Been doing it for years. Will try to answer questions you might have.

I have major insurance issues. Why is it that companies have such a hard time with claims for twins? My babies are almost 10 months old and some of their birth bills are still not paid! And two weeks ago, I couldn't fill two of the same prescriptions for the two of them until the insurance company gave my dd (baby B) her own member number and her own group number. My parents who also had twins had the same problem almost 30 yrs ago! What's the problem? With all of the technology available in the world, why is this still such a problem?

TIA! You can see that this is really bugging me and any insight would be helpful. I am so tired of calling our insurance companies.

NJ Mom, most likely it's because they have the same birthdate. Most insurance companies identify dependents by DOB. Since your babies have the same DOB, it throws off the claims processors. I know, it's ridiculous, they have different names and all. But unfortunately, even our little ones are "just a number" when it comes to being one of millions of claims processed every day. If their "number" (ie: DOB) is the same - you run into problems with insurance.

Wish I had more "help" to offer, but there really is none until they get individual insurance ID numbers.

Yeah, I thought it was the birthdays that caused the problem. I was hoping that there was some little trick I could learn! Thanks for answering and for offering help!

do you know of any companies offering affordable insurance for maternity, I'm already preg.? also good insurance for kids/family ?

Sorry it took so long! I responded under your other post.

What is a good program? Mine is (I think) outrageously high. $820 for fam of 4 80/20 1k ded. Am I deluding myself thinking there is a better deal out there?

Hey lady! Look at BCBS individual/family plans through Blue Cross and Blue Shield of North Carolina - Your plan for better health -- you can get free quotes there.

I know they have some really reasonable plans for about $150 per person. If there are no pre-existing conditions, you should be able to find one for less than you're paying now. Probably with a copay for visits instead of 80/20.

HTH!

Is it hard to have a case manager assigned? I have a daughter with special needs and it's a real pain talking to a million different people to try to get insurance stuff worked out. What do you need to do to request it? Anything special? Thanks!

thanks...bcbs is who i have now!

Wow, and it's that much?? Did you go through an agent?

my daughter and her husband want to do invetro procedure as the dr. has told them it is their only option and he said Illinois insurance is required to cover it but when they check with their insurance , they say since it is partially paid by employer that they are not legally responsibible to cover that procedure. any advise or tips for them?

It seems like most of my claims get screwed up because they are put through electronically. At least this is the reason I get when I call to find out why I rcvd a bill from the doctor. Usually what happens is the claims adjuster looks it over, acknowledges an error and says it will be put through manually.

Ok, fine. Does these mean that the average person who doesn't call the ins co every time they get a bill may be paying even when they really don't owe anything? Thanks.

"they say since it is partially paid by employer that they are not legally responsibible to cover that procedure. any advise or tips for them"

If they're insurance is employer-funded, it's up to the employer whether they want the insurance to cover it or not. Has your daughter/SIL asked the employer about it at all? They may add an invitro 'rider' to the policy, but it's really up to the employer in the end.

It seems like most of my claims get screwed up because they are put through electronically. At least this is the reason I get when I call to find out why I rcvd a bill from the doctor. Usually what happens is the claims adjuster looks it over, acknowledges an error and says it will be put through manually.

The insurance companies always put it off on the doctor/hospital as a "billing error". I've worked on both sides - insurance claims adjuster and now as a billing manager for a physician. I can tell you that 9 times out of 10, the insurance company LOSES the claim, or doesn't process them in a timely manner. It sometimes takes our office 6 months to be paid by the insurance company. After it's sent to the insurance company several times, and the doctor has waited 6 months to a year (depends on office policy) for payment - it's up to the patient to find out why it's not been paid. The reason being:

The insurance policy is a contract between you and your insurance company. If you get a claim from a doctor that you think your insurance should pay, ask the doctor's office to resubmit it - the insurance company probably lost it or is just WAY baglogged (usually the case). If a claim is paid incorrectly, however, you need to contact the insurance company directly because that is a dispute with your contract with them, not the doctor/hospital. Now, all that said, I personally will try for 6 months or so to get a claim paid at my office. If I submit it 3 or more times to the insurance company and there is no good reason for it not being paid - then I make it the patient's responsibility by sending them a bill. You'd be surprised how quickly someone will get on the phone and call their insurance when THEY are being billed for something the insurance should pay. And strangely enough, the claims get paid almost immediately by the insurance - once the patient calls. Interesting, huh?


And yes, if someone gets a bill they shouldn't, and doesn't question it - that's their fault. We all have to be aware of what we're paying for! We know that better than most here at AFC. :wink: