I am a coding specialist for a Eye doctor in rural Missouri. I have had numerous people call in and complain because there is a Out of Network deductible for their services rendered by our doctors. We explain to our patients ahead of time that we are not providers but we can bill their claims out for them and everything is subject to their plan. Come to find out there aren't any In Network doctors within 65 miles.
I felt especially bad for a couple from the town I live in that we have been seeing since 1996. This patient has to have test ran every 3-6 months to monitor a condition for his eye (he only has one, and now has glaucoma in his other eye).
Anyways, I spent an hour on the phone and I found out there is a waver that the parients can fill out to get their claims processed as in network if there isn't any In network docs within 30 miles, so we did all of that and got an authorization for all backdated services and through the end of the year. Now about 2 months later and 9 calls and 4 hours + on the phone with people that can't help me I am still stuck! I have spoke with Supervisor after supervisor that promice the moon and all I get is rejections and duplicat claims.
I finally called the patients Insurance agent to inform him that the insurance that he sold these people was not something that is working for them, started to explain all the problems with In and Out of networks and he and said "People hear what they want and he has been selling this insurance for 5 years" well Mr Gary I want to let you know that this poor guy with only one eye has been coming to us for a very long time and you should ask more questions and "qualify your customers" before you sell them a useless insurance plan!!!
BEFORE YOU BUY HUMANA - CHECK TO MAKE SURE YOU HAVE DOCTORS IN YOUR AREA!!! HUMANA IS NOT THE SAME AS MEDICARE!