Health Insurance-My EOB says $25.00 copay for specialist visits, but also says outpatient physician service other than office setting 15% co-insurance. Help me understand this, Please. Insurance |
- Health Insurance-My EOB says $25.00 copay for specialist visits, but also says outpatient physician service other than office setting 15% co-insurance. Help me understand this, Please.
- Insurance sent check for a water damage claim without submitting contractor bids. How to proceed?
- Health Insurance: In-Network Specialist refuses to treat me. Can I get an exemption to see Out-of-Ntwk Doctor?
- Claims Rep -- HR 6 month Interview
- Optometrist office only "Partially in network", is this real? or was I being lied to?
- Car deemed total loss
- Phone Insurance thought renters insurance
- question about Prius battery in redone valuation report
- Need help choosing medical insurance plan
- Would it be possible to change my claim?
- Was hit by a driver in a parking lot
- Looking for any CRM Exam Advice
- Progressive is quoting $650 per 6 mo for same coverage as GEICO at $1,050 per 6 mo, why such a large difference?
- Company is changing insurance and I'm about to have my first child.
- In what situation, would anyone buy this health policy?
- Dump Trucks
- My parents lost their health insurance, can my dad’s employer legally do this?
- Turning 26 question
- Roof Replacement vs Repair Post Hurricane (NC)
- Dad's truck was totaled. What to expect.
- How long until a surcharge is removed for an at fault accident? New York specifically.
- [HEALTH, WV, MN]
- Please help, other insurance company just denied liability!
- Health Insurance Innovations is a SCAM!!
| Posted: 06 Dec 2018 04:01 PM PST I have a blue shield ppo and am located in CA . When I see a specialist under one network I usually pay the 25 dollar copay at their clinics. But when I go to another network (UC clinc) and see a specialist under them they charge me differently with the 15 % coinsurance. And they are calling themselves " hospital based clinics". On my bill it says Acct class: outpatient: one of the specialist: billed 99205 office/outpatient visit new, level 5, another specialist billed 99204 Office/outpt visit, new, level 4, another specialist billed 99244 Office. These are specialist under the second network. I pay the 25 dollar copay but still end up getting a bill that says I owe the co-insurance. Is this being billed incorrectly? They do not admit patients in their clinics but they are associated under the name with a hospital. Can someone will more knowledge tell me if this is correct on how they're billing me. I read another post and someone mentioned balance billing. [link] [comments]  |
| Insurance sent check for a water damage claim without submitting contractor bids. How to proceed? Posted: 06 Dec 2018 09:43 PM PST Hi, I submitted an insurance claim for a water damage in the bathroom and the ceiling downstairs. Downstairs the adjuster estimated that all walls would need to be painted but the contractors I take a look estimated that patch & painting couple of the wall would do. Now, insurance sent a check based on the adjuster estimate which contains the price for painting the entire room downstairs with considerable money allocated towards painting. Question: Do I have to use the money allocated in the insurance estimate for painting or can I use it for upgrading the bathroom (vanity, faucets, modling, toliet, flooring etc.) upstairs? [link] [comments]  |
| Posted: 06 Dec 2018 05:55 PM PST Hi there, I have a Health Insurance which only covers me when I see In-Network specialists. I need to pay 100% if I see Out-of-Network specialists. I am an Adult. I might need to see a Speech Therapist for medical reasons (symptoms due to concussion). All the In-Network Speech Therapists near me (within 50 miles) only see Children, not Adults. Given this situation, I've been told that Health Insurance firms could make an Exemption for me to see an Out-of-Network Speech Therapist. And then it will cover part of the costs. However, when I call my Insurance company, they mention that it's Open Season, and that I need to choose an Insurance Plan where I can see Out-of-Network doctors. Of course, these plans are more expensive. (Or, they say, that my plan going forward will not allow any Exemptions.) What is the lingo I should use to confirm whether it will give me an Exemption or not? Is there any possibility for me to stay with my current In-Network-Only plan and apply for an Exemption? Thank you! [link] [comments]  |
| Claims Rep -- HR 6 month Interview Posted: 06 Dec 2018 09:25 PM PST Hey, hey, I'm still posting here as Insurance Pro reddit wouldn't add me to their sub. I have an HR interview every 90 days, that goes over:
