So you have insurance but it doesn't cover stuff when you are actually ill? Does your insurance policy actually spell stuff out so that you can predict what will or won't be covered?
Note: I'm from the UK and find the stories about US healthcare insurance grimly fascinating....
Not just health insurance, but healthcare is crazy too.
Spent a total of 36 hours on the phone with the hospital to figure out how much something would cost because I knew I had to pay out of pocket. And they weren't even right when they finally gave me a number.
Had a doctor remove a cotton ball from my ear in the hallway. Charged me 2.4k for that. Didn't have insurance either.
My wife's friend delivered her own baby in the hallway and they still sent her a bill for delivery.
My wife had her gall bladder removed, supposedly the most common surgery. Surgeon charged 25k, hospital charged 65k, anesthesiologist charged 3k, and a doctor that talked to her for 25 seconds charged 1.5k. Insurance and the hospital argued over the bill for almost a year, during which time the hospital kept sending me payment due notices.
I'm currently fighting insurance because they won't cover a GI tract test without "proof" from another test first.
OK that's understandable. You don't want random people asking for tests all the time, but the Dr already saw me, and gave me meds to fix the issue that would give the insurance company "proof." There's just new complications now.
So I get to wait until everything comes back in full force. Last time I couldn't work for a few weeks, but hey at least they're saving a few hundred at most now....
This is still a better experience than the issues I had with my jaw. The jaw issues are the only pain in my life that was bad enough I blacked out twice from it. But insurance won't cover that because they think it's a dental issue, dental won't cover it because it's the jaw.
The only treatment for the jaw I got was because a jaw specialist lied on the insurance papers. He said he wrote down headpains, not jaw issues. He said he learned that telling insurance companies the truth is not what gets them to cover their clients.
/sidenote
that jaw pain is second to none. It runs circles around any migraines (the dark room, no sound kind) I've ever had. Never knew there was such pain before.
On the phone in advance, was given some hint of what could go wrong.
Basically, it depends on how the provider "codes" the treatment. You can contest the code, i.e. say you should have been billed for something other than what they are calling it. There is apparently a very wide range of things similar visits could be coded as.
Note: I'm from the UK and find the stories about US healthcare insurance grimly fascinating....