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Unexpected medical bill

 
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amother




Black


Post  Mon, Dec 31 2018, 2:50 pm
A few weeks ago I noticed my otherwise healthy daughter’s outer ear was a little red and swollen. I thought it was a bite but took her to the doctor to confirm, and to get a note from school about it so she wouldn’t get sent home.

Sure enough, the doctor said it was a bite. However, she thought my daughter’s throat looked swollen, and she sent us for an ultrasound. I hadn’t noticed that her throat was swollen, and my daughter was otherwise in good health. To me her throat looked fine. But I took her for the ultrasound in order to comply and be on the safe side. I assumed it would be covered by her insurance like everything else she had needed on the plan had been.

The ultrasound turned out completely normal, but now I got a huge bill for it in the mail that I wasn’t expecting. Insurance covered part but not all of the cost. Had I known about the cost I would not have done it.

I know it’s a long shot but is there anyone I can appeal to? Yes it’s better to be safe than sorry but honestly I feel like this was a complete waste of money.
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amother




Magenta


Post  Mon, Dec 31 2018, 2:56 pm
Did they outright deny the ultrasound claim or did they apply it towards ur deductible?
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amother




Blue


Post  Mon, Dec 31 2018, 2:56 pm
Is your insurance a medicaid insurance?
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amother




Black


Post  Mon, Dec 31 2018, 3:00 pm
amother wrote:
Did they outright deny the ultrasound claim or did they apply it towards ur deductible?


Applied it towards the deductible.
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amother




Black


Post  Mon, Dec 31 2018, 3:01 pm
amother wrote:
Is your insurance a medicaid insurance?


Yes. My kids are on Medicaid but my husband and I are not.
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amother




Navy


Post  Mon, Dec 31 2018, 3:19 pm
What grounds would you appeal it on? My experience is that you can't appeal because the results were normal.

If the doctor didn't code it correctly, that would be something that could be corrected but it appears from what you have written that ultrasounds are covered at a certain percentage.

Unfortunately one really has to be on top of how stuff is covered. I don't know specifically about ultrasound tests but I know that MRI and CAT scans (for example) are covered differently than other procedures.

I wonder why the doctor needed an ultrasound for a swollen throat - Did you ask him or her what was the point of the test? While I agree that one doesn't want to scrimp on health care, I have found that doctors sometimes prescribe tests that aren't needed - for example, I had a sore hip and I was almost positive that it was an arthritic hip based on my symptoms. The orthopedist I went to just needed an X-Ray (cheap) to diagnose it as an arthritic hip but one primary care doctor I had seen wanted me to get an MRI (very expensive) which was completely unnecessary.

Similarly I had a sore toe and the orthopedic doctor only needed an X-ray to diagnose it. What was funny was that I think he thought I was poor since I wasn't dressed in fancy designer clothing and so he told me if I was Steven Spielberg (meaning rich) he would suggest orthotic inserts but he didn't think they would help LOL LOL
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amother




Black


Post  Mon, Dec 31 2018, 4:27 pm
Thanks so much for your informative reply. I will try to be wiser next time.

I’m new to the American system. How does it work - are you able to look up if tests, medications, and procedures are covered by your insurance before the doctor orders them? I would love some practical advice about when and how to check these things. Thanks.
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amother




Blue


Post  Mon, Dec 31 2018, 4:31 pm
amother wrote:
Yes. My kids are on Medicaid but my husband and I are not.


There are different rules for medicaid insurance. I don't understand the deductible. Is that for your kids' medicaid? What state are you in?

There is a medicaid expert on here. She did a.m AMA thead.
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wow




 
 
 


Post  Mon, Dec 31 2018, 4:33 pm
amother wrote:
Yes. My kids are on Medicaid but my husband and I are not.


As far as I know Medicaid doesn't have a deductible but you wrote in the previous post that they applied it toward the deductible. That doesn't make much sense...?
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amother




Black


Post  Mon, Dec 31 2018, 4:35 pm
wow wrote:
As far as I know Medicaid doesn't have a deductible but you wrote in the previous post that they applied it toward the deductible. That doesn't make much sense...?


I also didn’t think that Medicaid had a deductible but that’s what it said on the bill Sad

I’m in Florida.
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amother




Navy


Post  Mon, Dec 31 2018, 4:40 pm
You should have received a comprehensive book detailing your insurance coverage. It should also contain a short summary of what things are covered and what the coverage levels are. I would suggest reading at least the summary so you have some idea of how your coverage works. It can be complicated between co-payments and deductibles. If you have questions after reading the summary, contact your insurance provider with a list of your questions regarding coverage.

As I wrote some tests are covered at different levels and also some tests require insurance pre-approval for coverage. Unless something is K/H an emergency, it never hurts to contact your insurance company to verify coverage. If something is going to cost you a lot out of pocket, you should ask the doctor why the test is necessary and if there is an alternative that would be just as effective. Again, I don't suggest cheaping out on medical care but I also believe that one needs to be an informed consumer or one can wind up paying for unnecessary and expensive medical procedures.

Also you should also be an informed consumer of medical care. If a doctor prescribes something that seems a little bit out of the ordinary, ask why they feel the test is necessary. Not trying to second guess what you did but I find an ultrasound test prescribed for a "swollen" throat in an otherwise healthy child to be strange. At the very least I would have asked what it was for as it just seems odd - mind you, I'm not a medical professional.

You also have to be careful with prescriptions because not all drugs are in the formulary and often a drug can be just as good as another drug and one will be in the formulary and the other won't be - and of course, absent strange circumstances, generic drugs are going to be as effective and cost you less.

ETA - And you really need to contact whoever is providing you with Medicaid to find out why you were charged if in fact Medicaid has no deductibles or co-payments.
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amother




Aubergine


Post  Mon, Dec 31 2018, 4:45 pm
amother wrote:
I also didn’t think that Medicaid had a deductible but that’s what it said on the bill Sad

I’m in Florida.


What Medicaid plan do you have? My kids have FL Medicaid too, so I may have some information. I've never heard of a deductible with Medicaid. There may have been a mistake with the billing. You can start by calling the company that sent the bill. Are your kids possibly covered under a private insurance as well?
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amother




Teal


Post  Tue, Jan 01 2019, 9:23 pm
amother wrote:
There are different rules for medicaid insurance. I don't understand the deductible. Is that for your kids' medicaid? What state are you in?

There is a medicaid expert on here. She did a.m AMA thead.


Can someone link to this thread? I have some questions I'd like to ask about appealing denied coverage on Medicaid. Or is amother navy the OP of that thread?
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dvoras




 
 
 


Post  Tue, Jan 08 2019, 11:24 pm
Call refuah medical Associates at 4136791823. They are located in brooklyn, they can help deal with the insurance issues. And negotiate a better price for you.
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