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0 pointstheGnuMe2y ago0 comments

Why didn't the insurer pay? Was it not covered? And what setting was it in, outpatient or ER? If ER then you should be able to dispute with your insurer to get it covered. If outpatient you might be able to negotiate with the Financial Services folks that they (the doctor) did not submit for pre-authorization appropriately per industry standards.

That's where you build your argument that they acted inappropriately and did not disclose prices (did they?). The next question is are you on a State plan or a corporate EIRSA plan? If State they you can file a complaint with the California department of insurance. If you have a corporate plan, which is likely self funded, then I would ask your HR to talk to your insurance rep. You might find things get retroactively covered at that point. Or you can talk to the news. They love to report on these things.

Stanford has pattern of inflated charges. Hearing tests in audiology for example are ridiculously overpriced without insurance and they don't pre-authorize. And most insurers don't cover hearing tests anyway. Stanford could fix this by not being greedy.

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dheera2y ago

> Why didn't the insurer pay? Was it not covered? And what setting was it in, outpatient or ER?

Outpatient. Routine preventative care, I have a heart condition so echocardiograms are done every 2-3 years as a preventative measure. Insurance plan claims 100% coverage of preventative care with no deductible or coinsurance. I tried to dispute with insurance but they insist that it wasn't preventative (it's my body, my health, I know better than them that it was preventative) and they consistently would put me on hold for VERY long times on the phone until 5pm and then say "whoops, we're closed"

> The next question is are you on a State plan or a corporate EIRSA plan?

Self-purchased out of marketplace plan (HealthNet). I was self-employed at the time.

> Or you can talk to the news. They love to report on these things.

I would absolutely love if someone can put me in touch with a contact.

theGnuMeOP2y ago

Look into https://www.dmhc.ca.gov/fileacomplaint.aspx

I imagine an expert from the DMHC can advise on your specific situation.

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