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kristin31
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Joined: 15 May 2002
Posts: 8045
Location: Caught in the crossfire of childhood and stardom
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 Posted: 10/11/04 - 10:05 Post subject: Insurance company nightmares...
Larry has bad hips from arthritis. The cartilage is totally gone from his left hip and almost 90% gone from his right. He needs hip replacement, but the restaurant screwed up his insurance paperwork so that the dates and wrong; it makes his hip issue a pre-existing condition, and the insurance company won't change the dates even though the restaurant got it wrong.
That means he can't get his hips fixed until next May. He's in so much pain constantly; he can barely walk but he's on his feet constantly because of his job. He runs around all night and spends most of the day in bed in pain, worrying that he's going to ruin his liver to boot from all of the anti-inflammatories/painkillers. I'm so afraid that he is going to end up permanently disabled because of the paperwork issue and so frustrated with everything I don't know what to do.
Thank you for letting me vent.
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RexRacer
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Joined: 17 Aug 2004
Posts: 814
Location: A pancake house of ineffable crappiness
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Posted: 10/11/04 - 10:53 Post subject:
So sorry to hear this.
I'll defer to G3 on this, since she is the Queen of Consumer Advocacy, but my advice would be to keep that wheel squeakin' and keep going up the ladder. In my experience eventually you get the person who can fix it with a phone call. Trouble is finding out who that person is.
Low end people are often inclined (or even instructed) to "No" your every request, even worse in the insurance world than most, I'd guess.
Good luck!
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Gogirlgo
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Joined: 25 Jul 2002
Posts: 4777
Location: No deal, stalker.
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Posted: 10/11/04 - 11:00 Post subject:
I'm sorry to hear it, Kristin. When I have a problem and get "no" from a gatekeeper, I find out who the CEO of the company is and call their office. It works wonders, b/c people who makes scads of money usually understand the value of customer service.
If you'll PM me and tell me what the company is, I can probably find that out for you.
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rolling rock
The Pinball
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Posted: 10/11/04 - 11:07 Post subject:
 that stinks kristin
it can't hurt to do what GGG suggests...really.
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Cappy
Excelent
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Joined: 16 May 2002
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Location: Spreadsheetylvania
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Posted: 10/11/04 - 11:17 Post subject:
Going to the top isn't a bad idea. I think since its no fault of Larry's that he should be able to get the procedure done
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runaroundsue
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Joined: 18 Sep 2002
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Location: supporting GREENer pastures
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Posted: 10/11/04 - 11:22 Post subject:
The longer one can go without a hip replacement, the better....as they aren't a done deal and have to get replaced again 10-15 years. Does Larry's doctor feel an urgency? That is different. Many orthos make the patients wait until all other (pain management) avenues have been used up -- so to speak. I know lifestyle needs to be taken into account.
That said, most pre-existing denials are pure "bull" and you start making big waves and you will see action. As Go suggested, don't waste your time with the "little workers"....in pre-existing cases that would mean by passing the underwriter and going to his/her supervisor.....even better would be the vp of underwriting. VPs do not like "bad publicitiey", the underwriter/supervisor have no "concept" of this.....their job is to save money.
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elkid
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Location: hiding out in Philly
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Posted: 10/11/04 - 11:25 Post subject:
What I love is the billing discrepancy based on payor source. A few years back the Paramedic was involved in a worker's comp case that the state refused to view as a worker's comp case. Lucky us, we had no health insurance. The bills were ridiculous. When we sued the state and won, the bills were reissued at worker's comp prices. 1/12 the price of what was sent to us as private pay citizens. 
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kristin31
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Location: Caught in the crossfire of childhood and stardom
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Posted: 10/11/04 - 11:25 Post subject:
The orthopedist said he needed the left done immediately. The right to follow. They have new ceramic hip joints that I guess don't need replaced as often. He's gone through every pain medication from anti-inflammatories to Oxycodone and they aren't having an effect.
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runaroundsue
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Posted: 10/11/04 - 13:03 Post subject:
| elkid wrote: | | What I love is the billing discrepancy based on payor source. A few years back the Paramedic was involved in a worker's comp case that the state refused to view as a worker's comp case. Lucky us, we had no health insurance. The bills were ridiculous. When we sued the state and won, the bills were reissued at worker's comp prices. 1/12 the price of what was sent to us as private pay citizens. |
I agree. You'd think paying cash would be discounted due to all the less hassles the biller has to go through. Many times it's the opposite as the doctors may have an agreement with the insurance or HMO that gives them a certain discount. Hey if we all could get billed what medicare/medicaid did, we'd would think it's almost like going to a spa! Without these agreements, billings are perfectly arbitrary.....and they will bill for whatever they think they can get. After awhile providers can easily figure out the amount that private carriers will pay for a certain procedure. So it makes sense that a provider's billing amount would be above that amount to make sure they get 100%......so in some instances, it may be a procedure that might actually take less for. So if you ever "plan" to pay cash.....you should let dentist/doctor know and ask for a "cash" discount. If I pay my dentist before I leave the building, I get a 10% discount. If providers were "smart", they should give deeper discounts and say screw the insurance companies. But doctors have MDs not MBAs. It's easier for them to figure they pass the loss on Medicare on to private insurers when in the long run they'd be better off cutting out the middle man. As carriers get more "stingy" with paying providers and sticking the consumers with high premium, maybe there will be higher incentive to provide consumer based discounts.
Private Health care is here to stay until the consumers and providers work together better. As long as insurance companies are big and fat and have thousands of lobbyists in Washington, there will be no National Health Care. Kerry can dream though 
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andydp
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Joined: 23 Sep 2003
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Location: Upstate NY near Albany
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Posted: 10/11/04 - 15:22 Post subject:
I agree with everyne here. Keep pushing the "up button" on that organizaton elevator until you get the problem resolved.
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