I just HAD this interview at around my 90 days, and now I'm just getting another one, I think I had it 6 weeks ago. I'm thinking possibly b/c my manager is new and I might provide more feedback as last interview I didn't have anything to really say (on my manager) as I just got put on that team. So from my last post, where I stated I hate the call center. I'm at the point now, I just want to get through it. I decided I am getting out of the call center in another 4 months, as I'll be over 6 months but under a year and will be applying out. I really don't like this role, I stay b/c I'm paid well and there is promise to get a better position. I realized I probably could have got a straight auto rep position from the get-go but at least now I have experience with insurance and basically have experience in delivering bad news. I dislike that every minute is calculated. Heaven forbid if I am 1 minute late. I felt due to "point" system I had to work with laryngitis but eventually got too sick, still had to call out and still got a write up I believe. Also, and this is for you ADJs, I HATE HATE HATE that sometimes all the CLMT or the INSD needs to hear from you, "Hey, Mr. Jones, sorry I haven't got to your 5 emails and 10 voicemails, I'm still working on your claim." And you refuse to take the call or even worse....attempt to have a chat conversation over skype with me on how busy you are, do you realize I only have 7 minutes per status call??? The time it took you to explain your BS to me, you could have taken the call. Or worse, I then have to spend 25 minutes explaining something to that caller, hear them b*tching about their ADJ, and then guess what...I still got to send ya ass an activity. Or when you reach out to 5+ of their team, and they don't respond. Basically, I'm just on auto mode in this job, not really in the mood to do this HR thing. What do I need to actually tell them? I have no plans to leave company, but want to get into a role where every minute is not managed and I'm actually responsible for my own work and taking my own calls, replying to my own e-mails, and having a glorious 1 hour lunch. [link] [comments]  |
| Optometrist office only "Partially in network", is this real? or was I being lied to? Posted: 06 Dec 2018 09:13 PM PST 2 of my kids need eye exams and glasses. both are covered by Medicaid in Texas. So I did the normal thing, went to the insurance website, and found a local Optometrist who met my needs and called to schedule an appointment. The secretary who answered the phone informed me that they were only "partially in network" so the exam would cost $69 per kid and I would get a 20% discount on glasses. I thanked the woman for her time and hung up, but her answer didn't sit right with me. The kids specific Medicaid plan covers one eye exam and a pair of glasses with a $0 copay. I've heard of in-network and I've heard of out-of-network providers, but I've never heard of "partially in network" which somehow equates to the cash price without insurance before. Over the years I've used many types of insurance and health coverage including TRICARE, CHAMPVA (we still have this but no one takes it), Medicaid, the VA, and private health insurance. and not once have I ever come across something like this before. Was this just a roundabout way of telling me they didn't accept Medicaid? were they going to charge me and still bill Medicaid? or does partially in network actually exist? [link] [comments]  |
| Posted: 06 Dec 2018 08:44 PM PST I got hit in the passenger side back door it was the other drivers fault and her insurance, Allstate deemed it a total loss. All the damage however is purely cosmetic so I'd like to keep the car. I'm in Alabama and I know the steps to get a salvaged title but does Allstate report that it's a total loss to the state or can I keep the money and don't worry about it (I won't be selling this car to anyone). Or should I just negotiate a lower payout? [link] [comments]  |
| Phone Insurance thought renters insurance Posted: 06 Dec 2018 10:56 AM PST Hello, I've searched Google and this forum but haven't found my answer quite yet. I currently own my iPhone X, iPad Pro 12.9 inch and Apple Watch series 3. I cannot pruchase Apple Care at this point with them. I went to TMobile and feel like I pay alot , whoever I stay with them because I have their insurance on my phone's. But that's $45 a month. I have considered getting renters insurance separately. Is there a renters insurance with a cell phone type ride that would specifically cover these? Thanks [link] [comments]  |
| question about Prius battery in redone valuation report Posted: 06 Dec 2018 01:06 PM PST Does anyone have any experience with having to replace a Prius battery, and then the car being totaled? (AZ) Last year, the hybrid battery died, got a replacement from Toyota for a couple k. This was not reflected on the initial total of valuation, so I asked the insurance company if they could illustrate this for me. They come out showing the car is valued at "LESS" somehow (after a couple months of e-mails). So just want to make sure or see if anyone has any experience w/ a new battery and if there is anything else I should be doing... Should a hybrid battery that has been replaced recently be considered added to the value of the car? Insurance is saying it's a "normal maintenance item" after all that waiting but I want to make sure because it doesn't really make sense to me that the second report is less. Thank you. [link] [comments]  |
