Hello,
I just joined this sub. Are there any medical billers here? I have a question for you all
So, this week I called an employee at a hospital after the employees at the clinic gave me her number following a visit. She said that my family member’s health plan is a preventative and wellness health plan and doesn’t include surgery. After talking to that family member and the reps for the health plan. It was determined that the plan does include surgery which by the way is a PPO plan. I called the employee at the hospital to let her know that and she insisted that surgery is not covered and that we would have to pay the full price of the surgery up front. Even the rep for the health plan said that everything is in order meaning that the hospital and surgeon are in the network and that the hospital employee needed to submit a claim. Can any of you tell me if the hospital employee is not doing her job based on these events? Or what likely happened here?
There is more to this story but I tried to make it as short as possible. I personally think she was trying to scam us as does my family member and the rep for the health plan
submitted by /u/mamimexicana
[link] [comments]Hello, I just joined this sub. Are there any medical billers here? I have a question for you all So, this week I called an employee at a hospital after the employees at the clinic gave me her number following a visit. She said that my family member’s health plan is a preventative and wellness health plan and doesn’t include surgery. After talking to that family member and the reps for the health plan. It was determined that the plan does include surgery which by the way is a PPO plan. I called the employee at the hospital to let her know that and she insisted that surgery is not covered and that we would have to pay the full price of the surgery up front. Even the rep for the health plan said that everything is in order meaning that the hospital and surgeon are in the network and that the hospital employee needed to submit a claim. Can any of you tell me if the hospital employee is not doing her job based on these events? Or what likely happened here? There is more to this story but I tried to make it as short as possible. I personally think she was trying to scam us as does my family member and the rep for the health plan submitted by /u/mamimexicana [link] [comments]Read Morer/HealthInsurance