New Courier At Fedex Blues...

Ricochet1a

Well-Known Member
In the "real" Express that exists now (thank God I'm no longer under that insurance) - as opposed to the fairy land Express a recent poster has painted - employees are getting slammed with denial of claims, assertions of "out of network" and requirements for pre-approval of procedures. Many of these procedures aren't just routine diagnostics, but rather they are urgent tests which are required to adequately diagnose acute issues.

I know of an Express employee first hand that has just returned to work from a life threatening event - they just managed to avoid being displaced. This employee received good care in the treatment facility, but is now battling a blizzard of claims - many of which make claim that certain providers are out of network - when the health care facility this employee was an inpatient of WAS in network. How is a patient supposed to verify each and every health care provider being "in-network", when they are literally fighting for their life? I suppose a family member is to be present 24 hours a day, checking any potential specialist which provide care in a particular facility - to see if they are covered by Anthem or CIGNA (as appropriate).

This individual is looking at post insurance coverage medical bills from the treatment facility and providers totaling in the mid 5 figure range; and they have the "highest" level of medical insurance which Express provides for its wage employees. Unfortunately, this individual doesn't have any supplemental insurance and no insurance coverage from their spouse. Their credit rating is going to get trashed when this hits collections and it will take months to battle through the billing to get to the point where the insurance pays the remainder of their portion and the employee is left paying their yearly "maximum" for "out of network" services.

I'd have to recommend to any Express employee with any diagnosed health issue for themselves or a covered family member to get supplemental insurance, or make sure they are covered under their spouses insurance if that is available - in addition to their Express insurance. Having dual coverage is cheaper that getting supplemental insurance, and being covered under a spouses insurance doesn't require going through any pre-qualifying assessment if they apply during open enrollment periods. Having dual coverage essentially means that the insurance companies fight it out over which will pay the primary coverage and which will take up the remaining billing.

The situation that exists is almost worse than having no insurance at all. An employee will go into a hospital thinking that they are at most liable for a few thousand dollars in billing if any out of network providers are involved. After the plan administrators get through denying everything they possibly can, the health providers and facilites then forward the billing to the patient. When you sign that admittance form, you are accepting FULL responsibility for paying all bills, the billing to the insurance is only done to speed the process.
 

vantexan

Well-Known Member
And don't get lulled into a false sense of security. If when you are dealing with an emergency and the hospital tells you that they've taken care of the insurance end, don't assume that will be the case with future tests and procedures. Apparently they didn't get approval for my stress test, and since everything had been handled by them before I thought this was all part of the treatment and taken care of. I'll offer 10%, which seems very fair for what was involved in the stress test.
 

Ricochet1a

Well-Known Member
One of the things most people don't realize is the "reasonable and customary" limits that are placed on out of network coverage.

I managed to find the 2009 benefits book (knew I kept it), but I obvously don't have the 2011.

When looking at the 2009 coverage of Premier Plus, for in-network care there was an annual $1,000 maximum out of pocket per individual, and an annual $5,500 maximum out of pocket per individual for out-of-network care. On the face of it, not too bad. I know the deductables are higher now.

But there is something which this casual observation doesn't reveal. Most of the talented health care providers didn't sign the contract CIGNA offered at the time (even fewer have signed the contracts offered by CIGNA or Anthem now).

So when one is admitted for an urgent issue, one will indeed receive care, but they will inevitably receive care from out of network providers.

This is when the system begins to "burn".

There is that "reasonable and customary" clause in the insurance. Quoting out of page 81 of the 2009 benefits book:

The Plan will not pay any charges that are more than the R&C limit. You must pay the amount that exceeds the R&C limit according to CIGNA HealthCare's guidelines. Charges over the R&C limit do not apply to the out-of-network deductible or out-of-pocket maximum. Expenses for in-network care are based on a negotiated fee schedule and you are not responsible for charges in exess of the negotiated rate.


So, if you are in-network, you're covered - any "excess" billing is wiped clean by the provider, they can't demand payment for that amount as part of the terms of their accepting the contract with CIGNA.

