Another Insurance adventure.....and a easy way to document your adventures!!!

[Chalkie]

4 hours ago, Vladimir said:

How can I correct a wrong billing...if GEHA will not tell me what I was BILLED for in terms of medical services.

Do you not get EOBs?

[Vladimir]

19 hours ago, Chalkie said:

Do you not get EOBs?

I am traveling now, but under EOB I assume you mean the billing statement with the medical codes. 

Yes, I got the EOB's and called GEHA for them to explain what the billing codes meant.

I was told that telling me the billing codes was a violation of HIPAA and they could NOT provide me with the information!!!  Told me to go look up on the internet.

Which I did.  It had NOTHING to do with a annual physical.  How do you contest a improper billing when GEHA will NOT tell you what you were billed for in the first place!!!

Again, ATENA was the contractor that handled GEHA claims.  This year it is United HealthCare. 

Life will not got better.

[Chalkie]

1 hour ago, Vladimir said:

I am traveling now, but under EOB I assume you mean the billing statement with the medical codes. 

Yes, I got the EOB's and called GEHA for them to explain what the billing codes meant.

I was told that telling me the billing codes was a violation of HIPAA and they could NOT provide me with the information!!!  Told me to go look up on the internet.

Which I did.  It had NOTHING to do with a annual physical.  How do you contest a improper billing when GEHA will NOT tell you what you were billed for in the first place!!!

Again, ATENA was the contractor that handled GEHA claims.  This year it is United HealthCare. 

Life will not got better.

My wife worked a lot of years in the medical field and a job I had required we take an annual HIPAA test. To tell you that explaining a billing code to the patient is an utter load of BS. Law also says that you have right to appeal billing decisions. If they make an internal review and you are not happy with the decision you have the right of external review. This is to take the review process out of the hands of the insurance company and place it with a (supposedly) unbiased third party. I am curious though if you are getting GEHB and are of Medicare age. If so, my understanding is the Medicare becomes primary and GEHB is secondary very much like TFL for military retirees. 

[Vladimir]

33 minutes ago, Chalkie said:

My wife worked a lot of years in the medical field and a job I had required we take an annual HIPAA test. To tell you that explaining a billing code to the patient is an utter load of BS. Law also says that you have right to appeal billing decisions. If they make an internal review and you are not happy with the decision you have the right of external review. This is to take the review process out of the hands of the insurance company and place it with a (supposedly) unbiased third party. I am curious though if you are getting GEHB and are of Medicare age. If so, my understanding is the Medicare becomes primary and GEHB is secondary very much like TFL for military retirees. 

GEHA had TWO "utter loads of BS".

The first was that explaining the billing code to the patient is prohibited under HIPAA.

The second was the "incorrect" billing address which automatically kicked out a $51 dollar charge for my physical.  The original call to customer service identified the "incorrect address" and that it would be fixed.  When it wasn't fixed, I called again and talked to a supervisor that said they were NOT going to fix it and that I would have to APPEAL to fix it.  Really, you admit you made a mistake and now you want me to jump through a unnecessary hoop to fix it??

At that point, I had already initiated "fraud" charges through the state of Washington Attorney Generals office.  The Inspector General for the Federal government health FRAUD department told me to appeal and GEHA would refund my $51 dollars.  I told them I didn't care about the $51, but the fraud and stealing the money from taxpayers and patients was systematic and that needed fixed. 

We do have the best government money can buy and GEHA still owes me $51 dollars.

I waited for my next physical before doing anything since it was a month away.  I decided to wait a month to include the SECOND physical in the fraud charges.  

In 2020, President Trump signed the No Surprises Act, which required medical providers to tell folks in ADVANCE that they were going to be charged for an "out of network" provider.  The Biden Administration published the new regulations in 2022.

To paraphrase President Biden..." son of bitch, they paid for my entire physical without a co-pay of $51 charge".  Turns out, if they had to tell me before hand that some of visits to MY DOCTOR in HER OFFICE was out of network, and in network for other visits I would immediately drop GEHA.

GEHA is secondary. 

I pay $4,000 dollars in premiums for secondary coverage, and in addition the TAXPAYERS pay a additional 15,000 a year.  For this GEHA charged me $51 for a physical that they covered when I was working without CO-PAY.  As soon as I was under Medicare, they charged me $51 for the physical.

Does that make any sense??  GEHA and other insurance carriers are making a fortune off Federal retirees and the taxpayers. 

And it is still NOT enough for them.