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.
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.