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health insurance snafu - advice?
Posted by: mattkime
Date: May 25, 2017 12:23PM
as part of moving i had to transfer to a different doctor to get allergy shots. the injection material needed to be transferred from one doctor to another, via fedex. The office sending the material chose to provide my credit cart to fedex to pay for the service. no, i don't know why. yes, its weird.

Should the transfer of the allergens been covered by my insurance? if so, how do i go about submitting a claim to my insurance company?

fwiw, my allergy shots have been fully covered. i'm not entirely sure if thats true but i don't remember paying anything.

I figure its worth a try.







Edited 1 time(s). Last edit at 05/25/2017 12:38PM by mattkime.
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Re: health insurance snafu - advice?
Posted by: GGD
Date: May 25, 2017 12:51PM
"Should the transfer of the allergens been covered by my insurance? if so, how do i go about submitting a claim to my insurance company? "

Seems like good questions to ask your insurance company, their phone number is probably on your insurance card.

Is the "cost" that you're referring to just the FedEx charge? How much money are we talking abut here?
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Re: health insurance snafu - advice?
Posted by: mattkime
Date: May 25, 2017 12:55PM
>Seems like good questions to ask your insurance company, their phone number is probably on your insurance card.

I tried that, and the answer I got was "Sir, you have an EPO, you can't submit a claim for anything" ....which doesn't make sense to me.

It cost about $80.



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Re: health insurance snafu - advice?
Posted by: TLB
Date: May 25, 2017 01:11PM
As a layman, with a transfer, I would expect both physicians would be in network so the transfer should have been an in network expense and billed to the EPO. However, the insurance rep is also correct. There are generally no allowances for anything out of network, so there is no claim process. Everything out of network is on your dime.
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Re: health insurance snafu - advice?
Posted by: FormerlySaleenl
Date: May 25, 2017 01:11PM
I would be surprised if your insurance covered it. When I moved, my allergist recommended that I hand-carry my serum to my new doctor to save on the cost of shipping. And I had really good insurance through a university.
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Re: health insurance snafu - advice?
Posted by: mattkime
Date: May 25, 2017 01:21PM
>>There are generally no allowances for anything out of network, so there is no claim process.

So its possible for two in network doctors to coordinate in such a way such that the transaction itself is out of network?

....and i find it odd that it follows that there's no claim process since its all in network. what happens if an in network doctor charges a patient instead of the insurance company? surely this must happen on occasion.

---

one of the things the person on the phone said was that i should have contacted my insurance company before transferring the allergens. that was already after i talked to two doctors. how many people do you need to talk to do something so goddamn simple?



Edited 2 time(s). Last edit at 05/25/2017 01:24PM by mattkime.
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Re: health insurance snafu - advice?
Posted by: Robert M
Date: May 25, 2017 01:27PM
Matt,

Maybe I'm missing something here. You have to have the allergens shipped form your old doctor in Ny to your new doctor? That doesn't make sense to me. Wouldn't your new allergist have access to the same tools/equipment/products/etc as your old one?If not the same, then equivalents from whatever brands/vendors/etc he/she uses? I wouldn't think I'd have to have this stuff shipped from one doctor to another.

Robert
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Re: health insurance snafu - advice?
Posted by: GGD
Date: May 25, 2017 01:45PM
If the entire charge being discussed is a FedEx charge that was made to your credit card without your knowledge, then I suppose you could try disputing the charge with your credit card company. But there will probably be some blowback to deal with from FedEx and the NY doctor as a result, and I personally wouldn't attempt this.
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Re: health insurance snafu - advice?
Posted by: mattkime
Date: May 25, 2017 02:23PM
Both doctors expected the shot material would be transfered. The allergens are mixed together by a lab that likely specializes in such things.

At this point, I suspect the process of transferring allergens is somehow 'weird' by insurance standards and its allowed to fall through the cracks.

Quote
Robert M
You have to have the allergens shipped form your old doctor in Ny to your new doctor? That doesn't make sense to me.



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Re: health insurance snafu - advice?
Posted by: Robert M
Date: May 25, 2017 02:31PM
Matt,

The allergens are likely produced by a special lab. But, your local allergist should have a lab/vendor/etc that produces the allergens for him/her.

No doubt the allergens can be produced to suit your specific needs. Or, there are certain dosages that are commonly used and produced and your allergist puts together the shots for you accordingly. That's why I don't understand why your NY doctor needed to send the products to your new doctor.

The new allergist should have the appropriate records so he/she can have the allergens produced for you. Or, use the correct doses from his/her stock of them. This would make shipping allergens from one doctor to the other unnecessary.

