Thank you for your e-mail.
Due to the state's budget shortfall, the Health Care Authority (HCA) increased the costs of certain benefits, deductibles, and out-of-pocket maximums for enrollees.
The HCA mailed plan change notices with the open enrollment plan offerings to all state eligible employees during the months of September, and October 2009. Open Enrollment ended November 30, 2009. You may refer to the Web site [redacted] for additional information and frequently asked questions.
At its July 8, 2009 meeting, the HCA and [redacted: employees] approved several changes to premiums, members' costs for benefits, and eligibility to take effect January 1, 2010.
One of the changes is the newly added $250 annual deductible to your Group Health PEBB Classic[redacted] plan. The deductible applies to most services, including diagnostic laboratory services which are not covered in full until the deductible is satisfied. Services provided are processed under your coverage, with the appropriate cost share applying for the service. In your case, your laboratory services were applied to your deductible.
You may reference the complete PEBB Classic plan Certificate of Coverage (COC) on our Web site http://www.ghc.org/health_plans/pdf/ClassicActiveCOC10.pdf, listed under Health Plans, and then selecting State Employees (PEBB). To access the COC, select the Rates and Benefits link. You can select to view a summary of benefits or the complete COC, both documents are Portable Document Format (PDF) files.[redacted]
Surgery, with outpatient hospital charges listed on your Explanation of Benefit (EOB) is due to the category of medical billing codes are classified under. There are physician based, and surgery among theses categories. For example, coding for services which break the skin, including a blood draw, instrumentation used for probing, or removal of skin lesions are listed under the surgery category. This is due Group Health's[redacted] "compliance" with the Health Insurance Portability and Accountability Act (HIPAA) of 1996. HIPAA is a Federal statute designed to improve the efficiency and effectiveness of healthcare data usage by setting national standards for communicating data, protecting patient privacy, and for assuring the security of electronic patient information. It does not imply you had a surgical procedure; however, Group Health cannot provide a detailed explanation of the service you received on your EOB's or Patient Financial Services (PFS) statements.
Outpatient laboratory charges are listed as the place of service where your laboratory analysis was provided, specifically our Group Health Central Specialty Outpatient Laboratory, located at our Capitol Hill Campus in Seattle. Our Central Specialty Outpatient Laboratory is a hospital based facility.[redacted]
We thank you for your patience while we are completing implementation of our new computer software system, and we anticipate all the Group Health medical center locations will be able to collect payments at the time of service by the end of May 2010 with many locations now being able to process payments now.
Since your date of service was at the end of March, claims may take four to six weeks to process under your PEBB Classic health plan. Once the claim is completed it may take up to 14 business days to have your PFS account updated to indicate your final patient responsibility. Our records indicate you receive your PFS statements on or around the last or first week of each month.
I apologize for any confusion this matter may have caused, please let me know if I can provide any further assistance or explanation.
Mkay...When is a blood draw a surgical procedure? And how am I getting charged for standard laboratory procedures after some bizarre deductible is reached that are required for diagnosis that my physician ordered? If I don't get these standard laboratory procedures done, I cannot get my medication to manage my chronic condition because the physician cannot make an accurate diagnoses without the required laboratory work. I know THAT much!!! So, this insurance MAKES people get the laboratory work by withholding their medication prescriptions...Good thing, because it is important to track the patient progress.
My problem is with billing. Fair remuneration for the expense. I went from not paying anything for necessary laboratory work, to having to PAY EVERYTHING UNDER MY HUSBAND'S INSURANCE DUE TO MY UNEMPLOYMENT DUE TO BEING LAID OFF BY ASSHOLES WHO JACK THEIR WORKERS to now being hurt by the very institution I have asked to keep me sane from the drama I incurred!!!
That information is CRAP! And they KNOW it. They are NICKELING and DIMEING the American people on Health Care Reform. AND THEY KNOW IT!!! Resistant to the end. They're not even TRYING to help people. What they are doing, it saying FUCK IT and go FUCK YOURSELF Dick Cheney style. Money-grubbers!
My husband works HARD to pay for Health Insurance for both of us. In fact he works for the same ASSHATS that I worked for and attempts to try to help find cures and treatments for major diseases and chronic conditions. As professionals with doctorates, this place has done a GROSS DISSERVICE to supporting US citizens holding advanced degrees. A GROSS DISSERVICE!!!
So, what can I do?
- BROADCAST THIS--RETWEET...LET EVERYONE KNOW THAT THIS IS THE KINNA BULLSHIT THESE HEALTH INSURANCE COMPANIES ARE PULLING!!!
- I DON'T WANT TO DISCUSS THIS I WANTED FIXED! YES I WANT TO BE SPECIAL AGAIN! YES I WANT TO BE TREATED AND WORSHIPED LIKE A GODDESS BECAUSE DAMMIT I'M A GOOD PERSON!!! I DO TRY!!!
- THIS IS ABOUT INJUSTICE! I DID NOT RUIN MY 2009 SUMMER FOR HEALTH CARE REFORM FOR SOME DUMBTARDED ASSHAT TO GIVE ME THIS RUN-AROUND CRAP THAT I GOT ABOVE!
- LASTLY, I WANT THESE PEOPLE TO KNOW THEY HAVE VIOLATED THE CULTURAL DETERMINANTS OF HEALTH, STIGMATIZED MENTAL HEALTH CARE AND WELLNESS AND HAVE FAILED TO SUPPORT PATIENTS RIGHTS!
Meet my lists of demands!!! C'mon, I dare you! Don't meet them, every chance I get I will develop Tourette's Syndrome and will announce your laziness in public and lambaste you on Twitter and every social media outlet I have access to. Pay me off and I will still do it... That is NOT how you treat a volunteer for your "Living Well With Chronic Disease" classes...That's just wrong!!! I don't care about how woefully discrediting your efforts are, you have DONE ME WRONG AND I AM SICK OF IT!!!
I am sick of these teabaggers dictating policy when they haven't suffered day 1 of ill health!
