 We were robbed in Rome on Tuesday, now insurance co' are trying to wriggle out of paying us. any advice? |
On the metro in Rome on the second day of our holiday we were robbed, my bag, purse, jewellery and a large amount of cash plus my husbands wallet and credit cards
The Insurance company are ... |
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 Want to put dad in life insurance??? |
I want to get life insurance for my father. Will I be the beneficery for him-after he passes away? Also, is a medical check required for this?
Thanks in advance for all of the positive ... |
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 Car insurance!? |
how long before the policy expires does your insurance company send you the delightful letter detailing how much your insurance will cost for the following year!!
im looking around for ... |
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| So I was in a car accident -other driver's fault-just some rear end damage-approx 3500 worth of damage. My car has now been in the shop almost one month and i keep getting the run around -i ... |
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| I need health insurance for my husband and myself. I keep getting denied because I had a hip replacement and torn rotor cuff repair. I also take 4 meds daily[hormone replacement. anxiety,bld ... |
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 Who knows the answer to this question:? |
| I have a policy with 21st Century Insurance. I also have a teenage son in my house who uses my car to go to school everyday. He is not on my auto insurance policy and he caused an accident yesterday.<... |
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| I can't get health insurance now can i? |
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 Help with a home insurance claim...? |
we want to claim on our home insurance but have never done so before, what is the best thing to say and will they come out personaly to check we are telling the truth?
also how often should we ... |
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 Can my health insurance company refuse to pay for my son's broken arm because it happened at the neighbors? |
| My son broke his arm playing at the neighbor's house. Can my insurance company refuse to pay for the medical expenses? We got a letter stating that they wanted us to use the neighbor's ... |
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mr. bungle | My doctor is defrauding insurance company? |
I went to see two different gynecologists in same county but different cities within 1 month for EXACT SAME check-up/test(1st trimester pregnancy). Instead of charging the insurance the same or similar amount, one doctor charged $680 while the other doctor charged $130. Is one doctor defrauding the insurance or is this normal variance between different doctors? I live in Los angeles county |
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wish I were
 |
If you went twice for the exact same check up, then didn't YOU defraud the insurance co???? |
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CSUflyer
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Can't tell unless you know exactly what the listed charges are for. It's not a crime to charge different prices, the insurance company may only pay a flat rate for certain procedures anyway, no matter what the doctors ask for. If the doctor is saying he did things that he didn't, you will know when the insurance company sends you your version of the paperwork, then you can turn him in if necessary |
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jimmymae2000
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They are both cheap at twice the price, some doctors charge that much to take out a splinter. |
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♥♥The Queen Has Spoken♥♥
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Depends on what the demand of the higher paying doctor. That might be HIS usual fee. However it's my experience that insurance companies have a ceiling for what they actually pay any in network doctor. So they probably won't pay him $680.00. |
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M S
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Some people are specialists. Some insurances pay set amounts "in system". Some doctors are participating
providers and some aren't. The big question is how much did you have to pay, and will you be reimbursed by insurance? |
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dk
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Totally normal. It has to do with the agreements between individual doctors and the insurance company. Because insurance typically pays a lesser amount than billing, many doctors charge a high billing amount thinking that they may end up getting a higher amount from the insurance company. |
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zippythejessi
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In theory, a doctor can CHARGE whatever they want. It's what they get PAID is where the difference lies. When a doctor is contracted to an insurance company, they agree to accept whatever amount the insurance pays for whatever service they perform.
The only way I can account for the huge difference is to ask this: had you ever seen the doctor that charged the $680 before? Often, if you're a new patient, they charge significantly higher for your first visit because they're supposed to be getting your entire health history. Also, "specialists" charge a LOT more than "regular" doctors, so if that one was listed anywhere as any kind of specialist, that can also account for the price difference. |
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old school
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Most reimbursement is based on zip code. Yep. I worked on a few projects for a very large insurance company. It is not unusual for the rates to be different even for the same specialist. |
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tatertown_94
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Could it be one is an HMO doctor and the other is a private practise? Or maybe the reimbursement rates are different for a Preferred Provider vs. a Non-covered provider?
Reimbursement rates (a.k.a. charges) are based on the procedures billed and the diagnosis submitted. One could have listed you as a 1st trimester (congrats!) and the other possibly as a High-risk pregnancy. As for procedures, one could have submitted for general blood draws and the other for a triple screen test (too lengthy to go into here). |
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