THIS IS WHY I HATE INSURANCE COMPANIES !!!!

[LegitIncomes]

I had surgery about 6 weeks ago. I was not under any pre-existing clause, or anything else that would cause them to not cover the surgery....but I still get this in the mail.




Now I've gotta deal with this crap, should be fun!

[HeySal]

That's when you tell them that you don't understand and that a newspaper reporter and a lawyer could probably explain the charges much more easily.

[LegitIncomes]

Originally Posted by HeySal

That's when you tell them that you don't understand and that a newspaper reporter and a lawyer could probably explain the charges much more easily.

Sounds like you have experience.

Oh, I'll get them to cover a majority of the charges one way or the other...but dealing with it is such a pain, wastes so much of my time, I think I should bill them per hour for the time I'm dealing with it.

[ThomM]

Sounds like you didn't check with the insurance company before you had the surgery.
Never ever assume a procedure is covered, always check first.

[HeySal]

Originally Posted by LegitIncomes

Sounds like you have experience.

Oh, I'll get them to cover a majority of the charges one way or the other...but dealing with it is such a pain, wastes so much of my time, I think I should bill them per hour for the time I'm dealing with it.

They don't flinch when you say lawyer - but when you say newspaper reporters it seems to move the case along rapidly and to your favor. Trust me on that one. LMAO.

[LegitIncomes]

Originally Posted by ThomM

Sounds like you didn't check with the insurance company before you had the surgery.
Never ever assume a procedure is covered, always check first.

This was a "I need this surgery to live" type of procedure, I couldn't go without the surgery even if they told me they wouldn't cover it.

That said, yes, it should have been covered.

[christftw]

All your legit incomes are belong to them.

[LegitIncomes]

Originally Posted by christftw

All your legit incomes are belong to them.

LOL..Hopefully not!

[ThomM]

Originally Posted by LegitIncomes

This was a "I need this surgery to live" type of procedure, I couldn't go without the surgery even if they told me they wouldn't cover it.

That said, yes, it should have been covered.

I agree it should have.
Only reason I said what I did was because I've been in that position before.
I checked first, the surgery was denied.
I had the surgeon and my main doctor contact the insurance company and they where able to get it approved.
That is still worth a shot for you.

[HeySal]

Originally Posted by ThomM

I agree it should have.
Only reason I said what I did was because I've been in that position before.
I checked first, the surgery was denied.
I had the surgeon and my main doctor contact the insurance company and they where able to get it approved.
That is still worth a shot for you.

I hope you aren't still with that company and made it real loud and public what they did. There are certain things they claim to cover, and if they don't it's breech of contract at the least, fraud if you can show clarity that you were covered.....for which you can make them pay plus sometimes even get a refund for money you paid them in the belief that you had insurance.

I hate these companies too - legalized fraud is all I see.

[myob]

Being "medically necessary", you should not have a problem with most insurance policies. Did you submit the bill to your insurance company? I know many providers will bill directly to the patient, and it is up to you to follow up with your insurance carrier. Also, they may already have billed your insurance. Sounds like you really need to just make a few phone calls.

[LegitIncomes]

Originally Posted by myob

Being "medically necessary", you should not have a problem with most insurance policies. Did you submit the bill to your insurance company? I know many providers will bill directly to the patient, and it is up to you to follow up with your insurance carrier. Also, they may already have billed your insurance. Sounds like you really need to just make a few phone calls.

Yes, the image I posted is from the insurance company..not the hospital.

I'm going to call the hospital billing dept too, there's probably something they can help me submit, etc...

I'm fairly confident I'll get it taken care of eventually, it's just such a pain, you pay a company $800/month or whatever it is, for insurance, and then they pull crap like this.

[artwebster]

First rule of insurance - whether you are the insurer or the insured - DENY LIABILITY

[valerieSONORA]

The insurance companies are greedy POS's and they honestly don't care if it was a life or death surgery or not. Money is all they care about, not people's lives.

Legalized fraud is a good way of putting it, but I'd like to think of something a little more harsh. Haven't you heard the stories of women paying their insurance premiums every month for years and years then they wind up with cancer and the insurance refuses to pay for any treatment because one had a yeast infection once that wasn't disclosed and one went to a dermatologist for acne once which wasn't disclosed which made them legally able to drop these dying people who paid all their dues. I don't know why this is even legal. They actually have ppl who dig up anything they can so they can legally dump patients who need expensive treatments.

But anyway you should have checked first to see what they would they would say, at least if they said no you would know and the Dr.s might have been able to get them to change their mind.

Mention the name "michael moore" to the insurance company lol that should get them to pay. Tell them he's doing a Sicko II and they will star in it if they deny you.

All you Europe ppl that get free health care, feel very blessed, very lucky you don't have to deal with crap like this.

