz.com/index.php?topic=39722.msg495621;topicseen#msg495621

http://forums.poz.com/index.php?topic=46806.0

http://forums.poz.com/index.php?topic=39414.msg491701#msg491701


 In October of 2003, My t-cell count was 16, Viral load was over 500,000, Percentage at that time was 5%. I started my first  HAART regimen  on October 24th,03.

 As of 6/4/14,  t-cells are at 423, Viral load <40

 Current % is at 13% 

  
 62 years young.

Offline J.R.E.

  • Member
  • Posts: 7,094
  • Joined Dec-2003 Living positive, since 1985.
Re: New insurance and billing...
« Reply #5 on: April 11, 2007, 10:13:49 AM »
Hey Ray,

What Tim said regarding insurance assistance. Here in New Mexico, it isn't Ryan White but the ASOs who pay this through other funding, part of which probably comes from Ryan White, but that's another issue.

With my ASO, the rule is you are eligible for insurance assistance if you are on ARVs and earn less than 300 percent of poverty.

What Tim said about not counting your lover's income is important too. Since gay men cannot marry, your partner's income isn't considered with this program - and some others. (It is different for HOPWA, but that's another story.)

Anyway, its food for thought. I'm sorry you are being stuck with these co-pays. So far (knocks wood) mine are still fully covered.

HUGS,

Mark



Hello Mark,

You were posting as I was typing. I don't include Ed's Income. As I stated above, Im gonna see what plays out here, with the insurance company and Quest. I am OK for the time being. Sooner or later, the time will come, when I will have to get involved with a program, ( when I am no longer able to work ) but things are somewhat stable right now.

I have also been getting quite a bit of information from my doctors office ... so, I am trying to stay on top of all this as best I can.



((HUGS))------Ray
Current Meds ; Viramune, Epzicom, 40mg of simvastatin, 12.5mg of Hydrochlorothiazide.
Metoprolol tartrate 25mg



http://forums.poz.com/index.php?topic=40802.0

http://forums.poz.com/index.php?topic=45159.0

http://forums.poz.com/index.php?topic=39722.msg495621;topicseen#msg495621

http://forums.poz.com/index.php?topic=46806.0

http://forums.poz.com/index.php?topic=39414.msg491701#msg491701


 In October of 2003, My t-cell count was 16, Viral load was over 500,000, Percentage at that time was 5%. I started my first  HAART regimen  on October 24th,03.

 As of 6/4/14,  t-cells are at 423, Viral load <40

 Current % is at 13% 

  
 62 years young.

Offline allanq

  • Member
  • Posts: 689
  • still life with pills
Re: New insurance and billing...
« Reply #6 on: April 11, 2007, 11:58:15 AM »
Ray,

Your situation underscores a sad reality with insurance nowadays. Whenever an employer announces a change in its health insurance program, it's ALWAYS to the detriment of the employees.

Allan
Top (Breakfast): Prezista, Norvir, Isentress, Zoloft (2), Glyburide (2), Aspirin
Bottom right (Dinner): Prezista, Norvir, Isentress
Bottom left (Bedtime): Sustiva, Trazodone (2), Lipitor, Septra (no longer taking this)
Center: Alprazolam (Xanax)
Not shown: various vitamins & supplements

Offline SirPrize

  • Member
  • Posts: 78
  • SirPrize!
Re: New insurance and billing...
« Reply #7 on: April 11, 2007, 01:30:05 PM »
It has been my experience over the past years to "always" question the billing practices of the particular insurance company or laboratory service.  More times than not an incorrect ICD-9 code has been submitted incorrectly from the requesting physician or a transcription error at the labs.  After numerous telephone contacts this usually gets resolved, albeit a pain in the butt to deal with.

A word of advice to anyone that may just starting to have routine labs, switching insurance companies, etc:  Keep your billing records for a couple of years before destroying.  I have had to dig mine out several times to prove a particular service had been paid OR show that the invoicing office has misapplied a particular payment.
Due to current economic conditions, the light at the end of the tunnel has been temporarily turned off!

Offline jack

  • Member
  • Posts: 1,578
  • fomerly the loser known as Jake
Re: New insurance and billing...
« Reply #8 on: April 11, 2007, 01:37:26 PM »
quest is horrible. They always send me bills,even though my insurance covers it. I dont even open them anymore, just toss them. Why do all companies in health care have such horrible paperwork problems? It is a huge cost when you cant figure out who owes you what.

Offline J.R.E.

  • Member
  • Posts: 7,094
  • Joined Dec-2003 Living positive, since 1985.
Re: New insurance and billing...
« Reply #9 on: April 11, 2007, 06:07:44 PM »
It has been my experience over the past years to "always" question the billing practices of the particular insurance company or laboratory service.  More times than not an incorrect ICD-9 code has been submitted incorrectly from the requesting physician or a transcription error at the labs.  After numerous telephone contacts this usually gets resolved, albeit a pain in the butt to deal with.


