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If you guys have a HMO plan and you cannot go out of Network, or you won't be covered and/or will have a huge out of network payment, the insurance can always negotiate with the hospital and physicians for out of network payment, which is usually a percentage of charges.
Especially with the emergency MTH. You could not have worked this out in advance. Don't let yourself be stuck with the bills. There are ways around it.
What state are you in? Check that state's statute re HMO balance billing and check with your insurance company.
Daytripper......the person who got the authorization for your husband's coverage should have known about the difference in coverage and told you about it before proceeding with the elective surgery. I'm surprised a inpatient admission would have been covered 100% whereas there is such a huge balance for outpatient. This is backwards. There are very few Inpatient only procedures and those that can be done outpatient are not covered as inpatient. Make sure you know your plan and your rights.
This sounds insane.
Good luck.
Yeah, the lady who does the ins stuff at the surgeons office called for preapproval , I discussed this with her after the fact. I know quite often these conversations are recorded and asked her to check and see if the ins. company would provide a copy of it. I think they should have honored their approval of the proceedure....they are the ones who told the doctors office this was all covered. After all that I read my hubby's policy and it says 10,000 max per year for outpatient services. I also found a 5000.00 accident rider which helped with some of the costs not covered. Live and learn. It did turn into a bit of a mess. I guess on the inpatient part We would have incurred so much out of pocket , and then the rest would have been covered 100%. Water under the bridge at this point. It was not an inpatient proceedure anyway.
I'm just hoping I don't need any emergency help---my HMO, Kaiser is in CA. I have not even tried to change it. There is no Kaiser in NC. I keep an address in CA as is is cheaper then getting a new insurance here. I have been told in case of an emergency they will cover any place you must go so I am counting on that. For any regular medical needs I just have to fly back to CA for that which is still cheaper then trying to get another insurance here. It's really crazy!!
Tonight, if I get off of this computer, we are have steamed crab clusters with lots of garlic butter on the side for dipping; potato cubes baked with olive oil and marjoram, thyme, and parsley; baby mixed greens with 3 kinds of olives (green, Greek and Kalamata), tomatoes, feta cheese, and cukes with Greek dressing; and a crusty French baguette fresh from the bakery.
The chicken just falls apart!
1 TSP.oil
1 med. onion
1/2 C. ketchup
1/2 C water
2 TBSP. vinegar
2 TBSP.brown sugar
11/2 tsp.worcestershire sauce
1/2 tsp.chili powder
1/4 tsp.celery seed or 1/2 flakes
3 lb.chicken skinned and cut into serv. pieces
Heat oil in a large skillet. Add the onion and cook until softned. Stir in ketchup, water,vinegar,brown sugar,worces.sauce,chili powder,and celery seed.
Add chicken placing what used to be the skin side down.
Cover, cook for 30 min. ..uncover and cook for another 15 min. or until tender.
Hope you enjoy as much as I do!
Tonight, if I get off of this computer, we are have steamed crab clusters with lots of garlic butter on the side for dipping; potato cubes baked with olive oil and marjoram, thyme, and parsley; baby mixed greens with 3 kinds of olives (green, Greek and Kalamata), tomatoes, feta cheese, and cukes with Greek dressing; and a crusty French baguette fresh from the bakery.
Tonight, if I get off of this computer, we are have steamed crab clusters with lots of garlic butter on the side for dipping; potato cubes baked with olive oil and marjoram, thyme, and parsley; baby mixed greens with 3 kinds of olives (green, Greek and Kalamata), tomatoes, feta cheese, and cukes with Greek dressing; and a crusty French baguette fresh from the bakery.
Gotta' run. Oven just preheated!
Yummy, can I come over?!?! The older I get the less I enjoy cooking. Also, if you are single at home why cook? Left overs for me tonight. Boring.
I tried the recipe for the cheesy chicken casserole on the back of the Campbell's Cream of Chicken soup tonight. It is delicious, and easy. Granted, you need to understand I never make anything exactly as the recipe calls for, and instead of two cups of a frozen vegetable mix, I use chopped fresh onion, celery, and carrots, and then added frozen peas and green beans to make the two cups of veggies. I also seasoned the casserole with fresh rosemary, thyme, and sage.
Highly recommend the recipe.
Also wanted to thank you Guys for the chicken recipes I tried earlier in the week. Equally as good. I loved the Chicken Cordon Bleu.
Tonight we had grilled Ahi Tuna, marinated in soy, fresh lemon juice, fresh garlic, parsley, thyme and ground pepper. Julienne fennel salad and yellow saffron rice.
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