If you are out-of-network, you are personally liable for any charges over the R&C limit, these charges DON'T apply to the out of pocket maximum.

So if a neurosurgeon provides care (which will inevitably be out of network, no neurosurgeon is going to accept the rates CIGNA offered 2 years ago), they will charge their fee which NO ONE actually pays in full. Let's say it is $15,000 in this case.

The insurance will look at the actual procedure done by the neurosurgeon, and claim that the task's R&C fee is actually $7,000 - which is true, that is the average amount this procedure would collect. The insurance will then compensate the out of network provider at 70% of the R&C amount - which would be $4,900 in this case (assuming the annual maximum out of pocket hasn't already been paid). The patient would be thinking that they would only be liable for the other 30% of the R&C ($2,100 in this case), and if they had already reached their annual maximum out of pocket, the insurance - CIGNA - would then pick up this amount.

What happens is that the billing for the neurosurgeon will then come after the patient and claim that they are owed the remaining $8,000 or $10,100 (depending on the circumstances). This is when the whole thing goes to collections and a mess starts.

This is where having dual coverage comes in, the other insurance would battle with the billing department, and make a settlement of the final amount payable - the patient only receives the statements in the mail reporting the progress of how the billing is being whittled down.

Given the very low rates of compensation being offered by the current CIGNA and Anthem plans, most providers aren't signing contracts with the plans - meaning they are by default out-of-network.

The EXACT same thing is happening to Medicare and Medicaid - in order to cut costs, the government in these instances is offering less and less compensation for services rendered - so providers are refusing new patients and some outright refusing to provide care for those with these insurance plans. So people have these "plans", but are finding there are no providers who will accept them - and those providers who do accept them, have real issues with quality of care. There is a de facto two-tiered heatth care system developing.

Guess which "tier" Express health insurance is moving into. You (current employee) are paying more and more each year for your coverage - and it covers less and less while the selection of heath care providers keeps on getting narrower and narrower.
 

armymom

Member
Remember. "FedEx Cares".

This is not a FedEx problem it's an insurance problem. You continually want to place blame for everything. I'm sure upper management doesn't know your claims have been denied. What is your complaint with the insurance? Have they been denying you also? I had Cigna previously but now i have the Fedex Choice Premier with Blue Cross Blue Shield and no problems to speak of.....what level of insurance have you chosen or do you get a choice?
 

MrFedEx

Engorged Member
This is not a FedEx problem it's an insurance problem. You continually want to place blame for everything. I'm sure upper management doesn't know your claims have been denied. What is your complaint with the insurance? Have they been denying you also? I had Cigna previously but now i have the Fedex Choice Premier with Blue Cross Blue Shield and no problems to speak of.....what level of insurance have you chosen or do you get a choice?

FedEx is self-insured, so they have a vested interest in denying claims to save money. So it is a FedEx problem. God, how can you be so clueless.
 

armymom

Member
For anyone who is in need of a copy of the 2011 Benefits enrollment guide, I will be glad to email you a copy. It does state that with Cigna the provider handles the preauthorization and with
Anthem it is the members responsibility to handle all preauthorizations. Please pass this word on to your fellow employees. Anthem can and obviously will deny you for not doing so...It does get quite confusing as to what is covered and when....but ultimately it's up to the employee to keep track of it.
 

armymom

Member
FedEx is self-insured, so they have a vested interest in denying claims to save money. So it is a FedEx problem. God, how can you be so clueless.

Geesh you certainly know everything so maybe you can fix it for all of us! So what have you done to work on this problem? Other than just complain....Maybe since you know so much you can do something about it and help your fellow employees.
 

vantexan

Well-Known Member
For anyone who is in need of a copy of the 2011 Benefits enrollment guide, I will be glad to email you a copy. It does state that with Cigna the provider handles the preauthorization and with
Anthem it is the members responsibility to handle all preauthorizations. Please pass this word on to your fellow employees. Anthem can and obviously will deny you for not doing so...It does get quite confusing as to what is covered and when....but ultimately it's up to the employee to keep track of it.

