So a year ago, actually a year and a week ago tomorrow, I broke my arm. I tripped on the fucking stairs in the back of my house which caused me to take a header into the pantry door and then down onto the concrete floor. So anyway, it was basically a broken elbow, and it hurt like shit.
After four casts(they kept slipping off my arm which, again, ended up hurting like shit) I was finally deemed a candidate for surgery. So I had surgery on June 14, 2006 to put a plate and screws into my arm. And now I have a really cool Frankenstein scar on my arm.
So here I am in June of 2007, and you finally got around to paying the claim after God knows how many phone calls from me and the people at the surgery center.
I wouldn’t dare ask what inspired you to pay. I’ll just sit here quietly, muttering profanities under my breath.
-Lil
When I had knee surgery, the insurance company just declined every bill that was sent to them.
Typical scenario.
We’d get a bill
Call them, and say, “you have to pay for this.”
They’d say, “you have to call the hospital and get them to call us.”
We’d call the hospital.
Hospital would call us back and say, “it’s all taken care of. They’ll pay it.”
Go to 1.
This went on for so long that the insurance company turned a bill over to a collection agency. They just wouldn’t pay it for like 6 months – something that we’d repeatedly be told that they were responsible for – and then they’d call a collection agency.
It happened in different degrees for initial exams, MRIs, follow-ups, the surgery, the meds, the physical therapy.
After all of this, I wrote the human resources person at my company and described it to her.
Later that year, we dropped Blue Choice and changed to United Healthcare. Believe it or not, they’re way better. It’s absolutely friggin’ insane the things they do.
I wish from the beginning I’d tracked how much time we spent on the phone with them.
These sound remarkably similar to almost every experience I have with them, almost every time I go to the doctor for anything. Claims are paid partially or not at all, and it takes months, multiple calls, and faxes to resolve the issue.
It’s to the point where I suspect something more sinister than simple incompetence or bureaucratic entanglement. I’m beginning to think it’s an intentional business model, something akin to the “mail-in rebate” pseudoscam, where companies count on (and ultimately profit from) a large percentage of people not bothering to complete the rebate form, or giving up in frustration when the paperwork gets “lost” and the rebate never arrives, etc. Surely there must be people out there who simply pay the doctor’s bill either because they’re unaware they aren’t responsible for it or are frightened at the prospect of collection notices and marred credit.
I’m not one of those people, but they’ve sure caused me a lot of wasted time and hassle, so yes. They may eat me as well.
Bout time you got the message. They employ doctors to reject claims . They are rewarded for how many they shoot down. That is the system. It will be a war as long as profits are increased by cheating subscribers.
It distinctly varies by company. For my job I work with people from lots of different sorts of health insurances (though I’m mostly insulated a little from the medical plans, as we have an entire group that handles them for us unless there’s a problem). It’s well known in the business who is good to work with and who isn’t. Things like that Aenta doesn’t even notice major issues for years on end, and even after they know about them often will rather ignore them for years more; or that MetLife has good people and good dental coverage systems, but their life insurance administration is a nightmare. I don’t recall anything specific about United Healthcare being difficult to work with, but that might just mean that they’re not the worst and therefore don’t stand out from the crowd.
For instance, my husband had an ER trip this past December that was declined at first. I looked at the EOB and realized that the hospital had billed my primary insurance instead of the United Behavioral Health carveout. When I called the hospital billing department to explain, I could practically hear the poor woman’s despair over the phone - apparently they’re HORRIBLE to work with. And sure enough, despite being his treatments being all pre-approved since then, they’ve consistantly declined EVERY SINGLE BILL. Then the hospital (presumably sighs and) resubmits it, and then they approve it, despite no changes to what was submitted to them. Fuckers.
I work in medical billing and even I can’t figure out why some insurance companies just decide, apparently arbitrarily, that they’re not going to pay a bill.
The only decent way to protect yourself is to get pre-authorization, in writing, that you are permitted to see a particular doctor within a given range of days, to have a particular service done.
If you don’t get satisfaction from your insurance company, go to your state (or country’s) office that regulates insurance: in Washington it’s the Office of the Insurance Commissioner.
I have Blue Cross of California, and they have been remarkably. . . great. I also had an injury leading to surgery. I was expecting a nightmare morass of unpaid bills, lost claims, angry phone calls, denied things. They paid their percentage of everything promptly, without a single complaint. My surgery was on 4/24 and as of last week they had paid every nickel of their share. I was. . . shocked.
(And now that my company was getting bought, and we’ll probably be changing plans. Sigh.)
The only thing that they seem to have a problem with is their pharmacy plan has some sort of rule where they will only pay for one narcotic prescription per month. The thing is, my surgeon saw me every week and would prescribe me a weeks worth of painkillers at each visit. (It sounds irritating, but it was actually nice-- he was comfortable giving heavy duty ones immediatly post-op because it’s only a week, and then I got to taper down slowly strengths of painkillers.) But, the insurance company would only pay for one script per month, regardless of the dosage. This then caused the pharmacy to get all wierd, too. I think they thought I was a junkie.
I rarely have trouble with my insurer, Medical Mutual of Ohio.
