<p>My son had a bad cold in October, so my wife told him to go to Health Services to have it checked out. They couldn't find anything so they sent him to get a chest x-ray (which turned out to be totally unnecessary since it just confirmed that he had a bad chest cold. They told him that our insurance (Healthnet) would cover it except for a deductible. Well, Healthnet rejected the claim, saying they needed to pre-authorize it, and I just got a bill from the provider (which is not UD) for $133. I will call Healthnet to try to get them to cover it, but if they won't I will be calling UD Health Services and telling them that it's their responsibility. They have my son's health insurance information on file, and they didn't even send it over to the x-ray place with him, never mind thinking to call the insurance company to get authorization for it. Why ask for the insurance information if you're not going to do stuff like that? Never mind that their medical imaging provider (on site!) is not actually covered by the hefty health services fee.</p>
<p>Anyone else have problems with UD Health Services?</p>
<p>IMHO you are lucky you got hit with only $133. Others with HealthNet out of state have been hit for more. Healthnet is very slick about changing the rules and trying to get out of paying every last nickel. I know of a case where the kid needed emergency gallbladder surgery and the parents had the same fight for many times what your bill was. The school health center is obligated to make medical decisions on your child’s behalf, that’s what they did. They could have been misled by HealthNet who will hide behind Hipaa and other laws in not providing them with information. In all fairness Udel offers a student health policy that is not perfect by any means but is there to eliminate the out of state out of network crap that we all face. You don’t have to be a doctor to figure out that there may be a need for an immediate chest x-ray. That’s usually done under acute circumstances, akin to going to an ER. Good luck trying to hold the Health Center responsible for your child’s bill. By the time your child graduates we may all be covered under the government, that should be even more fun.</p>
<p>I would start with the insurance company and ask why it it had to be pre-authorized. It could be that the physician did not do a good job of charting the reason why the chest x-ray was ordered and the insurance company did not see it as being acutely urgent. Medical procedures are coded before they are submitted for payment and a lack of charting supporting the necessity for the test may lead to non-payment.</p>
<p>I work in the health care field in an ambulatory setting, much like a university health center would be run, but we see all ages of patients. You state that the chest x-ray was unnecessary because it just confirmed a bad cold. Yes, but it could have confirmed pneumonia and if that was missed due to not doing a chest x-ray, your son could have become much sicker. Many diagnostic tests are run to rule out diagnoses as much as to confirm them. I am not arguing whether this is wrong or right and you will find different physicians have different styles of running their practices. Another physician may have felt confident that his exam ruled out pneumonia without further diagnostic testing.</p>
<p>In over 10 years of working in this type of setting we NEVER consider whether the insurance company will pay or if the procedure must be pre-authorized. We would not be able to work efficiently if we had to spend our time on the phone with the insurance company to pre-authorize tests. Think of how long it takes you to get a live person on the phone that understands what you want and multiply it by 60 patients a day (that is a very conservative number where I work but may be what the university would see in cold and flu season).</p>
<p>I am not saying your frustration is wrong. I would start with the insurance company asking why they require pre-authorization for a chest x-ray in an acute setting and find out whether better documentation will induce them to pay the claim. </p>
<p>Insurance companies drive me crazy!!! The governmental rules to get payment for IVs, IV meds, and injections are just nuts. The way we must document and charge for these is complicated beyond belief. I am an RN and try to keep out of the billing end as much as possible but we do have to be educated on some things because the documentation is directly related to the reimbursement.</p>
<p>We are covered with HealthNet as well. Our daughter was referred to the Cristiana ER by UD health services, also in October. All we had to do was call her primary care giver (we are oos) within 24 hours and inform them that she had been seen in the ER, they then sent authorization for the visit. I also called Cristiana the next morning and provided them with all of our insurance information. HealthNet covered the nearly 2000.00 dollar bill and our co-pay was 30.00.</p>
<p>Care givers cannot receive authorization by calling Healthnet. Authorization for care must be submitted by your PCM just as with any other sort of speciality referral.</p>
<p>Haven’t been back here lately. UDMom, I do not need to get referrals from my primary care doctor under my HealthNet plan. I finally called HealthNet and started an appeal. Apparently the problem was that because they did not see the doctor visit (since it was handled in-house at UD) they rejected the radiology claim. There seems to be a reasonable chance that they will honor it, but I need to get my son to sign a form saying that he will allow them to process the appeal.</p>
<p>I spoke to someone at the UD Health Services and they claimed that the woman who does the x-rays tells the patient that they may not be covered (the person was not available when I called). That was not what my son said and he’s been in Israel since I called so I can’t verify it one way or the other.</p>
<p>Meanwhile I called the radiology place and told them I was appealing and not to send the bill for collection, and they put in the claim again, and of course it got rejected.</p>
<p>Not having much luck with the Health Center with regards to accurate diagnosis - 3 strikes now. Can anyone recommend a internal medicine or general practitioner that their son/daughter has used in Newark? Would love a dermatologist referral as well!</p>
<p>So, I got good news from HealthNet. They approved my appeal and are going to pay the claim. Their reasoning was that because they do cover urgent care outside of my coverage area, and they considered student health services urgent care, they covered the x-ray.</p>