| Need help choosing medical insurance plan Posted: 06 Dec 2018 06:40 PM PST So my employer gave me quotes for 2019 health insurance plans. This is my first time doing this and I'm not sure where to start. The plan would be for me only. There is also a possibility I may get pregnant in 2019, so I have to take that into consideration. Any advice is appreciated. Thanks in advance! [link] [comments]  |
| Would it be possible to change my claim? Posted: 06 Dec 2018 10:41 AM PST I got into an accident today, mostly scratches, I mentioned I'm not injured in the moment (I assume due to adrenaline?), but after I calmed, I noticed some minor pain (I'm not sure if it's related to the accident, but it wasn't there before). My question is, if I get it checked out, would it be possible to include it in the claim if something does come out of it? [link] [comments]  |
| Was hit by a driver in a parking lot Posted: 06 Dec 2018 06:11 PM PST I was backing out of a two way parking lot at a restaurant slowly and saw a car speeding along the way. The moment I saw the car I had stop and Had only backed out maybe 1 foot or so? and they had hit me while my car was stationary. I immediately turned off the car and asked the driver why they had hit my car and they called their insurance. I had recorded the surroundings of the car and took many pictures and I had to stop the driver from moving her car from the impact. I called the cops and was told that they do not come to private property for collisions esp if it was one from bumper to bumper. I also noticed the driver may have been high? because the smell of weed was coming from her car and herself as well and the car was damaged from other collisions possibly? But it was definitely not from me. We both gave out statements to the insurance people and I was called a couple of hours later telling me that my claim was rejected before I was even able to send in video evidence and picture evidence and its pretty clear from the pictures that she had hit me. Do I contact the claim people again and ask them to reevaluate the claim with pictures and the video instead of statements? I'm not sure why they would have a conclusion without even taking a look at pictures and claiming that they made a decision based on what I had explained and what the driver had explained. I also let them know that the driver may have been under the influence but they still took her side. [link] [comments]  |
| Looking for any CRM Exam Advice Posted: 06 Dec 2018 04:24 PM PST Hi all, I'm taking the first course for my CRM designation through The National Alliance. I am in the month long 2x per week webinar version and I really don't know what to expect from the exam. It is just the Principles of Risk Management course so the content has been fairly straightforward and the online practice quizzes are pretty easy. My concern is how detailed or picky the graders are since the format is 20 short answer questions. If anyone out there has taken this or other NAI courses I would appreciate any personal experiences or study tips! Thank you!! For reference I have been working at an independent retail broker for 1.5 years marketing accounts to group captives. I also have a B.S. in Risk Management & Insurance. [link] [comments]  |
| Posted: 06 Dec 2018 03:42 PM PST I set up both quotes to have the exact same coverage in terms of liability, uninsured motorist, deductibles, etc on a $65,000 vehicle. Liability and uninsured: 250/500k Deductibles on comp/coll: $500 All of the other misc things like rental coverage etc are the same. Any reason that GEICO is almost 50% more? I've been a customer with them for 18 years on my father's policy. Do I lose any "history" by switching companies? Is Progressive good? Will they jack up the rates after 6 months? Is GEICO just better in terms of handling claims, repairs, etc? Thanks for any insight [link] [comments]  |
| Company is changing insurance and I'm about to have my first child. Posted: 06 Dec 2018 11:53 AM PST So I (23M) work for a small-ish company in TX and they have decided to change payroll companies that also serve as a broker(?) for the insurance effective Jan 1, my wife (26F) is due on Dec 26 (and she will be giving birth before the end of the year for that tax credit and to not have to start over on the deductible). The actual insurance company is staying the same (Aetna), and I am planning on bumping up the coverage due to the newborn and all. (I was going to do this regardless) The process just started so I haven't even gotten to look at the different plan options or anything, I'm just nervous about becoming a father and this new bit of uncertainty isn't helping. My main concern though is that because I'm technically on a different plan, will I have trouble with all the hospital bills than will inevitably come after the fact? I'm not as informed as I'd like to be on how the billing works. Thanks for any advice and assistance! [link] [comments]  |