[ptone]

Originally Posted by valerieSONORA

All you Europe ppl that get free health care, feel very blessed, very lucky you don't have to deal with crap like this.

First of all, health care isn't free anywhere, Europe or otherwise.

Secondly, there are plenty of horror stories regarding health care in Europe and other socialized countries. I'll be glad to point you to some.

But, I mostly agree with your opinions on the insurance companies. I once worked at one and was disgusted by their treatment of the providers and their desire to control how a doctor treats his patients.

[seasoned]

Well, I have NEVER had THAT problem. In fact, right now, I am fighting a charge that WAS covered! SERIOUSLY! The insurance company paid $1888.88 more than they should have. The hospital gave me a senseless test.

They may have billed it wrong, applied to the wrong insurance company, or something similar.

Steve

[LegitIncomes]

Originally Posted by valerieSONORA

The insurance companies are greedy POS's and they honestly don't care if it was a life or death surgery or not. Money is all they care about, not people's lives.

Legalized fraud is a good way of putting it, but I'd like to think of something a little more harsh. Haven't you heard the stories of women paying their insurance premiums every month for years and years then they wind up with cancer and the insurance refuses to pay for any treatment because one had a yeast infection once that wasn't disclosed and one went to a dermatologist for acne once which wasn't disclosed which made them legally able to drop these dying people who paid all their dues. I don't know why this is even legal. They actually have ppl who dig up anything they can so they can legally dump patients who need expensive treatments.

Yep, I agree, and I've heard of those cases you are referring to.

I've had this problem my entire life..had surgery when I was about 18months old...and I will always need another surgery every 8 years or so.

Because of that, I've always taken care to make sure I have insurance, always get premiums paid on time, and never have any lapses in coverage. So I basically do all I can do, and then stuff like this still happens.

Why? Because like you said, they simply don't care.
I know this should have been covered, so they probably denied it the first time around because of some paperwork mistake by the hospital....anything they could find to deny. They'll eventually pay, but they sure know how to work everything to their benefit, and away from the benefit of the person paying for the insurance.

[valerieSONORA]

Originally Posted by ptone

First of all, health care isn't free anywhere, Europe or otherwise.

Secondly, there are plenty of horror stories regarding health care in Europe and other socialized countries. I'll be glad to point you to some.

But, I mostly agree with your opinions on the insurance companies. I once worked at one and was disgusted by their treatment of the providers and their desire to control how a doctor treats his patients.

You missed my point. Yes it's free in certain countries as in out of pocket costs. You don't get big bills in the mail. I know taxes are high to pay for it. BUT be glad you don't have to deal with HEALTH INSURANCE COMPANIES they can be a PITA especially when they refuse to pay for medical treatment, tests, a surgery that you need to live (like the op), or your meds. Not dealing with the insurance companies itself would be something to be grateful for. They are PITAs and I watched a Dr. who used to work for one testify at congress that her job was to find ways to deny people the health care they need, have paid for and deserve. People died as a result, she had a conscious so she left. BUT I guess congress didn't care because it's still legal to drop people who have paid all their dues and then come to need healthcare.

I even had one of my meds denied recently cause somebody decided to make everything harder on people and you have to jump thru hoops just to get your meds. I ended up just paying for it to avoid the hassle at around $2 a pill. It was the generic for ambien.

[KimW]

$2 a pill for the generic?? rediculous.
I think insurance and hospitals are in it together.
Its funny how I can get a prescription for a med and when I go to fill it the pharmacist says thats be $70 with my insurance benefit, and then I can get a coupon from the maker that will charge me $5 per script and they will pay the rest up to $250 ,good for 12 refills. Somethings not right here.

[valerieSONORA]

No, a lot of things aren't right. Like when there's $100+ medicine per prescription here and then you can go to another country and get it for pennies. What's up with that?

And not understanding this health care bill-which can be voted on tomorrow I wonder if that will make things better or worse. They say it's to help cut costs-but I've heard lots of truly scary things about it :gasp:

[LegitIncomes]

Originally Posted by valerieSONORA

They are PITAs and I watched a Dr. who used to work for one testify at congress that her job was to find ways to deny people the health care they need, have paid for and deserve. People died as a result, she had a conscious so she left.

I watched that also....even though I know stuff like this goes on, it was still very chilling to hear coming "from the horses mouth".

[Radix]

You need...

[Michael Motley]

'medically necessary' and 'covered' arent the same thing. The insurance company is a business, they dont care if you live or die, they just care if you pay the bill.

[TLTheLiberator]

Originally Posted by Radix

You need...

Is that the dude from Sienfeld???

LOL


TL

[LegitIncomes]

Originally Posted by Michael Motley

'medically necessary' and 'covered' arent the same thing. The insurance company is a business, they dont care if you live or die, they just care if you pay the bill.

Absolutely.