But what surprised me is that we have never, not once, had trouble with my husband’s Medicare. Not once. They’ve been perfect. I wasn’t expecting that.
I’m with Maus Magill. This subject drives me to insanity. However, this is an instance in which not being alone pleases me.
I’m on a number of medications. They are all for conditions that are highly dangerous and potentially fatal but easily treatable when well managed. About a year and a half ago I got a new job and therefore new insurance.
My new insurance compnay tried to convince me I didn’t need these drugs. I actually laughed at the lady on the phone. I explained to her that either the company could stop their pissing contest now, pay for them and the situation would be over OR they could deny them, cause me to take trips to the ER and likely have a number of surgeries. I asked her if she’d ever had any of my conditions and of course she had no concept of what they even meant.
I’m no fool, I realize that both situations (the meds AND the denial of the meds) mean I pay a large portion of the bills for all these conditions but I’m just sayin.
Many years in medical billing. Insurance companies suck, all of 'em.
I have spoken to ex-employees of various companies who say that, yes, there are unofficial, unwritten policies that employees will “lose” a certain number/dollar amount of claims. Employees who don’t follow the rules don’t do well at those companies.
My favorite was when my spouse was added to my insurance. I had carefully read all of the information available, which stated that “pre-existing conditions” were problems that had been previously treated. (Remember, I worked in medical billing - I was very familiar with non-covered pre-existing conditions.) The first claim filed, they denied for “pre-existing condition”, which now meant any condition that had existed prior to coverage. Lying bastards.
Medicare is actually one of the easiest and best companies as far as processing goes. That fact is one reason (among many) that I am a strong supporter of changing to a single-payor system. All you uber-capitalist free-marketers can whine all you want about “government inefficiency”. You’re flatly wrong in this instance - ask anyone in medical billing.
There are some problems in interpreting their regulations, usually because the regs are written by legislators - few of whom know crap about medicine. That, however, is a solvable problem.
Whoops, forgot this . I got this recently and have been looking for an excuse to post it.
It’s a discussion of the multi-million (billion?) dollar problem of insurance companies intentionally screwing doctors/hospitals in processing claims.
Here and here are a couple of companies that do nothing but monitor carrier processing for medical practices. (There are others.) They charge in the 6 and 7 digits for their services and PROMISE that they can recover more than their charges over the period of a few years.
IOW, we have an entire industry created to force insurance companies to abide by the terms of their contracts. That’s how fucking “efficient” our current system is. :mad:
When my son was 4 mos old he got RSV. He finally gets home from the hospital, United Healthcare sent out a home health care nurse to bring me the prescribed nebulizer and medicines and teach me how to use it.
They still haven’t paid for the nebulizer (they did pay for the nurse’s visit and the meds) despite sending me a letter (after many phone calls) that yes it was covered and that yes they will place it inline for payment. My son is now 5 yrs old.
Yeah, I didn’t add this part because it just makes me angrier, but when I first switched to UHC, when I first started at this last job, they tried to refuse payment on my prescriptions, that I’d been taking for years. Yeah, they’re expensive, but unless they know a better way to control my seizures, I’m gonna be taking them.
Luckily(?) I was downsized from my job in October(that was a whole ‘nother clusterfuck), so I’ve had extra time to devote to this situation. Before I left, I was actually an insurance clerk, so I already knew how braindead the people on insurance companies’ phones tend to be.
-Lil
I have a friend who was in a similar situation. Her new insurance company tried to convince her that insulin (to control diabetes) was “not a medical necessity”.
I also once had my insurance company assure me they’d pay for x-rays for an ongoing issue I’d been having. I went to the doctor, had the x-rays, everything was fine. About 18 months later, I got a letter from a collections agency saying I had to pay a couple hundred bucks for the x-rays. Insurance cheerfully paid for the actual doctors visit and resultant prescriptions, but not the x-rays. Five hours (I timed it) on the phone later and I finally got them to pay…
To add to my earlier comment in relation to the above. My favorite story of my meds and insurance is from my very early years of life. I was born with very low lung capacity. I was on nebulizers and inhalers and all sorts of crap. I spent A LOT of time in hospitals. I seem to have caught some luck though as I magically became a moderately healthy adult.
I digress. So when I was a yearish old my mother (who has some moderate medical training) would often have to shoot me up with steroids (or they’d do this in an ER, depending on the situation) or I’d have the nebulizer yadda yadda. My parents paid tens of thousands of dollars for all this equipment (some of which turned out to be poorly perscribed). Basically, it made them bleed money for a while. HOWEVER. The same insurance plan WOULD pay 100% of the perscriptions my mother needed for the anxiety, depression and general insanity she suffered from managing a sick child. TAKE THAT PREVENTIVE CARE.
(I realize this is a stretch for some to imagine as preventive care. But if you’ve ever been in this situation it makes a lot of sense. A friend of mine is going through this with her own child right now and jokes frequently that my own mother’s advice and comfort is worth more than the meds she can obtain on her plan.)
I had a c-section with Boglette #1. United Healthcare turned down coverage. The reason? “Not performed in an approved location.” I was at a Hospital. I called and asked them if I should have had the surgery on my kitchen table instead.
Turned out to be a minor typo in the billing number, but…