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What's the point? - Larsson Log — LiveJournal
grain of salt not included...
What's the point?
When I started working for drewuniversity I decided to do the buy up health plan, thinking it would be a good idea. I wouldn't need a primary doctor and all that, which was good for me because I hate doctors.

Now, I've only used, or attempted to use, the coverage once. This was for an emergency room visit when I managed to get a large cut in my head and had to get stitches. Clearly, an emergency. UHC doesn't agree. They just sent me an "explanation of benefits" which classified my emergency room visit as "out of network surgery." and since I didn't notify them in advance, they were only going to cover a percentage. That amount, conveniently for them, falls under the deductible for out-of-network non-emergency care. Therefore, they decided that I should pay the entire $300 bill. Reading the description of my coverage, I should have only to pay the $50 copay for an emergency room visit, in-network, or out-of-network, and no notification requirement is listed for emergency visits (obviously, unless they were to insist that I only have emergencies when their offices were open.)

First of all, since when are stitches for a head injury considered elective surgery? and how the hell can they consider this non-emergency care?

I guess I'll call them on Monday, but there's no a chance in hell I'm going to pay the $300. Hopefuly, they'll just agree that they made a mistake. Failing an appeal to UHC, I suppose I should take it up with Drew, since they are providing the benefit, and are ultimately responsible for honoring it, even if they contract the administration of it to someone else...

Current Mood: pissed off pissed off

1 comment or Leave a comment
nemo_wistar From: nemo_wistar Date: December 7th, 2003 09:02 am (UTC) (Link)
They, like most other insurance companies, will give you a hard tim eand hope you just pay the bill to avoid having to deal with them.

I never give them the satisfacton, and question *every* bill that comes my way. You never know.

In doing this, I've saved myself from having to pay some bills in the past.
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