When I worked before, my insurance company was United Health PPO.
As a result of a blood test, my pancreatic level (CA19-9) was poor, I had indigestion, and I suddenly lost 7-8 kg in weight.
An x-ray showed there was something white in the pancreas.
Although the possibility is low, it could be pancreatic cancer, so the doctor wrote a letter requesting a CT scan for an accurate diagnosis.
I went for a CT scan.
Since I was using PPO, I could go to any hospital without prior permission from the insurance company, so I went to get a CT without worrying about insurance payment.
3000 dollars from my wallet ㄷ ㄷ
image text translation
SHIN IMAGING LLC
NAME
PO BOX 19249
CHUN
NEWBURY PARK, CA 91319-9249
800-210-0857
=NT DATE
2/19,2021
PATIENT BALANCE DUE
SO.00
AMOUNT PAID
Generated on: 2/19/2021 6,04.41 PM
Detach Here
Date
Place of Service
Rendering Doctor
Code
Description
Amount
9/18/2020 SHIN IMAGING
BUENA PARK LINA LEMD
74170
CT ABDOMEN WITH AND WITHOUT CONTRAST
S3,000.00
9/18/2020
CASH PAYMENT AT TOS
(S393,18)
9/18/2020
CASHATTOS CREDIT
($2,606.82)
9/18/2020 SHIN IMAGING
BUENA PARK LINA LE MD
Q9967 OMNIPAQUE 300
S52.00
9/18/2020
CASH PAYMENT AT TOS
(86.82)
9/18/2020
CASH AT TOS CREDIT
(S45.18)
Total payments and adjustments:
(83,052.00)
Balance forward:
80.00
The balance given On this billing statement includes only
services shown Ifyou received other servicos
may be billed
separately.
the
{hey
If you look at the receipt, you will see that it is not a simple bill that has not been signed.
This is the receipt I received after paying the already adjusted fee in cash.
Well, I lost some money, but fortunately it wasn’t cancer but pancreatitis, so I quit drinking and am taking good care of my health.
The problem is
image text translation
Boran person El
Global Escalation Team
globalescalationteam@uhcglobal com
When receiving
date
April 4, 2021 7:56 AM
Standard encryption (TLS)
8
Learn more
Dear
am
letting you know that the claims for date of
service 09/18/2020 claim
Imaging.
I am
letting you know that the claim
was
reviewed for medical necessity and denied due to
treatment is not consistent with
published clinical
evidence.
Once the
explanation of benefits
generated you can file an appeal for the decision.
How you can appeal this decision:
As mentioned
on every Explanation of Benefits you
(((
receive from us,
A review of this benefit
determination may be requested by submitting your
appeal to us in writing at the following address:
UnitedHealthcare Appeals
P.O. Box 30573, Salt Lake
UT
84130-0573
or faxed to 801-938-2109 or
888-697-8323
The request for your review must be
made within 180 days from the date you receive this
statement.
If you request a review of your claim
denial,
we will
complete
our review not later than 30
after
we receive Your request for review.
If you
City;
days
I am applying to United to pay for CT costs.
United refuses to pay for MRI due to excessive treatment.
They even circulated emails all over the place saying they had an MRI done in September 2020, and in April of the following year, they dragged on for 7 months and refused.
Aside from that, when I used United PPO, there were a few other minor cases where I was denied medication or specialist visits. I wondered why I would pay so much to use PPO if that was the case, so I changed my insurance to a reputable company called Kaiser the following year…
image text translation
Claim denial rates by
insurance company
Kaiser
7%
Permanente
Oscar
12%
Ambetter
14%
Industry
16%
average
BCBS
17%
Cigna
18%
Molina
19%
Aetna
20%
CareSource
20%
Anthem
23%
Medica
27%
UHC
329
Based on available in-network claim data for plans
sold on the
marketplace
There’s a company at the top with a 7% rejection rate.
The reason they have a low rejection rate is…
People with Kaiser insurance can only go to hospitals operated by Kaiser.
They have built and operated a huge number of hospitals across the United States, ranging from university-level hospitals to medium-sized secondary hospitals in small towns.
image text translation
~geunrek-dae
rosemead
Kaiser
Permanente
west
Baldwin Park
Ontrey Park
Medical Center
West Pu
South Elsonrec
Kaiser
anente East
Kaiser
~OS
Angeles
Permanente
ical Offices
Pharmacy
Crossroads
Kaiser
Medical offices
inter
Permanente
Rose Hills
Montebello
Medical Offices
Hacienda Hirut
Goode
nice
Pico Rivera
Kaiser
Permanente
Burl Gartens
Whittier
2
Medical Offices
Kaiser
ermanente
Downey Medical
Santa Tet France
harmacy
Center
+1
+6
South Whittier
Lahabo
Lenut
Target
East Whittier
Kaiser
La Mirada
Pharr
3
Permanente
Kaid
Lamount
Norwalk Medical
Perman
Bellflower
Offices
Habra
Medical Offices
Offt
39
+2
Buena Park
Kaiser
Permanente
La Palma Kaiser
Cerritos
Medical Offices
Kais
Permar
Hawaiian Gartens
Euclid M.
19
Offic
water
If you ask your friends in the medical field, they will tell you that it is difficult to get a job at Kaiser Hospital, and the quality of the doctors is so good.
Anyway, since the insurance company builds a hospital and provides its own medical services, the rejection rate is bound to be low as their own doctors do the diagnosis.
The best thing above all is
In the United States, I searched for doctors/hospitals contracted with my insurance.
Internal medicine at hospital A
MRI goes to hospital B
Hospital C has an insurance contract with Hospital C, so I receive orthopedic treatment from Doctor D at Hospital C.
Freelance doctor E, who works in the neurosurgery department at Hospital C, does not have a contract with my insurance, so I feel like going to see the neurosurgeon at Hospital D.
Hospital hit and run is severe.
I can’t handle everything in one day, so I have to take a lot of sick leave.
However, when I go to Kaiser Hospital, I can just go once and see all the medical treatments in one day, so I am very satisfied because everything is resolved.