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Some help understanding this please
Posted: Oct 16, 2011
I'm young, a new mom, and have little in the way of "life experiences". I don't want to keep making stupid costly mistakes, so I've decided to seek some help. I want to understand my new health insurance. I took my little one to a highly recommended pediatrician, got there, signed all the papers, and afterwards was blindsided when the total bill for the check up was $170! All I was prepared to pay was the $35 dollar payment that my insurance told me I had to pay! The lady there was sweet, and told me that the doc was "out of network", and allowed me to pay the 35, which was all I had, but told me I needed to pay the rest within 60 days. I was embarrassed.
What does that mean? (out of network), and why didn't my insurance explain that? or is it something I should just know? I feel so stupid, like when I try to be responsible, I keep making mistakes, like signing up for a credit card that has a high yearly fee and that even charges a fee for apparently not using it. I didn't know that most cards don't charge a fee. I bought an extended warranty on a TV that has a 5 year warranty already; I bought a membership at a gym for 35 bucks a month with a 2 year contract, when if I had inquired a bit, I would have found out they have a pay by month or use fee without a contract for 7.95! things like that. I frustrate myself, but also wind up costing myself quite a bit.
I'd like to understand the insurance though because I have a newborn baby and I have some health issues that need to be monitored. Thanks for your help, and please don't think I'm stupid. I know I have a lot to learn. I'm only 22.
;
Used to be a bill collector - for a hospital. sm
[ In Reply To ..]Pls don't take any of this personally. I understand what you're going through as I tried to help many pts get things pd. Ultimately, it's the patient's (parent in your case) responsibility to know which docs you are allowed to see in network. You should have been given at the very least a website for the ins that will let you find and choose a doc in network. I'm rather surprised they didn't tell you Before the visit as we always tried to do that. Pls ? your HR person & he/she should be able to direct you. Good luck!
Help with understanding - sm
[ In Reply To ..]Your insurance company can give you some information on who is in your network and who isn't. Whenever you make an appointment with a doctor or dentist or even for eye exams, first ask if they accept your insurance and are in your network. That way, you will know right from the start what you are expected to pay as your copay and deductible. For the other things you have purchased, don't be afraid to ask questions. Take the time to call around and compare deals. These people are in the business to make money and when they sell you a contract, it's money for them. Lastly, don't be so hard on yourself. We have all learned many things the hard way. Good luck to you and your new baby!
In network and out of network - Happy MT Robin
[ In Reply To ..]Yes, some of the responsibility was yours, but quite frankly, the majority of the responsibility was the doctor's office, in my opinion. I work part time at a counseling service in the billing office and we do fee agreements for everyone of our clients so they very clearly know how much they are expected to pay at the time of each visit. If that was not in the paperwork that you signed at the beginning of the visit, then quite frankly I'd raise a stink with the doctor's office and ask why they did not tell you this up front when you walked in the door.
So, what you have to do now is look at the ins. co. website or call their provider referral line and find an in-network physician, i.e., one who is contracted with the health plan to provide services at agreed upon rates.
Don't feel bad or put yourself down. As you say, you're young yet. I'm 48 and still make stupid mistakes. Dave Ramsey calls mistakes like that a "stupid tax" and it's the best way I've heard to describe it. I work with insurance billing and it's confusing, so if you've never had to deal with it before, it can be a nightmare.
extended warranty, etc. - serene one
[ In Reply To ..]Since others have explained about in/out of network,
Most extended warranties are just money-makers for the person selling them, especially small appliances and electronics, cars too in most cases. By the time a small appliance or electroics break, most people aren't going to remember they have the warranty and/or they aren't going to be able to find the paperwork, Cah-Ching for the person that sold it!
There are web sites that compare credit cards and most other things as well. Just don't be an impulse buyer ever, NEVER let anyone talk you into buying a membership on the spot, saying it's a one/limited time offer, believe me it's not, they just want your money. Take your time and research before you buy or committ to something.
Don't beat yourself up either, you have to make mistakes to learn.
Consumer Reports - sm
[ In Reply To ..]Consumer Reports magazine is a good source to get you thinking about what you are buying and where you are spending your money. Available at most libraries for free, cheaper by subscription, or buy full price at a news stand. This is good for anyone who is buying appliances, cars, and general info regarding insurance, savings and financial. I have learned to look at every expense I have and made a thoughtful decision; i.e. I have a "trac phone" cell phone with a monthlly charge instead of a contract, I discontinued my cable TV and just have a download movie service, I use VOIP telephone with my internet connection. I also use coupons, buy energy efficient applicances, unplug/turn off everything when not in use. I have my car engine block heater on a timer in the winter. Learning to shop in second-hand stores and estate sales. Good luck.
Noah's mom - Laney
[ In Reply To ..]Hi. You are living my life of twenty years ago. LOL. Don't be too hard on yourself. I would start with your insurance provider and check their website or even call to inquire for a list of 'in network' clinics for you and your baby-there are bound to be many avaialable.
As far as other expenses go, the internet is a vast universe of knowledge. I use google daily to research things before buying or doing. Next time you're about to undertake a purchase over 'X' amount, do a little research first. You'll be surprised at how much you can find out and when you do eventually hit upon something that will save you from wasting time/money, you'll be really proud of yourself! Another area of support might be to join a social group for new moms; whether that be online or in person. Remember everyone makes mistakes, that is how we learn. Best of luck you you :)
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