Insurance coverage -- grrrrr!

[catwoman]

Last year United HealthCare certified QAS as being "in network" even though it wasn't, since no one else was in network for testing supplies.
That's not so this year.
UHC told me today that a company (not far from Cleveland OH) is in network this year.
I can stay with QAS -- if I want to pay a $500 deductible and 30% co-pay for supplies.
Or go with the in-network provider and pay only $200 deductible and only 10% co-pay.
I'm not really thrilled at having to change providers ...

 

[Karlynn]

Marcia, we no longer have UHC as of the 1st of Jan. But we had them for several years. I had the same problem last year. I can't recall the name of the company that is now "in network" but Lance told me that they buy their supplies from QAS!!!! The thing that disturbed me the most is that I wasn't able to talk to anyone at the company that really knew what the heck Protime testing supplies were. Not even the nurses in their medical department knew. I did not get a warm fuzzy feeling from that. I never was able to get them to give me a price for 25 cuvettes. They said they could once they found out what the deal was between UHC and them. I would hope that now they are a little more on top of things.

 

[catwoman]

Yeah, it's probably the same company. I hammered at them, saying I was sooo disappointed that I may have to change providers, that QAS had been absolutely wonderful and that I hoped they would be also. Dead silence on the other end.
When I called, the employee didn't have the slightest clue what I was asking about.
Duh.....

 

[Granbonny]

We have UHC (Delta Airlines)..and I ordered 25 cuvettes back in Dec..They paid the entire $300.00..when I called QAS..(They had charged me $60.00 on my Mastercard. They sent me a refund check last week.... 25 cuvettes should last me....6 months. I'm sure the next order, I will have to pay the 20%...Hoping I will not have met my deductable by June. Well, and I hope to stay that way. Bonnie

 

[Karlynn]

We have UHC (Delta Airlines)..and I ordered 25 cuvettes back in Dec..They paid the entire $300.00..when I called QAS..(They had charged me $60.00 on my Mastercard. They sent me a refund check last week.... 25 cuvettes should last me....6 months. I'm sure the next order, I will have to pay the 20%...Hoping I will not have met my deductable by June. Well, and I hope to stay that way. Bonnie

Bonny, based on my experience last year, I think you lucked out. I've found that, at UHC, the right hand has no idea what the left hand is doing. At the beginning of '04 they gave me a network gap exception number to order from QAS. Which I did. A month later they called to tell me that they weren't covering it because they had an in-network provider. Too late, it was a done deal. QAS came through and accepted my payment and called it a day.

Or it could be that Delta has a different package with UHC. I know the coverage can depend on the client company.

 

[Granbonny]

Karlynn

Karlynn

The only thing that UHC did not pay, was when my PCP ordered a Woman's appointment for me..last Sept. Pap smear, ect..I told him about it..and he said he would code it different next year... I see him every 6 months for checkup..Why? I have no idea other than he loves me? He was the on call doctor the night that I went to ER Xmas Day..3 years ago..He helped me for 3 months with my odd symptom's...and credits himself for helping me find my aneurysm. He just likes to see me..for b/p, ect. but I throw most of his scripts in thrash cans Like Statin drugs, ect.... B/T/W since my pap smear came back negative. he told me we could skip a year....2nd one in a row....Don't know if I should do this or not..but, my Mom never had a pap smear in her entire life. died at age 83...with just a weak heart... UHC pays full for my coumadin and my hubby's b/P pills (and they are expensive)His pills.. They paid for my Protime with NO questions asked 3 months after my surgery....Also, we do not pay anything for insurance. Delta covers it...Bonnie

 

[geebee]

I sure understand the frustration. I have been fighting with UHC since June over an ER visit in May. They are treating the charges for a doctor to read a lung scan and xrays as an "outpatient" service and applied my deductible to it and only covered 80% after the deductible. So, instead of having to pay only my $100 copay for the ER visit, they are saying I have to pay $539. It looks like I am going to lose this fight but I have not yet given up. How they could think I was an outpatient when I never left the ER is beyond me.
I now have Anthem PPO and they have been great so far. They are covering my INRatio monitor, supplies, etc. with absolutely no hassles.
Oh well, I guess $539 is not too much to pay to make sure there was nothing seriously wrong.

 

[catwoman]

My UHC policy may not be the same as someone else's, because the employer negotiates w/ the insurance company on how to handle things

As requested by Edgepark yesterday, I called back today (1/27) to give information for setting up an account. The CS employee today did not understand anything I was talking about -- thought I was talking about diabetic testing supplies -- nor did her supervisor (failed to get their names, darnit!). Supervisor said just because the company carries DME doesn't mean it carries all equipment.

After this, I yanked the chains @ UHC. The UHC care coordinator rep did a 3-way conference call with the CS manager, and I'll be dealing with only the CS manager from now on. The UHC rep has already taken care of all paperwork, setting up account for me w/ Edgepark.
UHC also oversees my flex spending account, so I guess that helps, too.

I really, really wish QAS was in network with UHC.
I don't like dealing with yo-yo's.

 

[Guest]

I don't like dealing with yo-yo's.

*bursts out laughing*

I know, my dear, that this is a very sore and serious subject for you...and I was right along with you in that serious mind set until I read this last line. I really did burst out laughing. I do apologize....

*sighs*

Perhaps that's the point of my post...humor. With all that we all have to deal with day in and day out, humor is certainly the best medicine (errrr...that is, unless you have a significant other ). Hmm...traveling (in my case, anyway) is also great medicine .

I am sorry to hear of all the leaps and bounds and bending over backwards you are having to do for this insurance "crap".... I know how you feel though, perhaps not in the same way, but similar.

I hope things work out for you.


Cort, "Mr MC" / "Mr Road Trip", 31swm/pig valve/pacemaker
'72/'6/'9/'81/'7, train/models = http://www.chevyasylum.com/cort/
MC Guide = http://www.chevyasylum.com/mcspotter/main.html

 

[Woody]

Last year United HealthCare certified QAS as being "in network" even though it wasn't, since no one else was in network for testing supplies.
That's not so this year.
UHC told me today that a company (not far from Cleveland OH) is in network this year.
I can stay with QAS -- if I want to pay a $500 deductible and 30% co-pay for supplies.
Or go with the in-network provider and pay only $200 deductible and only 10% co-pay.
I'm not really thrilled at having to change providers ...

Don't feel bad most other resellers that are in network for you, are buying through QAS they have a Corporate Contract with us. We would entertain any & all Insurance Groups for the same.