Healthcare Loophole

Wednesday, September 20, 2017

I’m just curious if others out there are experiencing this issue with healthcare. More and more I’m running into situations where facilities are in my insurance network but when I receive the bill I’m informed that the provider was not.  It has happened to me twice in the last few months.

The first case involved my son receiving treatment for a laceration at the Erlanger Medical Center ER. It seems that Erlanger is in the Gilsbar Insurance network, but the ER physician that treated him was not.

The second case involved my wife having a wellness mammogram at Chattanooga Imaging. Again the facility was in network but the physician that read the mammogram was not. In the Chattanooga Imaging case they filed the entire visit under the physician’s ID number so Gilsbar does not want to pay for any of it…..the mammogram or the reading.

I guess now you have to ask every doctor that walks in your room for proof that he/she is in your insurance network. Oh, and if you have a test read by a doctor that you will never meet….well I guess it just the luck of the draw. 

These situations work out well for the insurance companies because they can refuse to pay. It also works out well for the provider because they can bill for the full amount since they are not restricted by an insurance contract. However, the patient (who has no control over the situation) is the one who gets trampled on.

To be honest, it really looks like the insurance companies and the healthcare providers have found a loophole in the insurance laws that they can both benefit from.

Bill Peers 



Roy Exum: ‘Mom Don’t Have…I Do’

It’s hard to know what goes through the mind of a five-year-old, particularly one who watches her mom go in and out of jail due to drug addiction. But little Sunshine Oelfke is obviously being raised right by her grandmother because the other morning, the five-year-old came into the kitchen before leaving for kindergarten with a baggie full of coins from her piggy bank. “I asked ... (click for more)

Problems With The Key Staff Findings On The Landfill

Concerning the proposed C&D Landfill in Harrison, on Sept. 11, the staff of the Chattanooga Hamilton-County Regional Planning Agency made a presentation to the Planning Commission for the rezoning request.  Mr. Schultz for the staff made the following statements which were titled "Staff Key Findings."  I would like to contend with their findings.  1. "Proposal ... (click for more)

Signal Mountain Committee Says Pulling Away From County Schools Is "Feasible"

After eight months of investigating the viability of Signal Mountain establishing a separate school district, a committee of six has determined that it is feasible and would meet the goal of improving the education provided to students. The committee was also tasked with identifying obstacles and if possible to find ways to overcome them.  Results of the report were presented ... (click for more)

County Commission Votes 7-2 For Rezoning For C&D Landfill At Harrison

The County Commission on Wednesday voted 7-2 to approve rezoning for a Construction and Debris landfill at Harrison.  Voting in favor were Greg Beck, Warren Mackey, Sabrena Smedley, Greg Martin, Tim Boyd, Randy Fairbanks and Jim Fields.   Opposed were Chester Bankston and Joe Graham.  Commissioner Boyd said it was just the first step in permitting for ... (click for more)

Signal Mountain Hits One Last Bump In The Road At State Volleyball

MURFREESBORO, Tenn. – It’s not like Signal Mountain hasn’t been down this bumpy road before. Despite the obstacles created by losing early in the TSSAA state volleyball tournament, the Lady Eagles have proven to be cautious, but relentless drivers on a path back to title contention twice before. They’re on the same course this October. After losing to Knox Catholic ... (click for more)

Baylor Advances To State Final; Sale Creek Ousted

MURFREESBORO, Tenn. – The Baylor Lady Red Raiders are one win away from another D-II Class AA state volleyball championship. Facing the Brentwood Academy Lady Eagles for the third time this season here at Blackman High School Wednesday morning in the winner’s bracket final, Baylor was able to advance by winning in four sets, but it was a battle for the ages where two really good ... (click for more)