As general statement all insurance companies are predators. They prey upon your fear to charge you more money. Make the rules so complex, they never give you a straight answer. We decide to do a medical treatment based on what Cigna customer care told us what would be covered. Treatment occured and many of the costs were not covered. Cigna later said the first person gave us bad information. Now the Dr makes out because he gets 100% reimbursement instead of the reduced amount that would be paid by the insurance company. Cost to me about $3K. This is not how to deliver medicine. Government needs to stop big business raping the consumer.
Exposed again,lacking clinical knowledge[and of course customer care]Can't you ever admit you're wrong,and what is a 'normal doc' LOL.Are we still living in the Marcus Welby ages. Women also aren't adressed as fellas
Everything you say is troll -- that's why I reply. It's my fun to see what you'll say next.
I've no idea why you say I sell insurance, I don't.
For someone who's been on both sides.. well, your posts don't show it.
btw, still no reply to the bush thread? That's something of actual attempt to have a discussion.. but I guess you wouldn't be interested in that. Not really a thread where you can whine about CI.
godalegodale, if you're replying to my post.. something's gotten mixed up. I think it was hrmmunstr that was using the he/she stuff. I don't recall ever replying to one of your posts.. mine tend to fall indented under hrmmunstr.
My only point was to say what happened had nothing to do with CDHP -- as was asserted by hrmmunster -- in fact, the only reason I read/posted in this thread was 'cause hrmmunster did.
I've no idea why you are saying anything to me about getting personal.
Caught in my troll. Dah.Like I dont really know what Consumer Driven Health is.Yet,it apppears from your post your clinical knowledge is lacking,my sarcasm isn't.Thanks that there are people like godale who put you in your place expose you for the insurance salesperson you are.Please look at health ins. plans in two parts,administratively and clinically, not just in one,There lies our differences.Like I've said before,I've been on both sides Adm,and Clin.,You seem to look at it from just the Adm. side. TSK TSK maybe a Farmers Ins board would be more appo. P.N.
File an appeal and call CIGNA customer service to request your call records be released from any service interactions you have had during the past year. CIGNA may request in writing from you to release PHI (personal health information) but I am with a TPA and by law we have to release information such as call records. I would then take the call records and incorporate it into your appeal. If they refuse to provide your call records or process your appeal contact your state insurance agency to report.
First, I'm a "she," rather than a "he," who has spent over 20 years in the health insurance industry. While it is not the norm for an out-of-network doctor to interpret a diagnostic test done by an in-network doctor, it does happen. When it does, the claim for the interpretation should still be processed at the in-network level; if it is not, the member needs to call and request a correction. In most instances, the same doctor does not perform the diagnostic test and interpret it.
As you state, the fact that some of the plans are consumer-driven is not a factor; the benefit provisions would be the same in any PPO or open-access plan. CDHP's are about consumers taking control of their own health, understanding their benefit coverage, thereby controlling costs. Customer service departments exist to assist members with just this endeavor.
No need to get personal about this; I'm simply trying to help those on this board who were having issues with their insurance coverage and wanted to assure them that the issues can and will be corrected.
There's nothing to pick apart and I've no idea why you'd agree with him and argue with me.
To quote my original reply:
"Bah... that has nothing to do with CDHP. That's an issue of in-network vs out-network. I'd think it's a pretty odd situation to go to an in-network facility and then have an out-of-network doctor read the MRI.. or is that just me? I mean.. wouldn't your 'normal' doc (who'd be in-network) read the MRI?"
You, hrmmunstr, said "Or the provider of service, for example[an MRI ]is covered but they dont tell you that a non provider Doc is reading the report.Welcome to CONSUMER DRIVEN HEALTHCARE,where you, the consumer is less informed but should know more about your benefits,sick or not!LOL.Oh yeah one more thing,they'll give you a coach to root you on all the way to the ATM."
In fact if you read my posts... I say repeated "this has nothing to do with CDHP".
I'm glad the other fella's post got through to you.
1. If you received incorrect information from a customer service representative at CIGNA and have their name and the date you called, they can look it up in the call documentation system and verify the information you were given. When incorrect benefits are quoted, you have a right to appeal that.
2. If you go for an MRI and the doctor/facility where the MRI is done is in the PPO/HMO network, then the fee for the interpretation of the MRI is payable at the in-network rate, regardless of whether the interpreting doctor is in the network or not. This is because a patient has no control over who reads the diagnostic test. A processing error has occurred. You simply need to contact CIGNA and make them aware of this, and they will have the claim adjusted.
3. If you go to the ER at a PPO/HMO facility, all charges in connection with that visit that occur in that facililty are payable at the in-network rate. This is because the patient has no control over whether an ER doctor is in-network or not, especially when they are visiting for an emergency! Again, simply call CIGNA and advise them of the processing error and it will be corrected.
Realizing that it takes time out of your day to make these calls to correct errors that should not have been made in the first place, I would also suggest you make your HR aware of the situation so they have an idea of the service your company is receiving. They have other contacts at CIGNA that they can advise of these issues who can take care of the bigger issue.
I'm not sure I follow what you're saying.. but I'm going to ramble on anyway.
The fact remains.. that what's being described isn't a CDHP problem.. it's a quirk of having networks. The one and only solution to this is not having networks -- going back to an indemnity system.
Perhaps that's the solution.
The cost that goes to the consumer isn't the fault of the insurance company. Plans (like PPO plans) have set in/out of network benefits. Plans like true HMO's may have zero coverage for out of network. If a person goes to an out of network provider.. they are going to pay more.
This is completely inline with the concept of networks since.. providers will sign up to be in a carrier's network and give a greater discount on the premise that being in the network will drive business to the provider -- this is a basic "volume driving higher sales, so I'll charge less". If a person sees a non-participating provider, they are going to pay the full (non-discounted) cost.
If a person feels they are getting screwed, I'd bring up the issue to their HR department and whine and complain all I could. Most folks are covered under ASO plans.. which means it's the company (their employer) who actually pays thing. CIGNA, or whoever, is nothing more than a facilitator/coordinator.
Oh and the states legislation only impacts fully insured business. Thanks to ERISA, by and large, any self-insured (ASO) company is free from state mandates -- again, most folks if they cared to check are in a ASO type plan... so the state mandates tend not to apply.
The one thing you say that I totally agree with is that most folks don't have a clue and that's sad.