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Thread: Insurance woes

  1. #1
    Distinguished Community Member
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    Jan 2007
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    Default Insurance woes

    I am on medicaid and my doc runs a U/A every month - I am fine with this it protects us both. Evidently she or someone ordered the Spectro test the one that costs $500. Dollars and my insurance plan is refusing to pay. I have always used the little instant read cups that show right away ( I have always been neg except for what is supposed to be there. what gives? I take my meds as prescribed, My doc. trusts me... what gives? can my insurance co. drop me (medicaid - I am on a HMO - here in arizona it is achess ) What can I do?
    I am worried and scared
    Blessings
    Alex.

  2. #2

    Default

    Dear Alex 44....
    Why would you think your insurance would drop you....because the test was asked for...not for that reason...Periodically the Doctor may have to do other tests...it is goofy...Did you ask the Doctor and tell them what insurance you were on won't cover it...?...

    If you passed your tests...you aren't going to be dropped...and tell the place where you got tested that your insurance didn't cover it...you have no money and you can pay them $10.00 a month...I had an MRI once when I had no insurance and paid them that amount every month...it took years for me to pay...and then...they let some of it go...You can't pay what you don't have...but I would be sure to let my doctor know that your insurance didn't cover it...They may be able to make it be covered by writing the prescription different....who knows...

    That is the bad thing about the government having your insurance control...You live in fear...of their whims...it is stress...stress....stress...

    Call the Doctor....and explain...call the billing place and explain...and then do what you can...and don't worry about the rest...do your best...and let go of the rest....

    Love To All Beings....

  3. #3
    Community Member
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    Pa.
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    Default

    Alex44,
    The ins. co. can't just drop you. They have a contract with Medicare to supply you with coverage. I would talk to your doctor about this test and why she needed it now . If the doctor says it was medically necessary, you should be able to argue the ins. co. about paying it. Try not to worry about it, I know it's hard to do, but fight the ins. co. if necessary, they will probably back down.

  4. #4
    Distinguished Community Member
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    Oct 2006
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    S. Indiana
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    Default

    Alex, sorry to hear about this new hassle as it seems like if it isn't one hurdle to clear its another. There should be a patient advocate with medicaid you can contact to help with your case. If not, it is another reason I don't want the single payer health care plan so many uniformed people seem to want. When my private insurance denied my thoracic fusion I could turn to an attorney and my state insurance commission to force the company to cover this necessary surgery they were claiming was an optional surgery. I don't know if your state insurance commission can do anything for you but it could be worth a try. I am afraid that with private insurance we have alternatives to turn to but with gov't health care they are the final arbitrator. I hope you find that some options are open for you. Don't worry about being dropped by Medicaid as they can't drop you from their coverage as far as I know.
    1979 spinal issues, 1993 lumbar microdisectomy L3-4, 1996 360 3 level lumbar fusion L2-5, 1999 open thoractomy fusion T8-9,
    2002 C3-7 herniations and T4-7 herniations, 2004 total disability, a new limited life

  5. #5
    Distinguished Community Member Pharmacist.steve's Avatar
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    Nov 2006
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    Southern Indiana
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    Default

    There are companies out there that are pushing their tests to docs because they can provide some $$$ to the doc in some methodology. No matter how they do it... if the doc gets money for referring a specific testing from a company.. it is a ILLEGAL KICKBACK !. What is specific or special about this particular test? IMO... docs put too much faith in these urine tests... someone who is diverting the drug... will start taking the drug 24hr hours before going into the office and BINGO.. it shows up in the urine... they could be selling the balance on the street... and the doc is working under an illusion that the urine test is protecting them. I can guarantee you that every time they think that they have the process idiot proof... they come up with a better idiot ... Talk to a rep from the HMO and suggest that they questions the doc as to why he has went from an inexpensive test to one that is charging astronomical fees.
    Pharmacist Steve
    www.pharmaciststeve.com

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