Insurance woes (if this isn't allowed please delete)

cm2020 - Insurance is so confusing. What is covered/what is not/deductables/co-pays. The claims that go back and forth between insurance and the provider, trying to track what the insurance shows with what is on the bill. One "visit" might result in several bills - different specialists, the facility , a lab, etc. Usually I can only match them with the date of service. Last year I was so stressed with a new diagnosis, and so confused with all the billing, I used the "S" bomb with the insurance, and was about to drop the "F" bomb when I stopped myself, knowing that the person I was talking to had limited ability to even answer questions. I do my best to match bills with insurance claims, call the insurance with questions, and sometimes the provider. With a 3rd incident of BC, my DR ordered a genetic panel specific to BC, because she felt each occurence was a new one and not a recurrence. After 7 months, insurance denied the claim, saying the test was not relevant to diagnosis or treatment. The lab doing the test has done the initial appeal, and feels certain that insurance will cover most of the $1500 charge. At times my partner doesn't seem to get it either, the stress from just having BC, not knowing if treatments are helping, and the SEs. He tends to be quite healthy and energetic, and used to go jogging first thing in AM. He finally sort of got it with insurance, when I showed him one of the confusing ones.

Were the claims reprocessed on behalf of the providers, or the insurance company?

Yikes! Even if you, hypothetically, didn't meet your OOP maximum yet, what would your out of pocket for radiation be? I think I owed 20% of everything. If you are close enough to your OOP that claims being adjusted here and there change things, maybe it wouldn't end up being that much money?

A couple of suggestions---1) Have you spoken to your radiation oncologist about all of this? They need to know that you're concerned about cost of therapy. They may have a social worker that can help.

2) Does the facility have some sort of "patient advocate?" I had an issue where a missed bill went to collections (I thought I had paid it but clearly didn't), and the patient advocate sorted it out.

Just some ideas. I hate the thought of you canceling necessary treatment because of insurance issues. If the insurance and provider are both blaming each other, makes me wonder if it's some sort of clerical mistake.

cm2020, check all copies of explanation of benefits(eob) look at insurance policy for out of pocket and deductibles, if you have met these, make copies and send to insurance company again and again. Don't take someone else's stupidity out on yourself, keep going with your treatments, you are priceless, remember that always

Somewhere on your eobs would say deductibles have been met

If it helps you at all, I did not deal with any insurance claims until I was done with my radiation. For me, the radiation phase was when the whole I just got a cancer diagnosis actually hit me. Perhaps that's why you are feeling this way right now too. Put the insurance aside. I do not let them dictate my healthcare. The doctors don't either. They will still treat you. Go get your radiation done and deal with later. I hope you will feel a lot better once you get out of the active treatment. That will also give insurance company time to do whatever it is they're doing. Match up the EOBs (explanation of benefits) to the bills later. I had several claims go out to collections, but I eventually got to a good place and caught up.

So glad you're going ahead with radiation. Hope things go well. BTW - don't write any more checks later when you have the leisure to straighten them out.