I've had nothing but problems with my insurance co due to my pre-existing condition (CH)  and they have denied every claim with the exception of the "Polish brain tumor" removal:

Bronchitis- denied, need additional information to determine pre-existing conditions.

Tendonitis- denied, need additional information to determine pre-existing conditions.

Broken toe- denied, need additional information to determine pre-existing conditions.

So what DOES the insurance finally approve????

Oxygen for my CH!  Not only that, I get free refills for not 30 days, not 90 days.............for the next 365 days!!

mummymac wrote on Jul 9^th, 2008 at 6:35pm:


ROFLMAO!!

Jenn:

At least the did the right thing this time!

Ray   

Fight them on everything but the oxygen.

They COUNT on you not to make a fuss.  Be firm, be polite, and be relentless.  Show no mercy and they WILL cover your problems.  Pre-existing broken toe - HUMPF!!!

Mosaicwench wrote on Jul 9^th, 2008 at 10:01pm:


Now that there is golden(it's the POLICY to get ya to quit)! It is to the point with me now that I ENJOY making them deny me, deny me, deny me, deny me... AND THEN, I sic our insurance broker on 'em. Since I'm not the customer, they don't care squat about me. Get the broker on their ass (their ACTUAL customer), and AMAZING things happen. Only thing is, you got to pester the broker until he/she would rather deal with the knotheads at the insurance co rather than you. It aint easy, but then neither is clusterville. Suspect it would work with other probs too!

Nobody here here deserves what we go through. Passing along a TINY bit of the frustration can be exilarating. Go for it Polly dear!

Regards

Jon

I've had a few of those per-exsisting condition - therefor "Denied" as well.

I think all insurance companies have found the loop hole.  Pre-existing condition caused by liquid to oxygen lung intake caused by birth canal squeeze, or abdominal muscle exit during life event.

Great news about the oxygen....

WTG Midge!

One question.  How can you have a pre-existing condition for a broken toe?  Ya broke it, it's broke, ya fix it, insurance pays.  Nuff said.  Unless, of course, you drop the O2 tank on it. 

I'm just hanging on until I hit 65 and Medicare kicks i (if we still have it by then - 3 years), to get my knee replaced.  Because I had my left knee replaced 10 years ago, it is now considered a pre-existing condition if my RIGHT knee has problems.  My insurance pays nothing for me to go to my ortho for a cordisone shot in my right knee.

Insurance companies are like politicians.  They tell you what you want to hear to get the policy/vote, then they do whatever they darned well want to do, which is pocket your money.

Sandy

purpleydog wrote on Jul 10^th, 2008 at 1:05am:


Geez, sorry. I forget that some haven't been as "lucky" as me.

In my company, we don't deal directly with the health insurance company. We hire a "broker" to find us coverage. They actually go out and find us insurance. This is where "they are the customer, not me, comes in". We pay the broker, the broker buys the insurance and gets a commission. The insurance co views US as a nuisance and the broker as the customer.

Since I have had EVERY possible treatment for CH questioned, the stress of the battle was immense. O2, nope, not a proven treatment, not approved. Verapamil, that's a BP drug, NOT approved for this condition, Zomig, too expensive and we don't think you need more than 6 per mo. Imitrex, OMG, do you know how expensive THAT is, nope, not approved. And on and on...

My frustration level grew, and combined with the CH, I feared for my sanity. What the hell is a health insurance policy for if not to cover your condition?????? I finally went to our HR lady (yup, I'm a little s---l---o---w). She was aghast. Before I left her office she was on the phone DEMANDING to know what the hell was going on?

I got the brokers direct number and instructions to call it NOW. I did. She was rude, dismissive, and no help at all. I ALMOST gave up but talked to HR lady again. Now the fun began. She got on the phone again and made it clear to the broker that "we" were not pleased.

Within 24 hrs, I got a grovelling apology phone call from that broker (hey, we were THEIR customer). Within 72 hrs I got O2 approved, zomig, approved, verapamil, approved, imitrex, approved.

That there is what I'm talkin bout. Ya gots to find out who is who in the customer/vendor relationship. Like I said, lucky. We are being purchased and I know not what is to come. Best I can say is to pursue ALL alternatives and make 'em sweat.

Aint no wimps in clusterville. If nothing else, make 'em sell their souls.
Karma is a bitch if you are on the wrong side....

Best,

Jon