TheTrenchcoat Chronicles

Tag: health insurance

  • Trench’s Health Insurance Tips: Pre-Existing Condition

    Trench’s Health Insurance Tips: Pre-Existing Condition

    Today we’re going to discuss pre-existing conditions and how all health insurance companies are run by soulless scum sucking bastards who deserve to rot in hell.

    A pre-existing condition is defined as a recurring condition that you were treated for or diagnosed with 6 months prior to receiving health insurance coverage. That could be anything. It could be something manageable like diabetes or something life-threatening like AIDS or cancer. If you did not have continuous health insurance coverage at that time, the insurance companies will not pay for any treatment related to the condition for 12 months.

    Think about that for a second. You could have cancer and the insurance company would not pay for treatment for a year. A lot of people can’t afford to pay for that kind of treatment, so they might just forego getting treated until the waiting period is up.

    The insurance company is basically hoping that you’ll die before the waiting period expires. What’s worse is the law allows it. In North Carolina and other states, it’s REQUIRED. Why isn’t this practice considered discriminatory? Why isn’t this a violation of the Americans with Disabilities Act? How many people have died because of this? Which lawmakers and politicians have blood on their hands?

    And please feel free to post your pre-existing condition horror stories here. Let’s get the word out about this horrific practice.

  • Trench’s Health Insurance Tips: Diagnosis Coding

    Trench’s Health Insurance Tips: Diagnosis Coding

    Today’s healthcare pet peeve du jour is diagnoses and the coding of your medical claim.

    A lot of our patients come in just for a routine check-up, a cancer screening, or they have a family history of some disease. In all 3 of those cases, an office visit or procedure is considered “routine” because an actual disease has yet to be treated, and no other complaints have been presented. In some of those cases, health insurance companies do not cover routine services. So, let’s take a look at a little hypothetical situation, shall we?

    The patient comes to see the doctor for a cancer screening.

    The doctor uses the diagnosis code on the claim for cancer screening.

    Insurance company denies the claim because they do not cover routine procedures.

    The patient gets a statement from the insurance company saying they are not paying for the visit.

    Patient calls the insurance company to ask them why they didn’t pay.

    This part is important, so pay attention…The insurance company tells the patient that they do not cover routine procedures, but if your doctor had coded it as non-routine, then it would have been covered.

    What the patient hears is, “Your doctor coded it wrong.”

    The patient then calls me and wastes my time telling me that the doctor coded the claim wrong, and it needs to be recoded.

    Here’s where I bust the myth.

    The doctor did not code it wrong. In 99% of all cases, the doctor coded it correctly with the information provided from the patient.

    With the information that we have received from the patient, we can not recode the diagnosis as anything else in order to get the claim paid. That is known as INSURANCE FRAUD. I am not willing to go to jail just so you can get out of paying your bill. Health insurance is not an absolute. No matter how good your coverage is, you will eventually have to pay out-of-pocket. It’s inevitable.

    Do me and yourself a favor. Every year, you get a booklet from your employer that goes into great detail about your health insurance coverage. READ IT! LEARN IT! LIVE IT! And stop bothering me with your assclownic questions.

  • Trench’s Health Insurance Tips: Deductibles

    Trench’s Health Insurance Tips: Deductibles

    Here’s a little health insurance tip from me to you. It will make my life easier and make you look like less of an assclown.

    Say your health insurance policy has a $500 deductible. And say that you have a condition that requires you to see multiple practices (i.e. primary care, specialist, and hospital). This would require you to file 3 claims to your insurance company.

    Now say the hospital asked you to pay your $500 deductible up front and you do. The claims from all 3 practices get filed with the insurance company. However, the insurance company gets the specialist’s office’s claim first and takes out the $500 deductible from that claim, leaving you with a $500 balance at the specialist’s office.

    What’s that, you say? You shouldn’t have a specialist’s bill because you already paid your deductible to the hospital? Well, let me be the first to say, YOU STUPID ASSCLOWN!!!! Run up to the nearest wall and slam your head into it for being so stupid.

    Let it be known now, forever and throughout perpetuity that the insurance companies not only don’t know who you paid your deductible to, they don’t really care either. The insurance company will take out your deductible from whatever claim they receive first.

    Now that I’ve made you smarter, here’s what you can do if you paid one practice up front and the insurance company took out your deductible from a different claim. If you paid up front to one practice and the deductible was applied to another, you should have a credit at the practice you paid up front.

    DO NOT call the insurance company about it. DO NOT call the practice that is billing you for the deductible. Neither of those places can do anything about it. DO call the practice or facility that you have a credit with. They are not going to call you.

    After you pay a practice up front, it becomes your responsibility to get any credit back. Also, the practice that you have a balance with is not going to wait around for you to collect your credit. They will keep billing you and possibly send you to collections unless they receive payment. They are well within their rights to do so.

    Any questions? I didn’t think so.