Yes, and they got the benefits book to us in a timely manner, LOL. We got ours in mid-August. Doesn't matter though, the benefits card we got at start of the year has it in small print on the back that employee is responsible. I'm betting that since I didn't call that gave them a legal out to put the cost on me. Considering the kind of money involved I think the hospital should make sure themselves and if denied ask me if I want to proceed and explain the cost to me. As is they had handled everything up to that point and all this was new to me. But apparently it's too bad for me. Fortunately Texas doesn't allow garnishment of wages so I think I can work out a reasonable deal with them. But it means I'm a lifer in Texas or South Carolina as long as I'm working. Pennsylvania doesn't allow garnishment either but can't deal with the winter.
 

bbsam

Moderator
Staff member
My doctor wanted to do a stress test to determine how well my angioplasty and stent were doing. I guess Anthem decided since I was still alive that was good enough. Funny thing is that the new benefits book puts it on the employee to get approval first if you are under Anthem. The stress test was in March, the benefits book arrived about 2 weeks ago. Anthem denied the claim and the hospital says I owe them $7200. I may be filing bankruptcy as I got another notice today saying it goes to collections in 2 weeks.
$7200 for a stress test? WTF! That's not an insurance problem, that's a hospital-bending-you -over problem. Does it surprise you that insurance wouldn't pay $7200 for a stress test?
 

vantexan

Well-Known Member
$7200 for a stress test? WTF! That's not an insurance problem, that's a hospital-bending-you -over problem. Does it surprise you that insurance wouldn't pay $7200 for a stress test?

My angioplasty was over $50k and Anthem negotiated it down to less than $16k. Most likely they'd have whittled this bill down too if they had chosen to pay it. But $7200 for less than 2 hrs work is pretty extreme. On the other hand, the other hospital option around here doesn't have a great rep. A co-worker's brother-in-law went in for same procedure I had at the other hospital. They screwed it up and ended up doing an emergency quadruple bypass. The hospital I went to has an excellent national reputation.
 

Ricochet1a

Well-Known Member
Yes, and they got the benefits book to us in a timely manner, LOL. We got ours in mid-August. Doesn't matter though, the benefits card we got at start of the year has it in small print on the back that employee is responsible. I'm betting that since I didn't call that gave them a legal out to put the cost on me. Considering the kind of money involved I think the hospital should make sure themselves and if denied ask me if I want to proceed and explain the cost to me. As is they had handled everything up to that point and all this was new to me. But apparently it's too bad for me. Fortunately Texas doesn't allow garnishment of wages so I think I can work out a reasonable deal with them. But it means I'm a lifer in Texas or South Carolina as long as I'm working. Pennsylvania doesn't allow garnishment either but can't deal with the winter.

They may not be able to garnish wages, but they certainly can go to court and gain a judgment against you for the amount. With that in hand, they can get their cash in many different ways.

Your credit rating would also be trashed. You'd have a negative report filed against you for the unpaid amount, meaning that the interest rates on any variable credit you have would jump, and your ability to apply for new credit would be trashed.

All the "hospital" cares about, is that admittance form you sign. When you sign that form, you accept full and complete financial responsibility for all services received. Insurance billing is done merely as an administrative process to speed the collection of funds. When you are admitted to a hospital, any provider which provides care for you will have their billing service get a copy of that authorization form - that is their carte blanche to bill you for whatever service they state they provided to you. That form is the top form in your billing folder, and every provider will make sure they have a copy of it.

Real "health care reform" would've changed this dynamic. An admittance form would place the provider in the positon of financial responsibility when the patient's insurance is accepted. For instance, if patient provides insurance "X" upon admission, the provider would then make a decision (a sort of instant credit check) to accept that insurance as providing ultimate responsibility for all payments - with the sole proviso that the patient accept responsibility for all payment up to the maximum amount of the annual out of pocket limit.

