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Old 12-08-2008, 08:09 AM   #21
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You cannot be singled out for a rate increase because of your individual claims. The rate increase will depend upon the claims from all the policyholders in your risk pool, and what the insurance company has to payout vs the premiums it has taken in.

Thank you and Al. For me, Health Ins. is a bigger worry than the market. Probably because it was so hard to get.
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Old 12-08-2008, 05:00 PM   #22
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I figured it out from talking to the provider.

Yes, you guys got it right. The provider charges $80, and BC allows only $76.59. We paid a $40 copay, BC paid $36.59. The provider is a participating provider, and is not charging us the $3.41.

The "It is your responsibility to pay" line was totally incorrect. It should have read

"You have already paid $40 -- you do not have to pay anything else."

Footnote 01 should have read "This is the amount in excess of the allowed expense for a participating provider. The member, therefore, is not responsible for this amount."

--------------------------------------

With reasonable terminology and a clear statement, there would have been no confusion. Any point in being a curmudgeon and calling BC to tell them the statements are wrong and confusing?
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Old 12-08-2008, 06:07 PM   #23
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With reasonable terminology and a clear statement, there would have been no confusion. Any point in being a curmudgeon and calling BC to tell them the statements are wrong and confusing?
Al,
One can always express that the EOB is hard to read, and as a customer, you hope they will listen. I worked for a health plan for 16 years and constantly pointed out that our customers wouldn't understand -- the result is the same today as it was then.

As to them knowing you were seeing a preferred provider and therefore, any amount over the allowed would be waived? Well all it takes is programming (or a completely different type of plan, OR the provider's software that doesn't submit a bill for more than the allowed amount).

One can always hope!

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Old 12-09-2008, 01:01 AM   #24
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Glad you got it figured out.
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Old 12-09-2008, 03:38 PM   #25
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Interesting thread. I am with BCBS of Louisiana and my EOB's are very similar to Al's except it does have a footnote saying "Your provider is a preferred provider, you do not owe this amount".

One of my pet peeves with the EOB's is that they do not detail what the service is for, so it is impossible for me to tell if we (the insurance company and I) are being charged for the correct services. Last year I had a crown fitted at the dentist and I was shocked to see how much I had to pay compared to the last crown I had a few years back. When I inquired of BCBS I was told that the BCBS clerk and transposed 2 digits on the code and it appeared as something totally different than a new crown with a MUCH higher co-pay.
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Old 12-09-2008, 07:33 PM   #26
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Interesting thread. I am with BCBS of Louisiana and my EOB's are very similar to Al's except it does have a footnote saying "Your provider is a preferred provider, you do not owe this amount".
I have another EOB with that footnote. I don't know why it was different for this provider.
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