Professional Help Navigating Health Insurance Disputes
Is there a way to hire some sort of professional to help navigate health insurance and medical billing disputes? I don't want to lawyer-up and sue the insurance company, but I would be greatly relieved to pay someone hundreds or even low thousands of dollars to take the weight of insurance disputes off my shoulders.
I'll rant now about the multiple ongoing disputes I have, but honestly none of it's directly relevant to answering the question in the title. In ascending order of size:
$500 – I had two virtual PCP visits directly through my insurance company's (Anthem) website on their Care > Virtual Care page. Anthem's introduction says "Connect to the following virtual-only providers included with your plan's benefits" and then shows a single provider. Literally the Anthem logo was on the page by the talking head of my PCP. Now Anthem claims the provider was out-of-network. $15,000 – My wife was on Aetna while I was on Anthem. Our son was born. We made sure to add him to Aetna before we even left the hospital to avoid any confusion with the billing. My wife changed jobs when our son was three weeks old. We used the QLE to add them both to my Anthem insurance. Aetna originally approved the claim for labor and delivery, but then claimed that our Anthem coverage should be retroactive and primary for the baby. Anthem disagrees and says their coverage for the baby isn't retroactive. Hospital wants $15,000. I've spent hours on the phone with both insurance companies and the hospital and can't get a resolution. $100,000 – My PCP from above referred me to an in-network specialist. The specialist said I needed surgery and described it as "urgent" and "very urgent" and said I could die of a brain infention, though it wasn't quite an emergency I guess. Cue a bunch of phone calls with Patient Financial Services at the hospital and the insurance company to make sure all the insurance requirements were dealt with in advance. Both parties directly confirmed with me that the surgery was pre-approved. Four days after the surgery, I got a letter from Anthem that the surgery was approved and the hospital was in-network, but the surgeon was out-of-network. The hospital shows two pending bills totaling over $100k that list the surgeon's name at the top.
Most likely I can resolve all of these disputes with enough phone calls, but I'm worried sick and constantly miserable. Since the birth of my son my biggest task has been medical billing disputes. I honestly think I would've been better off if I got a brain infection so my surgery could've been done under emergency coverage. Even if it was much worse medically, I wouldn't be on the hook for six figures. This list of ongoing disputes doesn't include recently resolved disputes: 1) my continuous glucose monitor supplier left me without supplies for over 3 weeks and it took over 10 hours of calls mostly to the supplier, but also my doctor and the insurance company, to resolve, and 2) we're moving to a new city, so I scheduled an appointment with a doctor whose office confirmed they were in-network. Out of extreme paranoia and distrust of the insurance company, I called them directly to confirm the doctor was in-network but they claimed it was out-of-network. A three-way call between the doctor's office and the insurance left everyone baffled. I resolved that by giving up.
I am miserable and depressed and would pay thousands of dollars if someone I trusted not to cheat me would handle these disputes and tell me the correct amount of money I owe for my healthcare. I've looked at services like Yohana.com, but from what I've read they're not competent enough to handle the complexity of the American healthcare system. I thought about hiring a personal assistant on Upwork, but I don't know how to verify they're both competent about insurance and trustworthy enough to take all the personal information they'd need for this.
submitted by /u/07daytho
[comments]
