Health Insurance Nightmare

[proud2BlibKansan]

I have an HMO and decided to change my doctor. So I called my insurance company and asked how do I change my doctor. They said who is it, I told them, they looked up her name and said yes she is on your list of approved providers, just make an appointment and her office will have the form for you to fill out to make the change.

So I went in and had a yearly checkup. They said come back in the morning for blood work, etc. I asked for the form to change my doctor, the receptionist said our bookkeeper is gone for the day, I will leave her a note to have the form here for you tomorrow when you come in.

So I go in the next morning and the bookkeeper says we don't make that change, you need to do that before you come in to see the doctor. And she calls the insurance company, the insurance company tells me on the phone I need to get that form from my employer.

So my first problem is this - why the hell is my employer involved in my private health care decisions???

So I call my employer and she says yes she can send me this form or I can make the change online. (I ended up doing it online and it was the easiest part of this whole story.) I tell her well the insurance company said my doctor would give me the form. She puts me on hold for a LONG time and she comes back and says well I just called the insurance company and they have no record of you calling to make that request. I tell her I didn't give them my name, I just called and asked how do I change my doctor.

So she says well, they log all their calls and they have no record of anyone calling with that question.

:wtf:

And I am supposed to BELIEVE that not one person has ever called this insurance company to ask how to change their primary care doctor???

The end of the story is I have to pay out of pocket for my checkup.

And I am just grateful I am not really sick because I would be dead before the insurance company has time to make sure I am following all their rules.

[sandnsea]

1. Call your state insurance commission

And if there's somebody over whoever you spoke to at work, go to them too. No, you are not supposed to believe you are the "only one" who asked a question, no matter what the question is. That's how all these big companies play you. Fight, for the next person who is too sick to fight.

And, btw, I am now firmly in the single payer camp. I've had enough of this shit.

[proud2BlibKansan]

3. Good advice

I feel like I am really screwed because it's their word over mine. I also feel like I screwed up when I didn't get the name of the person I talked to at the insurance company. But it seemed like such a simple question; why would I need to make a record of who I talked to?

And yes, I am sick of this shit too.

[sandnsea]

4. My husband had hernia surgery

Triple hernias. One was years old, the other two new. They wouldn't do emergency surgery, and I figured then we would have insurance problems. I repeatedly told everyone who would listen to make sure insurance would cover everything. They don't do any clearing beforehand. AFTER the surgery, the health insurance said they needed more information, maybe somebody else was responsible. Well shouldn't they have asked that BEFORE the surgery? Turns out, they were trying to get our auto insurance to pay. Yep. He isn't sure, but he thinks he got the current hernia lifting something out of our trailer. If it had been hooked to the truck at the time, they were going to reject the claim and pass it to our auto insurance.

Not to mention my kids are about bankrupt due to medical bills from when their newborn got pneumonia.

That's it. I'm done. Single Payer. 100% health care.

[proud2BlibKansan]

5. My kids don't have any insurance

And one of them has had 2 major illnesses. He is in debt for tens of thousands of dollars. It's been a nightmare. I really hate to complain about my problems, since I DO have insurance.

[sandnsea]

9. They have insurance

They pay several hundred dollars a month for it. As you well know, it doesn't cover everything anyway and there are still thousands of dollars of bills. So not only are they paying around $400 a month for health insurance, they're supposed to come up with several hundred more a month to pay three hospitals, radiology, labs, ambulance, and who knows how many doctors. It's crazy. I really don't know what to tell them.

[BuelahWitch]

20. It is a simple question, one that they should be used to hearing

And it's stupid to expect you to have to document the name of the person you talked to. But if you have to call them again, be sure to get an operator number or some other identifier too. Their call centers might be spread out all over, with tons of "Marys" and "Bobs".
An operator number tells you which Mary or Bob it was.

[midnight]

16. In Wisconsin my state commissioner sent me a letter to my

complaint ,about a c-pap machine being denied, and told me that they cannot tell the insurace co. to cover this machine or anything else. How do you like that?

[sandnsea]

17. They can make your insurance company

cover what your insurance company agreed to cover. Each state also has its own laws regarding various coverage, such as mental illness and birth control and things like that. You would need to find out if your insurance company has ever covered a c-pap machine and under what circumstances, and then see whether they are treating you the same or discriminating for some reason. The insurance commission exists to make sure actual insurance is being provided for the fees covered.

[damntexdem]

2. Rejoice. This is so much better than ...

it will be if McCain is elected and has his 'reforms' enacted.