If the patient has a $5,000 maximum out of pocket with insurance "X", then the patient is automatically limited to that maximum amount of liability - when the provider accepts the insurance provided at time of admittance. This would make it the responsibility of the provider to check for any pre-authorization requirement - if they didn't, they'd eat the billing themselves. Providers have entire staffs which specialize in this activity - how in the hell is a patient and their family supposed to navigate this minefield of arcane medical billing procedures?

If the provider doesn't wish to accept the insurance as meeting final financial responsibility, they tell the patient at time of admission. Then it would be up to the patient to accept final financial responsibility (as is current practice) or to find another provider who will accept their insurance. If they can't find a provider who would accept their insurance, they'd know their insurance isn't worth a plug nickel.

Both the insurance companies and health care facilities/advocacy groups have plenty of lobbyist to make sure that they are placed at the top of the payment pyramid, and the patient is at the bottom. This is part of the reason for the push to nationalize health care (Obamacare), but that will be rendered unconstitutional in the end.

Years ago when I had a family member with an acute condition - and accepted the task of getting the billing resolved - I hired a specialist in medical billing to coordinate the two different insurance providers covering my family member. It cost me, but in the end, the time and effort saved more than made up for what I paid the expert.
 

Ricochet1a

Well-Known Member
My angioplasty was over $50k and Anthem negotiated it down to less than $16k. Most likely they'd have whittled this bill down too if they had chosen to pay it. But $7200 for less than 2 hrs work is pretty extreme. On the other hand, the other hospital option around here doesn't have a great rep. A co-worker's brother-in-law went in for same procedure I had at the other hospital. They screwed it up and ended up doing an emergency quadruple bypass. The hospital I went to has an excellent national reputation.

Two tiered health care system....

You chose to utilize a first tier provider, and since FedEx's insurance isn't in-network for these providers (they wouldn't accept the low compensation amounts of the contract offered) - you are left holding the bag.
 

DOWNTRODDEN IN TEXAS

Well-Known Member
For anyone who is in need of a copy of the 2011 Benefits enrollment guide, I will be glad to email you a copy. It does state that with Cigna the provider handles the preauthorization and with
Anthem it is the members responsibility to handle all preauthorizations. Please pass this word on to your fellow employees. Anthem can and obviously will deny you for not doing so...It does get quite confusing as to what is covered and when....but ultimately it's up to the employee to keep track of it.

This is not entirely correct. I had to have lithotripsy, that's where go in and blast stuck kidney stones with a laser. The admissions people at the surgery center said I had to be pre-authorized, so I called Anthem from my phone, and the Anthem rep said that pre-authorization isn't always necessary and wasn't in my case.

Anthem sucks *****, I don't care who you are. I would absolutely LOVE to have the crappiest version of Cigna back. My kidney stone wound up costing me $4000, the entire procedure was "in-network" with care providers "in-network" and the total was only $6000. How is my 20%, $4000?

'splain me that one Lucy
 

Ricochet1a

Well-Known Member
This is not entirely correct. I had to have lithotripsy, that's where go in and blast stuck kidney stones with a laser. The admissions people at the surgery center said I had to be pre-authorized, so I called Anthem from my phone, and the Anthem rep said that pre-authorization isn't always necessary and wasn't in my case.

Anthem sucks *****, I don't care who you are. I would absolutely LOVE to have the crappiest version of Cigna back. My kidney stone wound up costing me $4000, the entire procedure was "in-network" with care providers "in-network" and the total was only $6000. How is my 20%, $4000?

'splain me that one Lucy

I'll take a stab at it....

You are first stuck with the deductables. So, once your deductable is figured, then the your individual responsibility of the percentage of the remainder kicks in.

With an out of pocket of $4000 though, that would surpass any maximum out of pocket expense for in-network. This means that there were out-of-network providers doing "work on you", who were compensated at a much different rate that the in-network providers. All what I posted about earlier - you have absolutely no control over who is in-network and who is out-of-network once you are admitted to a facility. The facility doesn't "steer" network providers to providing your care, they use whatever attending physicians on staff as providers of care. Whether those physicians have signed contracts with Anthem - matters not to the hospital or the providers. Once they get your signed admittance form (acceptance of financial responsibility), you are left holding the bag.
 

