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WTF, insurance?!
  #1  
Old 07-10-2017, 01:24 AM
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Default WTF, insurance?!

I'm still on my state's low-income health coverage; I'll probably be bumped up a tier come the next enrollment period as I'm making (not much) more money.

A few months ago I was getting the runaround from some--but not all--of my annual appointments as according to them I have other insurance. Call Masshealth, they don't have anything else on file for me so it's a mystery exactly where this other plan came from (ThreeLetterDrug says that they can't tell me but Masshealth can, Masshealth can't tell me because they don't have anything else under my name).

Eventually I'm able to get my prescription through my normal clinic, they have the same 'issue' that ThreeLetterDrug did but they have to give me the lowest-priced option (TLD either doesn't have to offer that or doesn't know they have to).

Now I got a bill from "Journey" Labs who did some basic bloodwork during my physical in March. They're saying that Masshealth denied the claim because I was "not covered at the time of service"! I did get a letter from MH stating that my coverage would start April 1...which was a mystery as this happened a few weeks after the major game of phone tag, during which the rep confirmed that my coverage was in fact active.

I'm confused. Part of me wants to just say "screw this" and pay it, but I shouldn't have to...also, had I known the lab work wasn't going to be covered I would have told my doctor to hold off. I thought--and the rep seemed to confirm--that the issues were just with the prescription coverage.

Thoughts? I know what's going to happen if I call the insurance again...but I'm also confused by the timing.

First round of phone tag was in mid-March. Masshealth rep did confirm that I was covered.
The lab work was done the same day as my physical, March 31. Why was the exam covered but the lab work was not...shouldn't everything--physical plus eye and dental a few days later-- have been bounced if I wasn't covered?
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  #2  
Old 07-10-2017, 01:02 PM
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One thing I learned in the past is that the phone reps don't often check the actual date your coverage goes into effect - they just see that you've got coverage and that's pretty much it.

When I used to have to call insurance companies to confirm coverage for callers (I worked in a call center assisting employees of a major US company with understanding their benefits and being the one to call the insurance company if there was anything out of the ordinary) we learned that we had to clearly ask what date the coverage goes/went into effect - it was never just enough to ask if they showed coverage in place, because the agent on the other end would only ever confirm that there was a policy...which makes people assume that it's already in effect, even if it's not.

  #3  
Old 07-10-2017, 09:27 PM
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I've been on the same plan for a few years; the only thing that's changed recently has been my income (I recertified my eligibility back in February). If it wasn't in effect on March 31, I'd think my primary care office would have called (or messaged me through the online patient portal) to say "hey your insurance denied this"...would they not?

(that did happen for my eye exam a few days later, but was actually fixed with one phone call...my plan had merged with another provider late last year and while my information stayed the same there was something they needed to update but didn't)
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Last edited by Dreamstalker; 07-10-2017 at 10:11 PM.

  #4  
Old 07-11-2017, 04:21 PM
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In that case you should be good to go, I would think. It sounds like somebody at MassHealth dropped the ball and didn't properly research your coverage, or your coverage details didn't update correctly in their system. I hope you get it all sorted out!

  #5  
Old 07-27-2017, 11:03 PM
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I just got another letter saying that I am not eligible for the free plan as I "did not return eligibility information in a timely manner". That's bull...I mailed it in plenty of time and have no control over the mail system. It's actually dated two weeks after I know they got my paperwork.

The letter did state that I'd be receiving another letter regarding my eligibility for one of the plans on the exchange...depending on the cost, it might be cheaper/less hassle to just enroll in my job's plan when it opens up. I'm now questioning whether the state knows what they're doing... This whole merry-go-round seemed to start during the initial "repeal the ACA" chaos.

My coverage is supposed to end on August 1, but IIRC they have to cover me with the 'safety net' for an additional 90 days until I can enroll in something. Yay, another phone call which I don't have any time for this week...

ETA: Got another letter with options. So it looks like all I have to do is figure out which avenue makes more sense...technically, I can't/shouldn't be bounced from the state system due to my 'disability' status. So I should probably stay with them as I know my clinic already accepts the plan.
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Last edited by Dreamstalker; 07-27-2017 at 11:15 PM.

  #6  
Old 09-28-2017, 01:10 AM
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Well, either the testing wasn't covered (why the not, it's routine and I never had a problem before) or someone done screwed up with submitting it and I couldn't get a straight answer from anyone.

I was prepared to pay it (and happened to have the money), until mom ran up the credit card again for the car and then told someone who called from the lab: "I can't and won't pay this." So in addition to interest being tacked on I'm now getting nastygrams, my cellphone--which they did not have and I did not want them to have--is blowing up with hangups all of a sudden and it may have been sent to collections (gee, thanks for that...if there's a way that I could make you responsible for paying it now I would)

On an upnote, I have coverage through work that starts next month and was actually cheaper (pretax deductions) so may not have to deal with the state system anymore.
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  #7  
Old 09-28-2017, 10:34 AM
Sandman Sandman is offline
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If you went to a MassHealth approved lab.. What the collections company, and the lab did, was extremely illegal. You CAN NOT BILL a procedure on a MassHealth (or any medicaid) person that they (medicaid) won't pay for. Hell.. Nobody would give me my PSG sleep study since I had a non-psg sleep study done in the past, even though Masshealth told my provider numerous times fto call them as they were electronically submitting the bill for the proper procedure codes.

  #8  
Old 11-30-2017, 11:50 PM
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Well, now I have a collection agency on my back...it seems like that is partially mom's fault; I was ready and willing to work out a payment plan with the lab directly (and actually had the extra money) until she essentially told them "I'm not paying this". If I have to pay a third party, it's money orders only. MH still maintains that I was not covered at the time of the lab work...but that was the same day as my exam which was covered, probably because they have to under state laws. Unless the lab wasn't even accepting the free plans at all...that would have been nice to know beforehand.

Welp, whatever I can afford to throw them each month is coming out of my rent contribution....and here I thought I was finally getting on top of things by paying off a small CC within the zero-interest period.
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