Same problem here. sm

We have one of those "wonderful" HMOs that takes $96.00 a week out of my husband's pay and pays for NOTHING!

$20.00 copay for the PCP, but the PCP can never get you seen and suggest you go to the ER.  $100 copay for ER and then they only pay 80%.  My son went in for an earache (PCP was toooooooo busy) and with copay, I received an ER bill for almost $300.  I was DENIED because I didn't take my son to see his PCP instead of using the ER, even though I explained to them that the doctor TOLD ME to take him to the ER because he had no time.  His PCP office is staffed with 20 somethings that constantly screw up the paperwork and I have recently found a new PCP for my son. (I'm fighting this).

In addition, our  Rx plan is another $100.00 deductible (which we had not used yet) and charges for $10 generic, $20 "preferred" and $40 "brand name."

You guessed it.  No "generic" and no "preferred."  Another $40 for "brand name" ear drops, for which the cost was "applied to the deductible," which starts all over again in January.

Nearly $400 later for "swimmers ear," we are thinking about just dropping the insurance. But, knowing our luck, one of the kids would fall and break am arm. 

• a bit of advice re health insurance. - fg
  • Re: Health insurance - Kris
    • I guess we have to wear ID bracelets "no docs not on approval list" nm - fg
  • Thank you all!!! I will file an appeal for sure. nm - fg
  • I had a similar experience, had a cow when I got the bill from the hospital - sm - Laura E.
  • Definitely file an appeal - Also ex-medical biller
  • usually you can fight or there is a clause for emergency sm - ex ins biller
  • Same problem here. sm - broke
    • having done a plethora of reports on the subject - there is a way out - become a felon - free medic - c
      • I'll say. Most of the ER reports I do I figure the pt - sm

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