Hello!
This is going to be a complicated one, I think, so please bear with me. I’m just looking at what to expect as I try to fix all these. We’re based in NYC.
So backstory: my husband, whose job we get our insurance through, has switched jobs twice in the last year. That means we’re on our third insurance in the last year. Our first one, EmblemHeath/GHI, we had for about three years with no problems as he worked a New York City job — loved it and them. He then took a job with New York State, and we took on NYSHIP with United as our provider. Again, great insurance — I used it once for my primary doctor appointment earlier this year with no problems and filled one prescription under it. Our newest insurance, which kicked in this month, is Oxford Freedom through United — again, seems like a decent plan and I don’t think I have complaints on coverage yet.
So we ended up having to go to the ER for my husband last night, for a kidney stone. The ER accepts Oxford Freedom, so we should be on the hook for just a $300 copay. Annoying, but he was peeing blood/had bad pain after urgent care centers closed, so we didn’t want to wait until the morning. Kidney stones run in his family, with many having surgery immediately for them, so I didn’t want to mess with it.
The ER did not collect our copay while we were there. I thought that was weird, but it was 1 am and I didn’t argue. This morning I called Oxford to see if the hospital was indeed in network as I believed, just to prepare myself for a fatal mistake we may have made. They confirmed the hospital was in network. I also never received our ID cards from Oxford (we printed them before heading to the ER), and the representative realized our apartment number was missing from our address so that’s why we never got them in the mail. We’ll update with my husband’s job’s HR. They said we should expect a bill from the hospital.
So question 1: Could the no-copay collection be related to our address being wonky? I’ll ask a follow-up in a second.
So the hospital wrote my husband two prescriptions to help pass the stone — neither incredibly expensive. So I went to CVS to pick them up, asked if they needed our health insurance card, and they said no — because it seemingly processed under our EmblemHealth insurance, which we haven’t had (or so I thought) since November when my husband quit his job. I paid and left, and went home to research our old plan. To be honest, I wouldn’t have known what to say to the pharmacy, because she mentioned the insurance as I was typing in my debit card PIN.
Mind you, I last filled a prescription under our NYSHIP plan with no issues. My husband is notoriously bad at going to the doctor, and the only prescription he ever filled with EmblemHealth was his flu shot.
So it looks like his New York City job that he left in November never canceled his health insurance. I’m so grateful we didn’t have any weird double billing issues before this. He’s going to call Emblem today to get that fixed.
So question 2: Could our Oxford claims now be messed up because of Emblem somehow still being active?
And question 3: How do I stave off some double billing problems before they happen — I really don’t want to pay thousands for something that should, realistically, only cost us $300. I also know health insurance companies can be very annoying when dealing with this, so anything we should prepare to say/do?
Thank you!!
Edit: Our Emblem insurance may not actually be active, but somehow the pharmacy benefits are. I just realized Emblem *did* deny a claim we tried to do retroactively (my husband’s therapy), stating we didn’t have active insurance for it. He’s still calling today to be extra sure!
submitted by /u/rbratek
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Hello! This is going to be a complicated one, I think, so please bear with me. I’m just looking at what to expect as I try to fix all these. We’re based in NYC. So backstory: my husband, whose job we get our insurance through, has switched jobs twice in the last year. That means we’re on our third insurance in the last year. Our first one, EmblemHeath/GHI, we had for about three years with no problems as he worked a New York City job — loved it and them. He then took a job with New York State, and we took on NYSHIP with United as our provider. Again, great insurance — I used it once for my primary doctor appointment earlier this year with no problems and filled one prescription under it. Our newest insurance, which kicked in this month, is Oxford Freedom through United — again, seems like a decent plan and I don’t think I have complaints on coverage yet. So we ended up having to go to the ER for my husband last night, for a kidney stone. The ER accepts Oxford Freedom, so we should be on the hook for just a $300 copay. Annoying, but he was peeing blood/had bad pain after urgent care centers closed, so we didn’t want to wait until the morning. Kidney stones run in his family, with many having surgery immediately for them, so I didn’t want to mess with it. The ER did not collect our copay while we were there. I thought that was weird, but it was 1 am and I didn’t argue. This morning I called Oxford to see if the hospital was indeed in network as I believed, just to prepare myself for a fatal mistake we may have made. They confirmed the hospital was in network. I also never received our ID cards from Oxford (we printed them before heading to the ER), and the representative realized our apartment number was missing from our address so that’s why we never got them in the mail. We’ll update with my husband’s job’s HR. They said we should expect a bill from the hospital. So question 1: Could the no-copay collection be related to our address being wonky? I’ll ask a follow-up in a second. So the hospital wrote my husband two prescriptions to help pass the stone — neither incredibly expensive. So I went to CVS to pick them up, asked if they needed our health insurance card, and they said no — because it seemingly processed under our EmblemHealth insurance, which we haven’t had (or so I thought) since November when my husband quit his job. I paid and left, and went home to research our old plan. To be honest, I wouldn’t have known what to say to the pharmacy, because she mentioned the insurance as I was typing in my debit card PIN. Mind you, I last filled a prescription under our NYSHIP plan with no issues. My husband is notoriously bad at going to the doctor, and the only prescription he ever filled with EmblemHealth was his flu shot. So it looks like his New York City job that he left in November never canceled his health insurance. I’m so grateful we didn’t have any weird double billing issues before this. He’s going to call Emblem today to get that fixed. So question 2: Could our Oxford claims now be messed up because of Emblem somehow still being active? And question 3: How do I stave off some double billing problems before they happen — I really don’t want to pay thousands for something that should, realistically, only cost us $300. I also know health insurance companies can be very annoying when dealing with this, so anything we should prepare to say/do? Thank you!! Edit: Our Emblem insurance may not actually be active, but somehow the pharmacy benefits are. I just realized Emblem *did* deny a claim we tried to do retroactively (my husband’s therapy), stating we didn’t have active insurance for it. He’s still calling today to be extra sure!
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