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Author Topic: Sanity Check on Insurance - Solara  (Read 1221 times)

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Offline chalke43

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Sanity Check on Insurance - Solara
« on: September 15, 2015, 02:35:28 PM »
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  • I am pretty hands off when it comes to the financial aspects of my husband's diabetes. I make sure there is money in our HSA, but that is about it. We are on separate insurance plans, each through our own employers, so I haven't had much reason to familiarize myself with his health insurance benefits. As far as I know, neither of us keep track of what we pay out each year (I wish he did! But alas... he hasn't even set up an online account with his insurer to view EOBs).

    We pretty much know what his monthly DME costs are going to be, but when he requested a shipment from Solara a couple weeks ago, it was 6x what we normally pay. First they told him that his plan year reset, so he needed to meet his deductible again. He confirmed with his employer that his plan year starts 4/1, so he went back to Solara and told them no, it hadn't reset.

    Then they send him a chart of his alleged insurance coverage. They say he has spent $2,564.90 out of his $3,000 Out-of-Network deductible, and $0 out of his in-network $600 deductible. Neither of these numbers are even close to being correct. They are saying that he now owes the $600 deductible and then the coinsurance after that. HUH?! I am pretty sure Solara has always been in-network for him, and even if they weren't, why would we need to meet a new deductible if they switched to in-network during the same plan year?

    I'm prodding my husband to collect all of his EOBs and invoices so we can go over this, but I am really puzzled. Any thoughts from the insurance gurus out there?

    Offline Mich*09

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    Re: Sanity Check on Insurance - Solara
    « Reply #1 on: September 15, 2015, 06:15:53 PM »
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  • My thought is somebody at Solara doesn't know what they are doing.  >:D

    Mistakes happen, so stick to your guns until they prove they are right.

    And let us know how this turns out.
    Michelle
    Mom to - Jordan 22, Grant (19 dx 9/17/09 MM Revel 6/1/10), Brett 16

    Offline SarahMay

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    Re: Sanity Check on Insurance - Solara
    « Reply #2 on: September 15, 2015, 08:28:15 PM »
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  • My thought is somebody at Solara doesn't know what they are doing.  >:D

    I can confirm that MOST people at Solara don't know what they are doing.  <L>
    Sarah - wife to Aaron, mom to
    Matthew (9) non-D
    Jonah (8) DX 02/05/14 (Animas Ping, Dexcom)
    Isaiah (8) DX 01/10/13 (Animas Ping, Dexcom)
    Gideon (5) non-D


    Offline chalke43

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    Re: Sanity Check on Insurance - Solara
    « Reply #3 on: September 15, 2015, 11:48:15 PM »
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  • I can confirm that MOST people at Solara don't know what they are doing.  <L>

    That is the truth! We sat down and looked at all of the EOBs and it makes even less sense than before. I work in insurance and I enjoy handling this kind of stuff (<nuts>), so my husband is seeing what he needs to do to authorize them to speak with me. From the looks it it, they billed him for some shipments that insurance paid for 100% and underbilled him on others that insurance didn't cover. There is no rhyme or reason to the billing and I can't even tell who is more at fault in this whole thing - Solara or Cigna. I am going to make them walk me through each and every order one at a time to figure it all out.

    Offline SarahMay

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    Re: Sanity Check on Insurance - Solara
    « Reply #4 on: September 16, 2015, 11:32:52 AM »
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  • Do you go through Solara in Michigan or California? If Michigan, you need to talk to Jennifer. She's pretty nice but if she gets too frazzled, ask to speak with Allan.  <t-up>
    Sarah - wife to Aaron, mom to
    Matthew (9) non-D
    Jonah (8) DX 02/05/14 (Animas Ping, Dexcom)
    Isaiah (8) DX 01/10/13 (Animas Ping, Dexcom)
    Gideon (5) non-D


    Offline chalke43

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    Re: Sanity Check on Insurance - Solara
    « Reply #5 on: September 16, 2015, 02:21:14 PM »
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  • Thanks for the tip Sarah - Kevin's account appears to be serviced out of California. Apparently a bunch of the charges were being billed as out-of-network because Solara had a wrong address on their submissions (weird).

    Good news (I think). Two claims are being resubmitted to Cigna and based other claims, we think they'll be paid at 100%  <fx'd>.

    We are getting refunds on 4 other claims where we were charged coinsurance upfront but Cigna later paid at 100%.

    A billing representative handled all of this and she seemed fairly competent. We'll see if all of the changes actually go through. I anticipate several follow up calls but I'm prepared!

    Offline Mich*09

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    Re: Sanity Check on Insurance - Solara
    « Reply #6 on: September 16, 2015, 04:29:42 PM »
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  • That's awesome!  Your husband is lucky you are on the ball with this!  You should plan at least a night out with some of the money you will be saving/getting back!

    BTW - I'm having you take over next time I need help.  Seriously, you got this much accomplished in 1 day?  1 day?   <bclap>

    And 100% coverage is super awesome.  I'm thrilled with 80% coverage after a pretty hefty deductible!
    Michelle
    Mom to - Jordan 22, Grant (19 dx 9/17/09 MM Revel 6/1/10), Brett 16

    Offline chalke43

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    Re: Sanity Check on Insurance - Solara
    « Reply #7 on: September 16, 2015, 05:11:52 PM »
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  • That's awesome!  Your husband is lucky you are on the ball with this!  You should plan at least a night out with some of the money you will be saving/getting back!

    BTW - I'm having you take over next time I need help.  Seriously, you got this much accomplished in 1 day?  1 day?   <bclap>

    And 100% coverage is super awesome.  I'm thrilled with 80% coverage after a pretty hefty deductible!

    Thank you! I really anticipated it taking up my entire lunch hour and then some, but I happily had time leftover to eat. =) I really have no idea why some of it is being covered 100%. Per the plan, he should have a $600 in-network deductible and then 40% coinsurance for DME. I would be more than happy paying this, as it is MUCH better than his coverage at his previous employer.



     


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