ElysianConfusion

September 29, 2009

Figuring out Insurance is Torture

Filed under: budgets,crazy,insurance,money,network,websites — by elysianconfusion @ 3:53 pm

I have great insurance. My company pays 100% of the medical for me and my family, and it’s a Preferred Provider Organization. There’s a website to look up providers, and overall they’re pretty easy to use.

But I selected a dermatologist from the website based on her being in network. My insurance paid the majority of the bill, but told me that because she’s out of network, I have to pay 45.94. I know this isn’t a lot of money, but it’s still money, and I picked this doctor because she was in network. I asked the insurance company. They agreed, it looked like she was in network. They researched it. Then they told me that no, she was not in network. I sent them a screen shot showing that she WAS in network and asked how to select a doctor if the doctor they  list on the website (for over 4 months in a row) as being in network is actually not. They just said that they confirmed with the “network” that she wasn’t in it.

So I called the doctor’s office. They think they’re in network too.

All I can think is that somehow (although I did this step by step with someone from the insurance company on the phone) I did something wrong searching for a provider. Seems like I’m being stupid, right?

But actually, the process is quite baffling. You go to the website, log in, select “Find a Provider,” then select “Find a Doctor,” then “Select a Plan.” Ok, so I need to select one of these:

  • PPO
  • Extended Access PPO
  • ChoiceGuard
  • Complementary

(I have no idea which one is right. It says to refer to your card, which I do, and it doesn’t actually say any of those things on it.)

So I enter PPO, hoping that that’s right. Then I enter my zip code (or complete address) and proceed to the next page. Then I have to choose my network. Options here are:

  • FirstHealth
  • Healthlink PPO
  • Lab Card
  • LifeSynch
  • MultiPlan
  • National Capital PPO
  • PHCS Preferred Provider Organization

Ok, so my card says PHCS, Multiplan, and Lab Card. Ummm… ok, so I select PHCS because that’s the big logo on the front of the card. Interestingly, when you do that, the resulting page says MultiPlan in HUGE letters, and then on the right it says “Search on below logo: PHCS.”

Now I have to choose a provider type; I select Doctor or other health care professional, and press Continue. Now I have to enter my zip code (or complete address if I’m so motivated) again. And then I need to select the type of doctor. I select Dermatology. Then I can enter the doctor’s name, first or last, or both. (There are more search options I’m not using, such as gender, languages spoken, and hospital affiliation.)  I click continue and there’s my doctor’s name, address, and phone number. What am I doing wrong? And why is this so hard?

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3 Comments »

  1. Man, I would love to get some more posts about this topic. Thanks alot.

    Comment by NoraMarx — October 21, 2009 @ 3:45 am

  2. […] is Baffling Once again I have the returning bill. The insurance company insists that I selected an out of network doctor. I don’t even know […]

    Pingback by Insurance is Baffling « ElysianConfusion — January 15, 2010 @ 9:13 pm

  3. […] is Key! I’m still struggling with the dermatologist bill. When I checked, the doctor’s office had resubmitted the bill for another provider to see if […]

    Pingback by Communication is Key! « ElysianConfusion — January 15, 2010 @ 9:14 pm


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