Doctors visits and medicine ugh!!!!!

**emandmeagsmom** · 05-12-2006, 11:35 AM

I have to vent about insurance companies. My children have insurance with their father's wife insurance company. There was a dispute between the insurance company and our biggest hospital several years ago and this company does not like to pay insurance claims from subscribers with this hospital and doctors. I took my daughter twice to the er last year and we are having to pay the entire amount since they are not paying anything. Last Tuesday, I took my youngest daughter to the doctor and filed it on that insurance. THey informed me that there is a 300. balance for 1 year that they are not paying the charges. I think that is just awful. I am going to have to pay on that also. Had to get medicine for her and the copays were awful. Zithromax was 35.00. The price without insurance was 39.50 and we paid 35.00. Not much of a deal. A steroid was 20.00 without insurance and my copay on it was 18.00 and the last was 5.00. Better. I talked to my ex husband about it and they are going to call the insurance company about everything.
My health insurance will go into effect on June 1 and I have added them to my coverage and my ex husband is going to send me the difference from adding them on my ins. and what it would cost to just cover me. This insurance is going to be so much better. It will pay for a lot and the medicine will be a lot cheaper. Just had to vent.

**Darlene** · 05-12-2006, 11:39 AM

How frustrating. Hope everyone stays healthy & out of the docs offices.

**FreesiaE** · 05-12-2006, 12:59 PM

It is frustrating and actually I spoke with a friend a few weeks ago who works in the business. I was told that a big reason prices are so high is over utilization of services. I know I have at least one in my immediate family like this--every little cold, stuffy ears, sneeze, etc and she goes to the doctor.

**littlemotherhaywood** · 05-12-2006, 01:30 PM

That's awful. I'm glad that you're going to switch insurances for them and that your ex is going to help pay the difference.

**emandmeagsmom** · 05-12-2006, 01:38 PM

He is actually coming out easy on this as I am just wanting him to pay the difference on the medical. I will take care of the dental all myself. He said he could take them to his brother in law and all he would charge would be what the insurance pays but he doesn't handle braces and I know my oldest daughter is going to have to have braces in a few months and my insurance pays 50% for braces so it is going to be worth paying the 20.00 for dental insurance.

**frugalnana** · 05-13-2006, 03:16 PM

Most insurance companies go buy what is the usual and customary amount. So if the bill is $150 and the customary is $65 then they pay the percentage based on that amount. Some insurances will have the doctor write off the rest. Some won't and you will be charged for it. I had to go through this with my ex for our sons and it was a pain. Some insurances also have a tier plan for medications now also. So if your brand can not be generic then the highest tier may be $40, then $30 on down to $10 based on how long the drug has been out.
I have taken Allegra D for about 5 years now. When I quit work I was put on dhs plan and I just went to get my meds refilled, Cigna would not pay for it, they said it the Allerga was still in testing. I had a cow. The doctors office argued with them for about a week, then finally gave up, they gave me samples from the office. I can't take clariten or Zyrtec, they make me sick to my stomach. So when I have to get the prescription I will have to pay the full amount.
I hope your doctors office is understanding, I would also ask them if they would give you some type of discount. The hospitals here offer a discount if you meet a certain wage requirement. Plus they will still let you set up a payment plan.
Good luck.