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Offline franksolich

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Skippy's got a problem
« on: July 09, 2014, 07:40:40 PM »
http://www.democraticunderground.com/114212920

Oh my.

Quote
NYC_SKP (59,626 posts)    Tue Jul 8, 2014, 10:25 PM

Can an "in network" hospital bring in "out of network" physicians who you then have to pay????

This has to do with ACA covered california Anthem Blue Cross PPO Silver plan.

Just went through two stays at Stanford for treatment of an aneurism and a second stay for infection of the site.
 
Stanford Hospital is in network, but I have lots of charges not covered by Anthem Blue Cross PPO.
 
It's hard as hell to get a straight answer from them, their website "explanation of benefits" buttons don't work on my computer and phone calls to live people aren't helping.
 
For a plan that I thought had $6,350 max out of pocket, I'm learning now that this max only applies to "in network" and there's a different out of pocket for "out of network" that in my case is $10,000.
 
This seems different from what I thought I was signing up for, which was a $6,350 max annual.
 
Not it's looking like $16,350, if not more.

Please help if you can.

<<<can't help; Skippy'll have to help himself, as he voted for it.

Quote
Warpy (77,324 posts)    Tue Jul 8, 2014, 10:52 PM

7. If there was no "in network" physician at that hospital who was there and able to handle your case

(and I suspect that is the case), then you are going to have to fight them. And fight them you must. If they can't supply a doc capable of handling your problems from their "stable," it's up to them to provide and pay for a doctor who can handle them.
 
If yelling long and loud (now that you're better) won't do it, your payment plan will be five bucks a month.
 
I'm glad you're still with us, no matter how BC/BS tries to **** you over.

Quote
NYC_SKP (59,626 posts)    Tue Jul 8, 2014, 11:04 PM

9. Thanks, Warpy!

I still believe in ACA, and in one's individual responsibility to participate, but the devil's in the details.
 
Also, some problems in the roll-out, maybe. I hope I have a good case.

We'll see.
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Offline Maxiest

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Re: Skippy's got a problem
« Reply #1 on: July 09, 2014, 08:28:49 PM »
NOTHING IS FREE YOU ****ING IDIOTS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
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Offline fatboy

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Re: Skippy's got a problem
« Reply #2 on: July 09, 2014, 08:45:05 PM »
suck it up Buttercup
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Offline Tess Anderson

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Re: Skippy's got a problem
« Reply #3 on: July 09, 2014, 08:52:28 PM »
don't listen to her, Skippy:

Quote
Non-preferred providers (applies to PPO plans): Providers who have not contracted with Blue Shield (or Blue Shield Life as applicable) to be part of our preferred provider network. Non-preferred providers often charge members more than Blue Shield allowable amounts. You are responsible for the difference between the amount the non-preferred provider bills and any amount that Blue Shield pays. Some PPO plan benefits, such as certain preventive care and office visits, are not covered when accessed from these providers.

https://www.blueshieldca.com/bsca/find-a-plan/understanding-insurance/glossary.sp

the old bat should really be cleaning up all the rodent dropping in her house
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Offline fatboy

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Re: Skippy's got a problem
« Reply #4 on: July 09, 2014, 09:12:20 PM »
Skippy, all is well, the pittster has entered the discussion:
Quote
Response to NYC_SKP (Original post)

Wed Jul 9, 2014, 11:39 AM

 WilliamPitt (56,970 posts)

32. This sounds eerily familiar.

"It's hard as hell to get a straight answer from them, their website 'explanation of benefits' buttons don't work on my computer and phone calls to live people aren't helping."
 
I'm sorry for your troubles. Good luck. If my experience is any metric, you're going to need it*.

*good luck and plenty of cheap scotch.


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Offline USA4ME

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Re: Skippy's got a problem
« Reply #5 on: July 09, 2014, 09:37:55 PM »
Quote from:
Warpy

If they can't supply a doc capable of handling your problems from their "stable," it's up to them to provide and pay for a doctor who can handle them.

 :rotf:

Yeah, that'll work.

Just stick to being ugly, Von Hindenburg primitive.

.
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Offline Gina

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Re: Skippy's got a problem
« Reply #6 on: July 09, 2014, 09:51:42 PM »
Holy deductible!!  Now it makes sense when I hear people say he is worth more dead than alive. 

Here Skippy, go tell your story.
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Offline Gina

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Re: Skippy's got a problem
« Reply #7 on: July 09, 2014, 09:57:11 PM »
Quote
Warpy (77,324 posts)    Tue Jul 8, 2014, 10:52 PM

 
If yelling long and loud (now that you're better) won't do it, your payment plan will be five bucks a month.
 
I'm glad you're still with us, no matter how BC/BS tries to **** you over.