MrFedEx

Engorged Member
Geesh you certainly know everything so maybe you can fix it for all of us! So what have you done to work on this problem? Other than just complain....Maybe since you know so much you can do something about it and help your fellow employees.

How do you fix a rigged system? Since they are self-insured they created a bureaucracy where the "providers" (read deniers) such as CIGNA and Anthem simply deny a vast number of claims. Why? Because they hope you'll give-up, or just not go to the doctor next time when you are ill, or otherwise NOT utilize their services. I don't know everything, but it's obvious I know a Hell of a lot more than you do.
 

MrFedEx

Engorged Member
This is not entirely correct. I had to have lithotripsy, that's where go in and blast stuck kidney stones with a laser. The admissions people at the surgery center said I had to be pre-authorized, so I called Anthem from my phone, and the Anthem rep said that pre-authorization isn't always necessary and wasn't in my case.

Anthem sucks *****, I don't care who you are. I would absolutely LOVE to have the crappiest version of Cigna back. My kidney stone wound up costing me $4000, the entire procedure was "in-network" with care providers "in-network" and the total was only $6000. How is my 20%, $4000?

'splain me that one Lucy

I'll ' splain it for you Ricky. You are getting bent over. Fred's math is a bit off.
 

vantexan

Well-Known Member
They may not be able to garnish wages, but they certainly can go to court and gain a judgment against you for the amount. With that in hand, they can get their cash in many different ways.

Your credit rating would also be trashed. You'd have a negative report filed against you for the unpaid amount, meaning that the interest rates on any variable credit you have would jump, and your ability to apply for new credit would be trashed.

Actually a judgment is sought first so that a writ of garnishment can be obtained. Due to the authors of the Texas constitution being men who had serious debts back east, safeguards were written into it protecting debtors making Texas the single best state to be in if you owe money. If you don't owe taxes or child support then there's little that can be done to you. They can garnish bank accounts but each bank garnishment is a one time deal and if anyone is listed on your account that isn't party to the judgment then they can't touch it. Furthermore when the Statute of Limitations runs out then there's literally nothing they can do. My credit will take a hit but when you quit, your business goes south, you come back at low pay after living months on credit cards, your credit gets trashed anyways. Not a problem. I'm not paying extortion rates to anyone and if they try to intimidate me I'll just remind them of how wonderful Texas is.
 

Ricochet1a

Well-Known Member
Geesh you certainly know everything so maybe you can fix it for all of us! So what have you done to work on this problem? Other than just complain....Maybe since you know so much you can do something about it and help your fellow employees.

Working on the larger problem (Express employees getting the short end of the stick) ...

So what have I done to work on the problem... More than you'll ever know.

Best solution to solve the problem:

http://fedxmx.com/sites/fedxmx.com/files/FedEx_RepresentationCard.pdf

Get enough Express employees to fill this out, and the problem will be solved in due course.
 

MrFedEx

Engorged Member
Working on the larger problem (Express employees getting the short end of the stick) ...

So what have I done to work on the problem... More than you'll ever know.

Best solution to solve the problem:

http://fedxmx.com/sites/fedxmx.com/files/FedEx_RepresentationCard.pdf

Get enough Express employees to fill this out, and the problem will be solved in due course.

I hope you're not taking about unions! All you and MFE ever do is whine about how bad things at FedEx are! Unions are bad! Right-to-work states are good! I love the Tea Party! Michelle Bachmann is my hero! Just be glad you have a job with a Socilaist Kenyan Muslim in the White House! I am FedEx! I am clueless! I am proud of being clueless!
 

vantexan

Well-Known Member
I hope you're not taking about unions! All you and MFE ever do is whine about how bad things at FedEx are! Unions are bad! Right-to-work states are good! I love the Tea Party! Michelle Bachmann is my hero! Just be glad you have a job with a Socilaist Kenyan Muslim in the White House! I am FedEx! I am clueless! I am proud of being clueless!

Will suck to be you in November, 2012!! :happy-very:
 
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