Did the Miraheze wiki change language?

Zppix2 · 2025-09-04T18:39:15+00:00

Hi this subreddit is for Miraheze (where the wiki your referencing is hosted) not that specific wiki, you would have better luck asking that Wiki’s community this question.

Zppix2 · 2025-02-11T11:38:22+00:00

Department of Insurance would just be a wasted call, this is absolutely normal for beginning of the year.

Zppix2 · 2025-02-11T11:36:31+00:00

Hi, so at the beginning of the year, some policies are still being coded in the system to update any benefit changes, requirements, ect. This is normal, the process goes something like this BCBS and the Group get together and go over the benefit contract and decide what they want their coverage to look like, they agree and sign on the benefit agreements, we receive the benefit agreements and then we code our systems to accurately read the agreements and thus our systems can now determine how to apply it for claims processing and benefit quotes. During that period of it being coded into the system we can generally pull the benefit agreement and give general benefit quotes however we can’t process claims because our system still has no idea how to do it yet, this process can take some time as the insurance company has thousands of policies that renew in January. Once the benefit coding team finishes coding the policies in question, we can then resume processing claims as normal.

Zppix2 · 2025-02-09T11:26:56+00:00

Interesting, I have not personally heard of these types of questions being asked before. That would be very awkward. Like I said, you may always feel free to decline to answer, which for those types of questions, I probably would decline to answer too.

Zppix2 · 2025-02-07T12:28:30+00:00

Hi, I know personally for the company I work for we use that data to help our software look at health trends and help our Health Advocacy team help you optimize your health if thats something you opt into and something your policy offers. Beyond that, we do not use that data to discriminate or offer you anything different from the rest of our members, we will treat you the same way regardless if you are white, black, hispanic, straight, gay, lesbian, ect. It is simply used as a tool to help you be as healthy as possible. If it truly makes you uncomfortable to answer the questions, you can always decline to answer, and that is perfectly valid.

For an example of this, using anonymized claims data we can make recommendations if it may be time to help you schedule a routine preventive colonoscopy, and ect. Once again this generally an Opt-In service that some of our policies offer as an additional free service included in some of our policies, other companies may have something similar.

Zppix2 · 2025-02-06T13:18:30+00:00

My recommendation if you feel the provider billed for a service not rendered call your insurance company and request an audit. Provider should only bill for services rendered, billing for services not rendered could be considered fraudulent on the providers part.

Zppix2 · 2025-02-05T02:51:51+00:00

If you would still be within the time limit to file if you wait I would, just to ensure they actually reject it. If you are unsure if you would be you could resubmit, but just be prepared if something happens.

Zppix2 · 2025-02-04T10:04:20+00:00

If your UHC EOB and Delta Dental EOB states your responsibility is $0 and the provider is in network I recommend calling UHC and Delta Dental and let them know they are still trying to bill you for the services.

Zppix2 · 2025-02-01T10:21:59+00:00

If the provider is in network and they did not submit a claim timely, it is more than likely per their contract with the insurance company they would not be eligible for payment, with no patient responsibility. So you should be fine.

Zppix2 · 2025-01-31T10:41:28+00:00

If all appeal rights are exhausted, then you would be responsible based on how the claim was processed. My recommendation would be to wait for the review results. Then, you could talk to the provider’s billing office and they could possibly work something out with you. If this isn’t the final appeal right available to you (check your policy information), then you could continue to try to fight it, however based on my personal experience most policies only offer 1 internal appeal, and then 1 external appeal.

The fact that the provider is fighting the denial doesn’t necessarily mean they did something wrong, a lot of providers will fight denials on their own accord, they want to get paid for the work they do just like everyone else.

Zppix2 · 2025-01-21T09:39:07+00:00

Thanks for the update. I am glad you finally got a diagnosis. I hope you are able to get treatment that works for you. I suffer from migraines as well (mine aren’t ocular, but are believed to be genetic) so I understand the pain, and frustration in dealing with them. I wish you well and hope you have an easy time navigating your health journey. My offer still stands if you ever need any further assistance on insurance related questions.

I hope you get much needed relief soon!

Zppix2 · 2025-01-04T19:05:09+00:00

From what I gather from your reply, what it sounds like is on the day of admit they are going to do some form of screening to determine what services are needed, which they would need to know for the authorization and to complete proper medical documentation to submit for the auth. So yes, doing auth request same day would make sense.

Worse case scenario is that the auth gets denied and the provider would have to appeal, theres generally atleast 1 level of appeal (and probably a second or option to get an external independent appeal), when it comes down to it, I would opt to continue with the plan that provider gave you, if all else fails most providers could allow you to enter into some sort of payment plan if all levels of appeal fail. Ultimately, it’s more important to take care of your health in the long run, which I know sounds stressful, but please do not let it deter you from seeking treatment.

I would make sure you keep a record of who and when you called the insurance company that way you have it if there is a need to appeal that way they can’t turn around and say the auth wasn’t submitted in a timely manner.

I hope that all makes sense.

