Hey there folks. I’ve got a a bit of a weird situation so I’ll try my best to explain.
I reside in NY and I’m employed by a company based in PA. The insurance they offer is one called Geisinger. It’s supposed to be a pretty big insurance company in PA, but pretty much unheard of out of state. To cover for out-of-state aka out-of-network employees like me Geisinger partners with a third party called First Health Network
Here’s where things get a little weird:
I recently went to get an ultrasound at a radiology facility that’s in-network with First Health I found out later, after receiving a claim from Geisinger, that even though the radiology facility is in-network with First Health, it’s still considered out-of-network with Geisinger. Because of this, two things happened:
The total was $700something for the test itself (equipment and facility use ect) and Geisinger covered most of it. But I still owe $170 because the price was negotiated between the radiology center and First Health, not Geisinger. Meaning, I’m not getting the full discount I could get compared to someone in PA going to an in-network facility with Geisinger. The technician that conducted the ultrasound and results analysis was billed separately from the test, and this doctor was not in network with Geisinger or First Health. As a result, the bill for the doctor was $560. Geisinger covered $60, and I owe 500. Note that I didn’t have a choice in which doctor I got to conduct that ultrasound. It was just whoever was available that day. In total I owe $670.
I also found out that, and this is the most important thing, as long as I don’t live in PA and see doctors and facilities in PA that are in-network with Geisinger, any doctor I see or treatment I get in NY they are all considered out-of-network, even if they are in-network with First Health. Essentially, this means that no amount of money I pay will ever go towards my in-network deductibles, only my out-of-network deductibles. Knowing little about how our convoluted medical system works, I just assumed that I got boned in the ass by the insurance and this is just how things are. I resolved to pay the $670 whenever the bill arrives. I decidedly to ask HR if I could cancel my health insurance mid-year (idk why I asked because I knew I couldn’t) and HR ended up calling me asking if there was a problem with the insurance. I explained my whole situation and how I’ve decided not to opt for insurance next year and HR (to my pleasant surprise) took this very seriously. They said they were going to pull in their insurance broker and Geisinger rep ect to get this addressed and apparently they’re going to contact me soon. I’m very grateful that HR is taking this so seriously but here’s my question(s):
Do I even have a case to make? Or is this just how the industry works and HR is just being optimistic? Is it normal for a radiology facility, or any medical facility for that matter, to bill for a medical test and the technician conducting the test separately? Is it normal for a facility to be “in-network” but the technician conducting the medial test to not be “in-network”? Is it normal (not scummy) that I essentially can’t access my in-network deductibles even though all the doctors and facilities I’ve seen are in-network with First Health, the third party that Geisinger is partnered with? This is the question I would most like to find out, honestly.
So yeah, I know this whole thing sounds pretty convoluted but if anyone has any answers to any of my question I’d really appreciate it.
submitted by /u/MCShujinkou
[link] [comments]
Hey there folks. I’ve got a a bit of a weird situation so I’ll try my best to explain.
I reside in NY and I’m employed by a company based in PA. The insurance they offer is one called Geisinger. It’s supposed to be a pretty big insurance company in PA, but pretty much unheard of out of state. To cover for out-of-state aka out-of-network employees like me Geisinger partners with a third party called First Health Network
Here’s where things get a little weird:
I recently went to get an ultrasound at a radiology facility that’s in-network with First Health I found out later, after receiving a claim from Geisinger, that even though the radiology facility is in-network with First Health, it’s still considered out-of-network with Geisinger. Because of this, two things happened:
The total was $700something for the test itself (equipment and facility use ect) and Geisinger covered most of it. But I still owe $170 because the price was negotiated between the radiology center and First Health, not Geisinger. Meaning, I’m not getting the full discount I could get compared to someone in PA going to an in-network facility with Geisinger. The technician that conducted the ultrasound and results analysis was billed separately from the test, and this doctor was not in network with Geisinger or First Health. As a result, the bill for the doctor was $560. Geisinger covered $60, and I owe 500. Note that I didn’t have a choice in which doctor I got to conduct that ultrasound. It was just whoever was available that day. In total I owe $670.
I also found out that, and this is the most important thing, as long as I don’t live in PA and see doctors and facilities in PA that are in-network with Geisinger, any doctor I see or treatment I get in NY they are all considered out-of-network, even if they are in-network with First Health. Essentially, this means that no amount of money I pay will ever go towards my in-network deductibles, only my out-of-network deductibles. Knowing little about how our convoluted medical system works, I just assumed that I got boned in the ass by the insurance and this is just how things are. I resolved to pay the $670 whenever the bill arrives. I decidedly to ask HR if I could cancel my health insurance mid-year (idk why I asked because I knew I couldn’t) and HR ended up calling me asking if there was a problem with the insurance. I explained my whole situation and how I’ve decided not to opt for insurance next year and HR (to my pleasant surprise) took this very seriously. They said they were going to pull in their insurance broker and Geisinger rep ect to get this addressed and apparently they’re going to contact me soon. I’m very grateful that HR is taking this so seriously but here’s my question(s):
Do I even have a case to make? Or is this just how the industry works and HR is just being optimistic? Is it normal for a radiology facility, or any medical facility for that matter, to bill for a medical test and the technician conducting the test separately? Is it normal for a facility to be “in-network” but the technician conducting the medial test to not be “in-network”? Is it normal (not scummy) that I essentially can’t access my in-network deductibles even though all the doctors and facilities I’ve seen are in-network with First Health, the third party that Geisinger is partnered with? This is the question I would most like to find out, honestly.
So yeah, I know this whole thing sounds pretty convoluted but if anyone has any answers to any of my question I’d really appreciate it.
submitted by /u/MCShujinkou [link] [comments]Read Morer/HealthInsurance