Oh yes, I agree completely with you on this. I am one of those that very seldom am comfortable throwing away billing statements etc. This bill I received today has all the codes listed, and is very itemised, so I will be hanging on to these statements.



quest is horrible. They always send me bills,even though my insurance covers it. I dont even open them anymore, just toss them. Why do all companies in health care have such horrible paperwork problems? It is a huge cost when you cant figure out who owes you what.


Usually everytime I receive a bill, I pay it, almost the same day I get it. I am thinking, that things are just probably just crossing in the mail, But when I made this payment this morning, something told me afterwords, I should have held off , and questioned it first before making the payment. I"ll be watching it closely in the future.



Thanks-------Ray
Current Meds ; Viramune, Epzicom, 40mg of simvastatin, 12.5mg of Hydrochlorothiazide.
Metoprolol tartrate 25mg



http://forums.poz.com/index.php?topic=40802.0

http://forums.poz.com/index.php?topic=45159.0

http://forums.poz.com/index.php?topic=39722.msg495621;topicseen#msg495621

http://forums.poz.com/index.php?topic=46806.0

http://forums.poz.com/index.php?topic=39414.msg491701#msg491701


 In October of 2003, My t-cell count was 16, Viral load was over 500,000, Percentage at that time was 5%. I started my first  HAART regimen  on October 24th,03.

 As of 6/4/14,  t-cells are at 423, Viral load <40

 Current % is at 13% 

  
 62 years young.

Offline pozniceguy

  • Member
  • Posts: 1,175
  • Niceguy Dallas
Re: New insurance and billing...
« Reply #10 on: April 12, 2007, 12:05:37 PM »
Just wanted to reinforce what Sirprize said about keeping your  records....I personally fought with the  Hospital/insurance company for nearly a year..they applied a payment I sent to an account that had nothing due on it.....then after about six months started sending me Past due notices......I had checks showing payment but they insisted I had to pay open invoices...got all the way to a collection agency...which I refused to deal with....then during all this on going stuff they sent me a REFUND of the payment  they misapplied to the account with zero balance... I saved all documents sent a really detailed letter to the state insurance commission and a registered letter to the President of the Hospital...eventually got a letter of apology and they just wrote off the "payment due" ... took nearly a year  but I was not about to pay twice for their mistake..... they didn't even want their refund check back....KEEP YOUR RECORDS...THESE PEOPLE ARE SLOPPY AND WILL TRY TO BULLY YOU...  do not accept a "corrected account"  only accept a written explanation of the situation signed by the highest person in the food chain... 
Nick
remember the good times...honor the past but don't live there
Le stelle la notte sono grandie luminose, nel cuore profondo del Texas

Offline aztecan

  • Member
  • Posts: 5,382
  • 29 years positive, 56 years a pain in the butt
Re: New insurance and billing...
« Reply #11 on: April 13, 2007, 09:54:20 PM »
What Nick said.

I keep my records for seven years, even though they have been paid off. I do this with everything, including medical bills.

It has saved my paying double payments and having services cancelled.

HUGS,

Mark
"May your life preach more loudly than your lips."
~ William Ellery Channing (Unitarian Minister)

Offline J.R.E.

  • Member
  • Posts: 7,094
  • Joined Dec-2003 Living positive, since 1985.
Re: New insurance and billing...
« Reply #12 on: April 19, 2007, 09:29:42 PM »
Just to follow up on this,


There was an error made !! My copay should have been only $50.00, for all bloodwork. I have no deductable. I got in contact with Quest diagnostics,( after several calls today) they informed me that they received payment from Aetna and told me a rufund would be in the mail !


Ray
Current Meds ; Viramune, Epzicom, 40mg of simvastatin, 12.5mg of Hydrochlorothiazide.
Metoprolol tartrate 25mg



http://forums.poz.com/index.php?topic=40802.0

http://forums.poz.com/index.php?topic=45159.0

http://forums.poz.com/index.php?topic=39722.msg495621;topicseen#msg495621

http://forums.poz.com/index.php?topic=46806.0

http://forums.poz.com/index.php?topic=39414.msg491701#msg491701


 In October of 2003, My t-cell count was 16, Viral load was over 500,000, Percentage at that time was 5%. I started my first  HAART regimen  on October 24th,03.

 As of 6/4/14,  t-cells are at 423, Viral load <40

 Current % is at 13% 

  
 62 years young.

 


Terms of Membership for these forums
 

© 2014 Smart + Strong. All Rights Reserved.   terms of use and your privacy
Smart + Strong® is a registered trademark of CDM Publishing, LLC.