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Why do I work so hard to pay for insurance?

My husband and I spend over 400 dollars a month on health insurance and we still recive bills in the mail that insurance will not cover. We've called our insurance company and they say it's the way the dr's office "codes" the bill. When we talk to the office they blame the insurance but we're still left paying thousands of dollars a year besides what there taking out of our checks. We have premiums to reach but everything that we go see the dr for doesn't go toward our premium. It really upsets me that we end up paying more and more every year and our insurance covers less and less. Why is it like this?

Update:

You all have given me such great advice! Thank you all for your help! I'm really sorry that I can only pick one of you for my best! Thank you all again!!

6 Answers

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  • 1 decade ago
    Favorite Answer

    Yeah, health insurance is a pain. All these greedy lawyers suing doctors and hospitals have made it nearly impossible for the medical professionals to make any money and you should see the insurance costs that doctors have to pay now.

    That's why I never liked that guy who ran for vice president a few years back, John Edwards. He bankrupted about every doctor in South Carolina with bogus lawsuits where he claimed he was "channeling" unborn babies. What a tool he was !!

    I don't know the solution, other than stopping the greedy lawyers. There are lots of insurance agencies these days. You can always shop around for a better one.

  • 1 decade ago

    If your insurance is saying that the doctor's office is improperly coding the bills, first ask for a copy of the denial from your insurance and ask the doctor's office to print you a paper HCFA (which is the form the insurance companies get for claims) for your claim and keep a copy of it for yourself and you submit it in. This way, if it's rejected - you can go line by line with the insurance company and find out EXACTLY what is wrong so it can be corrected. (If your doctor says they can't print you a HCFA, they're lying - it can be done.) Then, ask for reconsideration of the claims by your insurance company.

    Make sure you're seeing in-network providers (or preferred network providers) - that can lessen your out of pocket expenses, and make sure things are covered. If your doctor likes to do procedures, make sure they're covered at his office (versus a radiology place for X-rays or a lab for bloodwork, etc.) - sometimes, if procedures are done at the doctor's office instead of the lab, it costs you more. The bottom line is - know your policy and what is covered and when and where it's covered. It makes a difference.

    Anything you have to pay for - keep receipts, if it's over a certain amount, you can write it off on your taxes if you itemize.

    Source(s): I'm a medical biller.
  • 1 decade ago

    If your insurance company is rejecting medical bills because the doctor charges over what they believe is 'Reasonable and Customary', you should talk to both of them about it for a better explanation.

    If the insurance company thinks the doctor is charging too much for the services he renders, the doctor may reduce the amount of the bill if you ask them to.

    Premiums go up due to inflation and increased costs. To keep offering health insurance as a benefit, many employers have to lower the benefit amounts and offer policies meant to cover only catastrophic losses, with high co-insurance amounts (Deductibles) that may leave you with large out of pocket expenses.

    The other alternative is often no insurance at all.

  • 1 decade ago

    I hate to say this but $400 per month for health insurance is actually CHEAP.

    Many family plans are over $1000 a month or more.

    What is happening to you is happening to everybody.

    We all want all of our medical coverage paid for entirely but we don't want to pay anything in premiums.

    Well somebody has to pay.

    If you paying premiums and using the services of health care providers and if you are getting more back in health services than you are paying in then you are WINNING THE GAME.

    That means somebody else is paying for your health care...and its all of us collectively.

    Instead of thinking of how much you are paying....look at it a different way.

    Think of what it would be like if you didn't have insurance at all and you had to pay the FULL price of all your health care costs.

    Take all of your bills and take the billed rate (before insurer discounts are taken out).....and add all that up over a one year period.

    Now take that amount and compare it to $4800 (which is what you are paying right now). Are you coming out ahead? Maybe, maybe not.

    If you are not, then consider that you are in a risk pool that will pay for you if you get sick.....in exchange for you agreeing to pay for them right now....even if you lose money right now.

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  • 1 decade ago

    If I knew the answer to this one I'd be a millionaire!!! its no different here in Australia, we do have gap insurance as well, for a little extra, the difference between what the doctor charges and what the provider pays out, is covered by that......

    Just make sure you get something for your money, if you wear specs, claim each year for new ones, and get something back at least,

  • 1 decade ago

    Sounds like a combination of bad health insurance plan, and poorly trained medical staff at the doctor's office.

    You might be better off switching plans.

    Luckily, your TAXES are probalby still a lot more than health insurance. So we can always point at the government and what a lousy job IT does, too.

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