Good luck!

I found that I am in the 37th Legislative District. The website says Adam Kline is the senator while Sharon Tomoko Santos and Eric Pettigrew are representatives. Do I handwrite a letter to one or each of them?

Thank you!

The people at Premera, though they scheduled my second appeal to be IN PERSON did not expect me to show up to the point that they didn’t even book the room or have the members of the panel ready. While it didn’t help my case, it did take them by surprise, and I believe if more people get directly involved, it will make a difference. I can only believe that all the people involved, doctor’s offices, insurance companies, etc. are banking on people not standing up for themselves and being passive consumers. It costs them time and money to deal with appeals.

Best of luck to you, and again, thanks for the response.

Despite the ER + radiology total costs being 7-10 times higher than the a physician charges, my out of pocket expense is now about 2x more as a result of paying the uncovered portion of the out of network physician than it would’ve been if I need only pay my ER co-pay, coinsurance, and meeting my deductible. My insurance plan’s “out-of-pocket maximum” is $1800 per year, but because of the out-of-network physician technicality I’ve paid over that much out of pocket while only about 1/3 of what I have paid actually counts toward it.

I work for a different kind of insurance company, we do auto, home, life, etc. While our contracts can in some regards be hard to decipher — any document that needs to be legally concise will suffer from this — it’s not difficult to know what is and isn’t covered and what the out of pocket cost will be if it is or isn’t covered. Health insurance is a big mystery though, with providers not knowing what a person’s insurance will or will not cover and the insurer not being able to aptly help their customers find providers and facilities that would have coverage all around.

When I visited in July I did not even notice that the several hundred dollar bill from Seattle Emergency Physicians was something not covered. I had actually assumed it was just part of meeting my deductible, coinsurance, and co-pay, so I went ahead and paid it. It wasn’t until my visit in August, which lasted an hour or two longer and thus incurred higher expenses, that I realized I had even larger bills the second time around despite having met my deductible from the first visit a month earlier.

I called the insurance company who suggested that I call the physician to see if they’ll reduce the bill. I thought this was odd since I couldn’t imagine a doctor reducing their price knowing full well they can ruin my credit if I don’t pay what they ask; this proved to be true, as the physician’s billing flat out told me they don’t reduce their fees. They recommend I speak with Premera again and file an appeal.

I sent a written appeal explaining how I had kidney stones unexpectedly at 6am and the following month at 3am and Swedish was the closest hospital ER I knew to go to, and since I knew Swedish to be a “preferred provider” for Premera I thought it a safe bet. I told them I was laid up for several hours at the hospital, during which time I have no idea what person that came into the room was even the doctor, and had no choice in the doctor overseeing my care. They responded about a week or two ago with a denial of my appeal. Their contract language does state that out-of-network provider costs may be left to me, but I have to be honest that I had no idea the hospital would have doctors that aren’t in the network that the hospital is in. After having kidney stones in 2001 and 2005 while insured with Aetna I was probably also a bit jaded because in those cases I simply paid a $50 ER co-pay and never saw another bill (though that was admittedly before the awful bloat of our healthcare system started turning into the higher rates and reduced coverages of health insurance plans we see today).

Should I continue to appeal? Should I forward a copy of my appeal to my congressman/woman?

Their website shows only 13 Emergency medicine PPO specialists in the entire state and none within 75 miles of my home. Their toll free number told me only 1 ER physician was within 75 miles of my home, they knew his name, but not what hospital he practiced at! They have refused to provide me with info. stating what other ER doctors in my area are contracted at. It’s truly amazing that they are getting away with this.

After they refuse my Level 2 appeal I am going to request an IRO. They have to pay outsiders to consider my case. I find it amazing that they will waste so much time and effort on such a small amount of money. I’m sure by now they have wasted much more money in correspondence and employee time then they would have by paying the remainder of my bill!