| In what situation, would anyone buy this health policy? Posted: 06 Dec 2018 03:22 PM PST https://i.imgur.com/GIiHWO5.png Monthly premium: $724 Deductible: $15,800 Out of pocket max: $15,800 [link] [comments]  |
| Posted: 06 Dec 2018 07:00 PM PST I find it halarious to see dump trucks with "Stay Back 300 Feet. Not Responsible for Broken Windshields." decals as if a sticker gives you some make believe immunity from not securing your load and fucking up someone's car. Can a lawyer comment on this? Could I make my own decal to limit or elliminate all my liabilities? [link] [comments]  |
| My parents lost their health insurance, can my dad’s employer legally do this? Posted: 06 Dec 2018 11:06 AM PST My dad has worked for Albertsons for 20 years, and had blue cross through them for he and my mom. (It's blue cross of Idaho where Albertsons is headquartered, but we live in Texas) Within the last few years he's had a lot of health problems, including vertigo, cancer with radiation treatment, and a handful of other things. His doctors have restricted him to working no more than 20 hours per week. This week their health insurance was terminated because he cannot work full time. This seems sketchy to me, how can something ordered by a doctor the insurance covers lead to him being kicked off the policy? My mom is retired on social security, so I'm hoping they can get some kind of Medicare at least, but is an employer really able to do that? Either way, what action can be taken? It seems so fucked up. [link] [comments]  |
| Posted: 06 Dec 2018 02:11 PM PST Hello everyone, I have a question. I'll be turning 26 in a couple weeks and subsequently losing coverage under my mother. At the moment I have excellent coverage, that will change the first of the year. My question is regarding a lump on one of my most prized possessions if you catch my drift. With my current coverage, it would be very cheap to get it inspected. But that's about all I would have time for before my coverage ends, if that even. If I do get it checked and it comes back positive just before my coverage ends, am I doomed to being denied good coverage for the new because it then counts as a preexisting condition ? I have put it off, and now am considering putting it off again, but I would be so disappointed if it turned out to be the C-word and realized I could have caught it earlier. I hope this is the right place for this, any advice is appreciated. [link] [comments]  |
| Roof Replacement vs Repair Post Hurricane (NC) Posted: 06 Dec 2018 01:21 PM PST TL;DR Insurer cut me a check for a new roof. Planning dept is recommending repairing it. If I repair rather than replace, does the next hurricane mean that I'm going to not get rain damage covered? Long version - My home was damaged in Hurricane Florence this year. I live in downtown Wilmington NC, within the historic district, which has significant restrictions on what repairs and changes you can make to the home are permissible. Roof peeled up in 5 places. Had a significant amount of water on ceilings, and will end up replacing about 400 sq ft of ceilings when all said and done. Insurer is Nationwide, but our wind policy is written by the NC Joint Underwriters Association, who covers wind policies in coastal NC. I immediately ordered the roof tarped, and got the property secure. Nationwide came out and inspected, and covered a new roof for the home + other damage. No complaints here so far. It's a steep standing seam metal roof on a tall house (about 30'). Since then, I've had 5 roofers come look at it. Most wouldn't touch it because it's in the Historic District. The one I like has a 6 month wait time for estimates. I get one roofer to take me seriously and we agree that if I get the permit and roofing type approved, he will take on the job for around what the insurer is willing to cover ($17.5 K, less the 5.5 for deductible). I am working with the Historic District planner + my roofing contractor to get the correct roof approved for the permit. In the historic district, we have to have prior approval before roofing. If you don't get approval, they can make you take your roof off and roof it again, so it's not to be taken lightly. Planning department is pushing me to get a contractor to repair the roof and questioning if it requires replacement. One of their employees gave me a trusted contractor that they recommend. My instinct is hell no, I would rather get a new roof. I'm trying to work with them to resolve it, but it seems like if I repaired (rather than replace) then my hands could get tied with my insurer in the event