[Greyhound]

6. These blood-sucking parasites are in the premium collection and health care denial business.

They produce nothing, contribute nothing, add a huge amount to the cost of health care, and extort enormous sums for the privilege of abusing us.
:grr:

[madrchsod]

10. i voted for him too......

[Selatius]

13. I would've voted for him but he dropped out before my state had a chance to vote.

In European countries, his policy positions are pretty normal. It is only abnormal in appearance in a right wing skewed environment.

[liberalhistorian]

18. The medical debt collectrolls

are even worse; I don't know how those fuckers sleep at night, I really don't. And medical bills shouldn't even be on credit at all, period. Try having cancer or another serious illness, even WITH insurance, and you're often ruined financially for life. That is such bullshit that I don't even know where to begin with it.

[proud2BlibKansan]

22. I realize I am lucky it was just this one office visit denied

and I am grateful for that.

But it is still bullshit.

[PA Democrat]

7. I swear the insurance company executives stay awake at nights dreaming up new ways to deny

payment for health care. It just infuriates me to think of all of the time Americans WASTE jumping through hoops to get insurance companies to fulfill their obligations, and all the time and money (passed on to us in the form of higher premiums) insurance companies WASTE putting up roadblocks for access to health care.

[proud2BlibKansan]

8. This one really blew me away

They tell an obvious lie and get away with it!

[onethatcares]

11. a bit off topic but did you know

that hospitals now charge an interest rate on the money you owe them so you will never, ever, in a million fuckkking years, ever, in no uncertain terms pay them off. Ain't life grand here in the divided states of america???:banghead:

[Selatius]

12. This is why I envy France. They use single-payer health insurance. They can see any doctor.

No matter which doctor you attend, they all send the bills to the same insurance entity, France's Social Security Administration. In France, there is no need to obtain permission from SSA because all doctors are on SSA's list. Also, your employer has nothing to do with your health insurance. If you pay taxes and are a legal resident or citizen, you are automatically covered regardless if you are employed or not.

[proud2BlibKansan]

14. It really blew me away that I have to involve my employer

That just seems really wrong.

[Selatius]

19. The notion of employer-provided health care is outdated at this point.

Back in the late 1800s and early 1900s, single-payer or any other notion of universal health care was still developing or didn't exist. The corporation back then was seen as the institution most able to pay for the health of workers, and labor unions in those days struck employers and demanded they cover the health of their workers. Thus, the notion of employer-provided health insurance was born.

However, things have changed, and it's now known that the government, not private entities, is best able to achieve as economists say, "economies of scale." Simply because it could theoretically cover everyone, it would have the most bargaining power in terms of negotiating fair prices in terms of medical procedures and pharmaceutical drugs. Thus, it could theoretically achieve the lowest cost.

As it stands, we have a fragmented system with multiple insurers with the best rates often conditional upon employment (because big employers represent a lot of people, thus they have some bargaining power in lowering the rate of coverage), and thus economies of scale cannot be achieved. Nevermind that these insurers are for-profit, meaning they tack on a profit mark-up on the service that they are supposed to deliver. This is an added cost for employers as well as individuals, and it is a burden to American businesses in the face of stiff overseas competition.

[blonndee]

15. I ended up owing about $4,500

because of a similar question. I had an emergency situation, thank goodness remembered to call my insurance to get their "permission" within 48 hours for a de facto approval of the service provider (which was the only local hospital, by the way), and ended up having to pay the entire thing out of pocket because they CLAIMED I never called. Not quite the same situation, but almost. It's like they can just say whatever the hell they want, and that's IT! (Kind of sounds like the * administration. SURELY there's no connection there!)

This is a fucking racket. Excuse my language, but I feel it is justified. That's what it is. I'm sorry you're going through this bullshit.

[proud2BlibKansan]

21. My son broke his ankle at camp when he was 12

And the hospital refused to even give him an aspirin until the insurance company authorized treatment. He sat there for hours while the insurance company took their time calling the hospital. They didn't give him ice either. To this day, that ankle bothers him.

[vanlassie]

23. I really think you may want to go back

and check again with the insurance company, giving them the chance to enter your name and member number into the system and give you information specific to YOUR employer's plan.

In an insurance call center, employees are to get the proper ID before telling callers anything about their plan.... because every employer has slightly different features!

If someone calls and just wants a "quick answer" they can very well get a generalized answer which would be incorrect for THEIR employer's plan of benefits. And some callers DO try to push for a quick answer without wanting to take the time to give their name, member number, etc.

You will be doing this to protect YOURSELF. Then the information is documented, and you get the name of the person you spoke with. Later it will be far less likely that someone could claim that they have no record of your call, because all major companies have automatic call documentation as long as you gave your ID to the initial automatic voice response on the call.