I'm so sick of these lowlifes.  They think everything is owed to them. :argh:
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Offline thundley4

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Re: Skippy's got a problem
« Reply #8 on: July 09, 2014, 10:18:09 PM »
Quote from: Gina on July 09, 2014, 09:57:11 PM
I'm so sick of these lowlifes.  They think everything is owed to them. :argh:

They got ObamaCare like they wanted, now they should just STFU.
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Offline Maxiest

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Re: Skippy's got a problem
« Reply #9 on: July 09, 2014, 10:19:38 PM »
Quote from: thundley4 on July 09, 2014, 10:18:09 PM
They got ObamaCare like they wanted, now they should just STFU.

No it's all just paving the way for single payer. 
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Offline thundley4

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Re: Skippy's got a problem
« Reply #10 on: July 09, 2014, 10:24:36 PM »
Quote from: Maxiest on July 09, 2014, 10:19:38 PM
No it's all just paving the way for single payer.

I would think that the VA problems would make any sane and rational  person rethink single payer.  Never mind.
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Offline Carl

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Re: Skippy's got a problem
« Reply #11 on: July 09, 2014, 10:34:53 PM »
Quote
Warpy (77,324 posts)    Tue Jul 8, 2014, 10:52 PM

7. If there was no "in network" physician at that hospital who was there and able to handle your case

(and I suspect that is the case), then you are going to have to fight them. And fight them you must. If they can't supply a doc capable of handling your problems from their "stable," it's up to them to provide and pay for a doctor who can handle them.
 
If yelling long and loud (now that you're better) won't do it, your payment plan will be five bucks a month.
 
I'm glad you're still with us, no matter how BC/BS tries to **** you over.

Uhm no,and you are stupider then rock moss.
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Offline GOBUCKS

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Re: Skippy's got a problem
« Reply #12 on: July 09, 2014, 11:40:00 PM »
Skippy's just working a storyline here, of course the whole thing is just a bouncy tale.

But it's great to hear a story about a DUmmy in distress with democrat insurance.

This is almost as good as the lezbo DUmmy Aerows and her eighteen-thousand-dollar coon bite.
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Offline SVPete

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Re: Skippy's got a problem
« Reply #13 on: July 10, 2014, 12:12:25 AM »
Stooooopid question ... how could some one who has been employed and had a health plan any time in the past 3 or 4 decades not know that they have to make sure doctors and specialists to who they have been referred are in-network? How did this DU-type avoid learning that?! Has this character been living off relatives or off taxpayers all his life?!
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Offline 98ZJUSMC

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Re: Skippy's got a problem
« Reply #14 on: July 10, 2014, 04:37:20 AM »
Quote from: thundley4 on July 09, 2014, 10:24:36 PM
I would think that the VA problems would make any sane and rational  person rethink single payer. 

Oh, no.  Once we get the ...."right"....people in charge, it will succeed.

Next time.

Quote
Never mind.

Yep.  :cheersmate:
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Offline franksolich

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Re: Skippy's got a problem
« Reply #15 on: July 10, 2014, 05:05:46 AM »
Quote from: SVPete on July 10, 2014, 12:12:25 AM
Stooooopid question ... how could some one who has been employed and had a health plan any time in the past 3 or 4 decades not know that they have to make sure doctors and specialists to who they have been referred are in-network? How did this DU-type avoid learning that?! Has this character been living off relatives or off taxpayers all his life?!

Actually, Skippy is one of the first primitives who should've been able to decipher the intricacies of something for which he advocated.

As an alum of one of the premier engineering and architecture colleges in America--and on a full-ride scholarship, he's ostensibly that bright--Skippy should've had the whole thing down pat and understood even before the ink was dry on the congressional bill.
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apres moi, le deluge

Milo Yiannopoulos "It has been obvious since 2016 that Trump carries an anointing of some kind. My American friends, are you so blind to reason, and deaf to Heaven? Can he do all this, and cannot get a crown? This man is your King. Coronate him, and watch every devil shriek, and every demon howl."

Offline fatboy

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Re: Skippy's got a problem
« Reply #16 on: July 10, 2014, 07:21:20 AM »
Skippy needs a shout out to Amber. LFR manages a whole team of dedicated healthcare professionals, working in sync to provide her with a full range of mental health, medical treatment and social services with NO OUT OF POCKET COST!
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Offline Maxiest

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Re: Skippy's got a problem
« Reply #17 on: July 10, 2014, 08:04:58 AM »
Quote from: thundley4 on July 09, 2014, 10:24:36 PM
I would think that the VA problems would make any sane and rational  person rethink single payer.  Never mind.