I have to make another claim from my roof. Like what happens in 2019 when another hurricane blows through and the roof leaks in the same place. Wouldn't the insurer have cause to not cover my damage? I'm trying to leverage what I can here with the planning department. I know they're trying to preserve the historic value, but I'm willing to do a historically appropriate roof (at expense of > $10K more than a regular roof). Bonus Question - I had 30" pour through the roof onto my gas furnace in the attic. My installing contractor deemed it a total loss due to corrosion in the unit (there's rust inside on piping) . Nationwide had an inspector test the unit and said that it fired up and didn't show signs of a failed heat exchange. Thus no coverage. Is this worth pursuing? My HVAC tech said that it works now, but it greatly reduced the life of the unit. I'm not sure what the process is to contest this with my adjuster. [link] [comments]  |
| Dad's truck was totaled. What to expect. Posted: 06 Dec 2018 01:02 PM PST A guy ran a red light and smashed into my dad 2004 GMC Canyon. Mechanic says it is totattled he is just waiting on insurance. My dad is a little sore but doesnt have any injuries. He is the only owner for this vehicle and had it in great shape and used it daily for work. I am trying to figure out what the insurance will pay out on this. I first checked KBB put in all info and it said it was valued around $3500. However when I do a search for the exact truck within a 300 mile radius in southern CA I see them going for 8-10K. Also once that is paid out is taxes title and registration included in the payout? [link] [comments]  |
| How long until a surcharge is removed for an at fault accident? New York specifically. Posted: 06 Dec 2018 08:18 AM PST I was told when I signed up that by the next time I renewed the accident would be dropped (after 3 years). I go to renew today and they are telling me it is actually 39 months in New York state, so I need to renew and the surcharge will drop next time. I am unable to find any law stating this or written progressive policy as of yet. Is it actually 39 months in this state or is it 3 years like they told me before? Sources would be awesome! Thanks! [link] [comments]  |
| Posted: 06 Dec 2018 11:44 AM PST I moved from West Virginia to Minnesota and took a new job. I had previously had insurance I bought privately (not through any employer). I got new insurance, they backdated to 10/1, and I tried to cancel my old insurance but they won't give me my premiums back from 10/1 forward. I'll have paid two months of premiums for nothing. I thought it was illegal to insure something that was alreadybinsured, but now that I think about it I was thinking about property that can't ethically be replaced twice for being broken once (insurance fraud). Am I just screwed? [link] [comments]  |
| Please help, other insurance company just denied liability! Posted: 06 Dec 2018 11:09 AM PST Hello, My gf was in an accident. She was driving on the highway in the right most lane, when someone pulled out as she was passing the drive in portion of the gas station. His left front bumper collided with gfs right side of car, leaving about 1.2K in damages. The cop got to the scene and asked for statements, she cam and got my gfs, then got his and spent much more time with him for his statement, we thought this was strange. After requesting the police report, it turns out he says that he was already driving in the lane and GF merged over and collided with him. She obviously filed with his insurance and we just heard back, after 1 month that they will be denying liability as there is not enough evidence to prove fault.
What are her options? what can she do to prove fault or get this covered in some way? she has liability only, not FC she will be reading this. TIA! edit: if they denied fault, and they are also not coming after gf insurance to cover their insured, isn't that strange? [link] [comments]  |
| Health Insurance Innovations is a SCAM!! Posted: 06 Dec 2018 10:04 AM PST I was told when I enrolled so many things that turned out to be a lie. They said that my daughters pediatrician would accept the health insurance Health Choice Plus ( she didn't), and now I have to pay that out of pocket. Yesterday I tried to take my 1 year old to an urgent care because she is throwing up and had very obvious congestion in her lungs but they didn't take it either. If I wanted to pay out of pocket there it would be $400, which I defiantly dont have. Long story short I have been paying $200 a month to basically be uninsured. I've been trying to get a refund because I shouldn't have to pay for something that I was lied to about, but they said because it has been a few months that I cant get my money back. I just want to spread the word about this fraudulent insurance company so no one else wastes their money. [link] [comments]  |
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