I've been in contact with the insurance company, and right now they are doing the "we want to make sure you don't have any other insurance, that might help cover the cost". No, I don't have any other insurance, if I did, I would have filed it also! So now I await their next stupid question.

[talewins]

You can shop a little smarter when you choose another company.
Every state has an insurance commissioner. Before signing up with any insurance company you can ask if that company has a record of not paying. Some, like this one obviously, stall off paying for a year, some for 90 days, and certain companies are so eager to pay they will rip the bills right out of the med's hands. If I had started paying premiums at childbirth and continued until I was 999 I couldn't repay all I have cost my insurance company yet they are just as friendly and willing as if I had not cost them a cent.
You can also get wind of bad companies by surfing. One insurance company (must have been yours) has an "I hate you!" club going. If people surfed a bit they would never have signed up with that company.
Last but not least you can do an end run by visiting each company's web site from direct links found at Where Can I Find The Best Insurance Information?
One thing to watch for in signing up with any company is: did you sign up for the cheapest policy available and expect the same service and coverage as provided by their most expensive policy?

[LegitIncomes]

Originally Posted by talewins

You can shop a little smarter when you choose another company.
Every state has an insurance commissioner. Before signing up with any insurance company you can ask if that company has a record of not paying. Some, like this one obviously, stall off paying for a year, some for 90 days, and certain companies are so eager to pay they will rip the bills right out of the med's hands. If I had started paying premiums at childbirth and continued until I was 999 I couldn't repay all I have cost my insurance company yet they are just as friendly and willing as if I had not cost them a cent.
You can also get wind of bad companies by surfing. One insurance company (must have been yours) has an "I hate you!" club going. If people surfed a bit they would never have signed up with that company.
Last but not least you can do an end run by visiting each company's web site from direct links found at Where Can I Find The Best Insurance Information?
One thing to watch for in signing up with any company is: did you sign up for the cheapest policy available and expect the same service and coverage as provided by their most expensive policy?

Thanks for the info.

[Arizona]

I hope by now you have resolved this issue. It is very confusing when you get the insurance papers in the mail for procedures on anything.

It really takes someone from the company to explain what the heck all of the numbers and other miscellaneous items mean! I have just gotten to the point that I will call and ask what it all means, more importantly, what I owe on the statement! That really seems to have helped me.

So for what it is worth, if you have not already done so, just call them and ask for someone to go over each entry with you.

Most importantly, I hope you are feeling better and that you never have to repeat that experience again. Take care.

God bless.

[daryamconsult_aust]

Do you have a Health Insurance Ombudsman in the USA?

[valerieSONORA]

Originally Posted by daryamconsult_aust

Do you have a Health Insurance Ombudsman in the USA?

No.
..............

[seasoned]

well, and I am NOT tru=ying that start a political discussion....

I have only had kaiser, guardian, aetna, and bluecross.

Kaiser I had various diagnostic tests, MRIs, xrays, and doctors appointments. I believe the cover is all I had to pay, but the insurance itself was expensive. BTW My father has this, and had open heart surgery(infarction)

THEN I had bluecross. I had MAJOR openheart surgery(aorta), drugs, and a few basic things. I had to pay some of the costs, but the insurance was CHEAP!

THEN I had guardian. I had drugs, diagnostic tests, etc... I had to pay some of the costs, but the insurance was CHEAP! BTW they DID declline some diagnostic tests CLAIMING it was a preexisting condition*. Luckily I knew it was against the law, etc... the moron insurance "agent" LIED BY OMISSION! I got them to cover it.

THEN I had aetna. I had drugs, diagnostic tests, etc... I had to pay some of the costs, but the insurance was CHEAP!

* It is illegal in the US to consider a condition as prexisting if you were covered for it when it happened, and have had no more than 89 days lapse in coverage since.

Do I wish it were cheaper? HECK YEAH! One product that they used that probably cost someone a couple dollars to make cost over $20,000!!!!! The cardiac surgeon that showed me the product CLAIMED his hospital only charged about $8,000. That was the HOSPITALS cost, NOT mine, but it DID affect the insurance company's bottom line. STILL.... Do I wish preexisting conditions were covered? HECK YEAH! Still, I can't get car insurance AFTER a car accident, so I can pay for it! I can't have my investment companies pay back money that I lost in an investment that failed.

AND, do I wish we had a government insurance program as a safety net? HECK YEAH! But we don't have a government that can be trusted to do that. The Bible says that those that are given responsibility over a large task should first have a history of handling small tasks. Let them succeed THERE, THEN we can talk!

BTW MOST, if not all, states DO have an ombudsman of sorts. It is the INSURANCE COMMISSIONER!!!! If your insurance should cover this, it is necessary, and their explanations are a stretch, etc... Simply call the commissioners office, tell them all that, and lodge a complaint!

Steve