How am I expected to know what is and isn’t a covered service if my insurance refuses to tell me and doctors refuse to tell me?
Insurance companies always say they will not pay for non-covered services. And doctors consistently say they can collect any amount they want after the fact for services that my insurance refuses to pay because it's uncovered.
Doctor says it's patients responsibility to know what the plan covers. Ok..but when I actually try to get this information from my insurance company, they flat out refuse to tell me!
The only information I can get from my insurance company is my member contract which I've read word-for-word, start to finish, multiple times. It only mentions general things like "cosmetic surgery" and vague things like "not medically necessary." Nowhere does it disclose specifics, procedural codes, etc.
If I go to a random specialist and they pull out some device, how am I suppose to know that what they're about to do is not covered (if I even have the ability to say something)? My basic assumption as a patient is that the doctor is only doing what they believe is medically necessary. And by that logic, it should be covered. How am I, a layperson, expected to determine whether an exam, tool, procedure, etc is or isn't medically necessary more than the person who had years and years of medical education and training?
My attempts to gain more information about what my insurance will cover beyond what is stated in my insurance contract has also been swiftly denied. When I call up, the only people I can speak to are member services representatives who only know as much about how my plan works as it says in the contract I've already read. In my attempts to call up the insurance's provider line, i.e. the people who do actually know the ins and outs of what is covered and how things are billed, they refuse to talk to me because I'm not a provider. I've tried multiple times over the years with numerous insurance companies and it's all been the same.
In one attempt calling up an insurance company, I did manage to get elevated enough to a "manager." When I asked them for more information on how things are billed and what is and isn't covered, they responded "I can't tell you that. It's proprietary trade secrets. If you want to know how much something will cost, you have to first incur the service and then wait for a bill." They then immediately hung up on me.
So, again…how am I expected to know this information?? What even is this.
submitted by /u/FederalCollege
[comments]
