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Comment by arkades | Hacker News Reader

1) know who to appeal to outside the company. This is the nuclear option. It's usually listed in fine print on every paper denial.

2) "My (partner) works in insurance. He does shit like this for a living. Please don't make me have to (goto 1)".

3) Feel free to cite the law where relevant, on paper, certified mail. The response is invariably "this is wrong, you misunderstand the law, but we will make an exception and (follow the fucking law this once.)"

I was in health insurance, management level, before I went into medicine.

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The number one rule is don't pay anything until it is resolved. The second you've made payment, nobody else cares to make any effort.

This is not something I'd recommend. Any lapse in payment will be used to suspend your policy in the future in the event you get flagged as a high-expense patient, backdated to the period you didn't pay your premiums on time.

Pay on time, keep documentation you paid on time. Hell, turn on autopay and keep documentation on -that-.

Don't ever think you can hold your premiums hostage. You'll only be screwing yourself.

Edit: if you're referring to clinic bills, be sure you're in active communication with the practice manager so you don't get sent to collections. If it's a hospital, you'll be sent to collections anyway - they automate that process, once you're sufficiently late.

I wonder if they meant that you shouldn't pay providers until things are sorted out. I agree that you need to pay your premiums, but doctors and hospitals will just send you to collections. Still not a great option, but it does keep the money in your pocket until things are sorted out. (Of course, I wouldn't do this unless I was very sure I was right, also, so that any collections issues would be an insurer/provider error.)

If you don't pay a bill, there's no error. The subsequent hit to interest rates on something like a mortgage outweighs most minor medical bills.

As far as your provider is concerned, whether your insurance should pay or not isn't really their problem. I have never been somewhere that did not make me sign a form saying that I agreed to be responsible for whatever my insurance did not pay.

Most providers understand the shit-show that is insurance, and will drastically adjust their behavior and prices based on who is paying.

Maybe, but that doesn't help if it goes to collections like the parent part describes.

It is (also) their problem. If they're in the network, they've agreed to certain terms as well.

I'm not saying skip out on your bills. I'm saying that the provider and insurance need to figure the bill out. I'm not floating a provider in my network so that I can fill out a ton more paperwork to get reimbursed eventually.

And yes, they do make errors in major ways. Just two years ago, I got as though I hadn't made my deductible. It was a $2500 difference. It's much easier to have a provider refile to get their money than for me to pay them and then work through the insurer's system to get reimbursement.

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