Insurance in Illinois USA

My suggestion may benefit hundreds of patients who pay premium for the coverage.

Co-payment:
 This is clearly written on the face of Insurance ID card and is paid at time of visit.
 A notice is seen at the reception window that this co-payment is paid at time of visit; office will not bill for it.
 Insurance card is copied by doctor’s office on each visit.
 Patient never receives extra billings from his doctor.
 Prescriptions written by the doctors are drawn from pharmacy and co-payment for that is paid before taking over medicines.
 Such co-payments are also stated to be paid at time of admission to a hospital.

If doctor wants to know of the illness in detail to give better treatment, he refers for examination, stress test, or blood work to a specialist.

 Patient is satisfied and relies on the first doctor for whatever treatment he has been giving or would give after further findings.
 Patient reports, with doctor’s referral, at the next location.
 Patient pays co-payment there and signs a typical authorization form for treatment.
 After some questions, answers and checkup at this location, medicines or exercises are prescribed – if this doctor has no setup to do tests to know more about the suffering, he refers to another facility to perform those tests.
 Patient goes there. Tests are done. Results are always sent back to the referring doctor.

Now patient starts worrying about what was so wrong with his health and what treatment he will go in for.

His worries are shattered when he starts receiving bills from parties whom he never visited; in Springfield, Lombard, St. Louis, etc. These demands are followed by reminders and a deadline to pay otherwise matter would be referred to a collection agency.

 Tooth extraction: 6.00 – co-payment mentioned in insurance benefits. Doctor extracted my tooth and asked for 34.00. What if I had not that much money with me at that time. He said he used a different procedure. When contacted, my insurance provider said “he must have used a different procedure”. How such things be talked about and cleared before treatment!
 Insurance providers suggest patient can take treatment, in case of emergency only, in another country and that will be paid if backed up with payment receipts. My wife had to go to Emergency for a cardiac problem. She paid money; brought back receipts but was never paid by the insurance provider; they have their reasons.

Questions:
1. Do these facilities admit patient without knowing that the treatment or test is covered by patient’s insurance provider;
2. Can they kindly check with insurance provider; it takes a phone call; that the treatment or test to be performed was within insurance coverage. This will save patient and themselves from complications about payment.
3. Is it obligatory at the part of these facilities or services to tell the patient that they are not a part of the hospital staff; they are outsiders; allowed to operate at that facility?
4. I remember when my friend asked a staff at the hospital if she could explain the patient about vegetarian healthy food recipes written on a piece of paper give by staff to the patient, she said, she will charge $20; perhaps she was also an outsider operating from table provided at the facility.

Dental and Vision

Expensive. Need cutting down so common man can afford.
Increase visits after putting in new denture to four.