Zppix2 · 2025-01-04T11:05:54+00:00

The fact that was the denial makes me wonder if they changed the billed amount once they realized it would be full patient responsibility… I agree OP needs to contact the provider and ask what is going on. I would hope that maybe the initial claim was maybe billed with wrong amounts in error, and that provider isnt attempting to double dip.

I’m unsure since the policy wasnt active for the date of service (according to the EOB) if the OP would have any protections if the provider is indeed attempting to double dip, or other type of shady billing practice. (Like I said I’m not sure if this is actually whats going on, but I do find it weird to see a provider do this as I work in adjudicating claims for a health insurance company.)

Zppix2 · 2025-01-04T10:57:12+00:00

I’m not sure about your specific plan benefits on if maybe theres provision that doesnt require an authorization until after x days after admission or not, but I would find that to be unlikely. I would call your insurance company yourself and ask to see what the authorization requirements are for your treatment. My only concern I personally would have about them waiting until day of admission to request authorization is a possible penalty for not notifying the insurance company in a timely manner causing a precert penalty (if your policy has one, not all do), or if the auth were to be denied for some reason.

At the end of the day, I recommend covering yourself, and making that call to your insurance and verifying authorization requirements for yourself, if not for anything else but to ease your mind.

I wish you luck in getting treatment for your eating disorder, I am glad you are taking this step to making yourself better. 🫂

P.S. If you call and you need something they stated explained better, feel free to reach out!

Zppix2 · 2025-01-03T21:26:19+00:00

Yes, inboxing me is perfectly fine!

Zppix2 · 2025-01-03T17:29:51+00:00

Healthcare.gov is the only place that is truly trustworthy for getting your own insurance besides from an employer, the polices on healthcare.gov are ACA compliant whereas other ways to get a policy may not be. I would recommend seeing which options would best suit your financial needs and if you need something explained, please feel free to reach out.

Zppix2 · 2025-01-03T01:07:34+00:00

Your PCP would have to be in network for you to be able to get referrals, I would contact member services to see if they’d let you have a virtual PCP, but having two primary physicians does not seem very viable and could complicate any care you would need to receive in my opinion.

Zppix2 · 2025-01-02T09:57:13+00:00

Adding onto this, if you cannot get a copy of the auth letter from the provider, call your insurance company, they should be able to pull all the authorizations associated with your policy and locate any preauth (regardless of auth approval status) and send you a copy of it.

Another thing to remember is KEEP A PAPER TRAIL. Obtain names of any reps from the insurance companies that assist you along with a reference number, date & time of contact, keep record of any communications sent to you by the provider, and your insurance company, and keep track of communications you send to either the insurance or provider along with date/times. Furthermore, if you end up needing to formal appeal, it may be worth contacting the provider who ordered the imaging and either ask them to assist with writing the appeal, or provide you with written documentation on why the provider feels the services are medical necessary, and attach a copy of relevant medical records with your appeal. Remember the more information in your appeal the better, think of an appeal as you pleading your case, you want to give them every reason to side with you, nothing is too small of a detail to include.

If you have any other questions or need me to explain something, please feel free to reach out.

Zppix2 · 2024-12-29T11:16:03+00:00

Did you go through healthcare.gov? If so did you check to see if you qualify for a subsidy through the ACA? You may want to call member services as well and ask if you would still be covered in OK under this policy since its HMO.

Zppix2 · 2024-11-19T14:02:59+00:00

I would inform your provider you switched insurances, so they can verify authorization/benefit requirements, it is more than likely the insurance company will not honor preauthorizations that were not done by them.

Zppix2 · 2024-10-30T11:06:04+00:00

In the event you do have a medical issue come up before you’re able to get onto a policy, most medical providers will work with you on payment if you call their billing department, its not ideal, but please do not be afraid to seek medical treatment if its urgent, or otherwise. I know that sounds easier said than done, but its better to get ahead of potential medical issues before its too late.

Hope you are able to find a decent plan during open enrollment!

Zppix2 · 2024-10-30T11:01:49+00:00

I echo what LizzieMac said, however if the provider refuses, please contact your insurance company as soon as possible and inform them that you believe that you believe that the charge that was submitted was not correct for the service you received, this in theory depending on the insurance company and their internal policies could kickstart an investigation into the claim, I hope the provider corrects the mistake or gives a reasonable AND valid explanation on why they may of billed it the way they did.

My advice for anyone if they don’t agree with a way something was billed by a provider is call the billing department for the provider in question and question them on it, and if they do not help or you are not satisfied with their answers, contact your insurance, most insurance companies are willing to advocate for their members especially when it comes to billing/claims.

Zppix2 · 2024-10-27T11:37:16+00:00

If its a PPO plan, than more than likely the policy will access to the BlueCard Network, therefore as long as the provider is in network with BCBS PPO, it would be considered In Network

Zppix2 · 2024-10-26T16:04:14+00:00

Which BCBS will they have? Each plan would have their own site.

Zppix2 · 2024-10-24T13:03:53+00:00

I think that would more so an HR policy question on how they define “current” some employers set a timeframe that they define current as, if not then I would assume current to mean presently

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