Yeah,  I was actually thinking about this the other day.  If you went onto the street in premonitory Obama voter areas and asked about Benghazi, the IRS scandals, and the VA scandals I bet you would get blank stares.   The message quit honestly in the next election for conservative voters and needs to be something to the effect of "Get of the damn couch and vote" and "How is Romeny looking now, you ****tards?"
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Offline franksolich

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Re: Skippy's got a problem
« Reply #18 on: July 10, 2014, 08:13:11 AM »
Quote from: GOBUCKS on July 09, 2014, 11:40:00 PM
.....it's great to hear a story about a DUmmy in distress with democrat insurance.

He's a desk-sitting governmental employee.....and in California, where they're really generous in recompensing their public servants.

He's got not only what's now (it didn't used to be) considered sterling medical insurance, but he makes good bucks; lots more than his counterparts in similar jobs in private enterprise, and he doesn't have to work as hard as they do, either.

Unless Skippy's been living like he makes a million bucks a year, he should be in clover.

I don't believe for a minute that the parts not covered by his insurance, represent more than a petty-cash expense to him.
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apres moi, le deluge

Milo Yiannopoulos "It has been obvious since 2016 that Trump carries an anointing of some kind. My American friends, are you so blind to reason, and deaf to Heaven? Can he do all this, and cannot get a crown? This man is your King. Coronate him, and watch every devil shriek, and every demon howl."

Offline franksolich

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Re: Skippy's got a problem
« Reply #19 on: July 10, 2014, 02:17:36 PM »
Quote from: fatboy on July 10, 2014, 07:21:20 AM
Skippy needs a shout out to Amber. LFR manages a whole team of dedicated healthcare professionals, working in sync to provide her with a full range of mental health, medical treatment and social services with NO OUT OF POCKET COST!

You know, sir, I just checked something; medical insurance policies the taxpayers in red states give to state governmental employees.

A "family plan" is $162 every two weeks--that's for the whole bunch, not just oneself--with a $250 deductible. 

I've been told it "sucks," when compared with what one had during the lousy George Bush economy, but when compared with today's Obama's America, it's top of the line, the best one can possibly get.

What the Hell are they doing out in California?
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apres moi, le deluge

Milo Yiannopoulos "It has been obvious since 2016 that Trump carries an anointing of some kind. My American friends, are you so blind to reason, and deaf to Heaven? Can he do all this, and cannot get a crown? This man is your King. Coronate him, and watch every devil shriek, and every demon howl."

Offline fatboy

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Re: Skippy's got a problem
« Reply #20 on: July 10, 2014, 03:49:46 PM »
Skippy takes a time out from administering his IV antibiotic to respond back to the Bostonian Drunkard:

Quote
Response to WilliamPitt (Reply #32)
Wed Jul 9, 2014, 03:29 PM
 NYC_SKP (59,639 posts)
36. Thanks! Fortunately, the CoveredCalifornia representative was very kind and helpful!

She acknowledged that they get a lot of this and explained the different steps I should take.

She directed me to the Department of Managed Health Care, and they were also super helpful and will initiate an investigation in 30 days, first I have to file a grievance with Anthem.

So, as ever, the Insurance Companies are the bad players in this, though I'm not thrilled with Stanford for letting "out of network" doctors anywhere near me.

So as this thread develops, we see a difference of opinion between the pittster and skippy as far as attitude is concerned. Both agree though that the problem is the insurance industry and the providers. The government in the form of CoveredCalifornia is lovely and will get right on the case in 30 days.
« Last Edit: July 10, 2014, 03:51:50 PM by fatboy »
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Offline Gina

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Re: Skippy's got a problem
« Reply #21 on: July 10, 2014, 03:53:00 PM »
Quote from: fatboy on July 10, 2014, 03:49:46 PM
Skippy takes a time out from administering his IV antibiotic to respond back to the Bostonian Drunkard:

So as this thread develops, we see a difference of opinion between the pittster and skippy as far as attitude is concerned. Both agree though that the problem is the insurance industry and the providers. The government in the form of CoveredCalifornia is lovely and will get right on the case in 30 days.

Right but they are more than willing to stiff the doctor and screw him over. 
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Offline whiffleball

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Re: Skippy's got a problem
« Reply #22 on: July 10, 2014, 04:10:57 PM »
The most 'informed people on the Internets' do not know the basics of insurance.  They can't be bothered to educate themselves on the most fundamental aspects of insurance. 
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Offline GOBUCKS

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Re: Skippy's got a problem
« Reply #23 on: July 10, 2014, 04:14:33 PM »
If this bouncy were true, which of course it's not, Skippy's credit rating would get bludgeoned at each step in the long and ultimately futile process.

In the end, he'd still be whining at bureaucrats, and sending his plight to Rachel, while being harassed by by collection agencies day and night.
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