Like I said... something just doesn't make sense to me.

Am I correct in assuming you had your records transferred from your old doctor to the new one? If not, then you definitely need to get this done ASAP.

Robert
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Re: health insurance snafu - advice?
Posted by: mattkime
Date: May 25, 2017 02:36PM
I think the thing that was missing was some sort of 'coordination of care' guidelines. I spoke to several people about this several times and

a) my situation wasn't seen as unusual
b) nobody really knew how to handle it.

if someone would have told me "don't worry about the old stuff, just transfer your records and get new stuff made" then fine, done, easy. But it seems that everyone muddled through the process.

Imagine that....such a problem happening in our grand healthcare system.



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Re: health insurance snafu - advice?
Posted by: AllGold
Date: May 25, 2017 02:36PM
Quote
mattkime
what happens if an in network doctor charges a patient instead of the insurance company? surely this must happen on occasion.

If the doctor wants to get paid he or she will have to correct the mistake.



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Re: health insurance snafu - advice?
Posted by: Robert M
Date: May 25, 2017 02:46PM
Matt,

Unless I'm reading your post incorrectly, there definitely seems like there is something missing in the way you've described the whole scenario. Are you giving us the whole picture or just what happened after the snafu?

Did you ask both your old _and_ new doctor as well as your insurance provider how to handle the shots and allergens prior to the move? If the guidelines weren't clear, then you needed to keep after all of them until you got a clear course of action. It's definitely on the patient. I'd love to say it's on the doctors and insurance provider but experience has taught me otherwise.

Robert
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Re: health insurance snafu - advice?
Posted by: Racer X
Date: May 25, 2017 02:47PM
Your Dr's office gave out your CC#? I'd be screaming if I were you.
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Re: health insurance snafu - advice?
Posted by: mattkime
Date: May 25, 2017 02:51PM
>Did you ask both your old _and_ new doctor as well as your insurance provider how to handle the shots and allergens prior to the move?

I spoke to _both_ doctors, I did not contact insurance to verify the plan.
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Re: health insurance snafu - advice?
Posted by: max
Date: May 25, 2017 03:56PM
Even if both doctors are in the plan, Fedex is not....
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Re: health insurance snafu - advice?
Posted by: GuyGene
Date: May 25, 2017 06:19PM
Quote
Racer X
Your Dr's office gave out your CC#? I'd be screaming if I were you.

agree smiley That's what bothers me in this story.



That old man - he don't think like no old man...
Now I wouldn't want to be within 400 - 500 yards of one of them nuclear bombs when it goes off! WW1 Vet Old Man
"He's pinned under an outcropping of rock. Lucky for him, the rock kept the dirt from burying him alive."
If idiots could fly, this place would be an airport. And I'd be a TSA agent.
A bonified member of The Mystic Knights of The Sea, George P. Stevens, President. Andy Brown, Treasurer, Algonquin J. Calhoun, Legal Consultant.
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Re: health insurance snafu - advice?
Posted by: mattkime
Date: May 25, 2017 09:09PM
I might call the previous doctor to ask why it was done like this.



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Re: health insurance snafu - advice?
Posted by: Racer X
Date: May 25, 2017 09:15PM
You should. Medical professionals, and the insurance industry have very firm laws against divulging personal info, and that includes banking info. HIPAA.
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Re: health insurance snafu - advice?
Posted by: August West
Date: May 26, 2017 06:23PM
Robert,

As far as new medicine in a new location, I suspect matt's issue might involve having a specialty medicine prescribed twice. IOW, If the insurance company pays for it every thirty days, and you desire a new prescription after 14 days, be ready to pay for it yourself.



Apologies to the anonymous forum member affected by my previous sig pic. It was my personal pic of a country expressing great grief as their leader, one of the most recognized people in the world, lay on his deathbed 8 years ago, days before he died. Like a naif, I did not realize it was offensively political, I considered it an expression of deep emotion and a reminder of the mortal coil's nature; that we all, great and small, can only hope to make a difference in our short time here, no matter the personal cost.

I'll post another pic from my work in South Africa that is, hopefully, apolitical.

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Re: health insurance snafu - advice?
Posted by: Robert M
Date: May 26, 2017 06:40PM
August,

Could be. Matt hasn't been forthcoming with that kind of information, though.

Robert
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Re: health insurance snafu - advice?
Posted by: mattkime
Date: May 26, 2017 09:31PM
New vials are mixed about once a year. I'm not sure about the refill policy as it hasn't been of concern until now.



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