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health care...dazed, confused, scared...help! (Read 1320 times)
jon019
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health care...dazed, confused, scared...help!
Aug 7th, 2009 at 10:46pm
 
Hello All,

This is NOT a political thread...I would be happy to debate/discuss politics, religion, and sex (the BIG three) with ANYONE, face to face...just not on an internet forum...I'm not smart enough or articulate enough to do that...

So, what am I asking/saying?

Well, first of all..I'm scared...

For the last 27 yrs I have worked for the same employer...the health care insurance is mediocre, at best, but it's all I have...

They denied O2 coverage (till lately), zomig coverage (til lately)... both hard fought coverages... won...now...after yrs of battle. It has been exhausting....

So, then, a NEW condition. I used to yearn for retirement before 65 yrs old...now, I cannot imagine being able...I'm trapped for as long as I can hang on!

Why?...because I have PRE-EXISTING conditions...ch, osteopenia, and now cancer....can anyone imagine an insurance co willing to cover ME?... FAT CHANCE...

Costs (and I'm only at the beginning of this nightmare) for the current condition are over $20,000...so far. The insurance carrier has DENIED 50% of that, covered 25% and left me to handle the other 25% (possibly 75%). If I didn't have savings...I would be destitute...Even my old standby of getting the insurance broker to intercede is useless as he will not return phone calls (he will regret THAT, as I will make his life miserable if need be, but, sigh, another battle I have little energy for...)

(Edited to add what I almost forgot...the original hospital where the biopsy was done, has billed me for a procedure totally unrelated to the biopsy. Insurance covering $18 out of the $400 billed. When I called to dispute...they said I had to figure out what happened...as far as they were concerned, it was a valid bill.

It can't be on the chart...WHICH THEY HAVE...but it's MY problem. NEVER considered I would need a paid advocate for this...looking like I will now. Don't have the time or energy for this...my best advice...DON'T get sick....there are sharks in the water...and we are bloody chum............)

What should I do?...what would you do? What happens when my employer tires of my 6 hr work days? I'm 54, medicare is too far away to even consider...and I'm scared...

This is NOT a poor Jon...pity me plea..this is a what the hell do I do now plea? My thinking is a little foggy right now, and I may not have explained this cogently...but I am desperate for advice. What do I do now?

Best,

Jon


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« Last Edit: Aug 8th, 2009 at 12:37am by jon019 »  

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Charlie
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Re: health care...dazed, confused, scared...help!
Reply #1 - Aug 8th, 2009 at 2:43am
 
Quote:
(Edited to add what I almost forgot...the original hospital where the biopsy was done, has billed me for a procedure totally unrelated to the biopsy. Insurance covering $18 out of the $400 billed. When I called to dispute...they said I had to figure out what happened...as far as they were concerned, it was a valid bill.


Don't pay the bill for now. Make them work for it and do not use a credit card.  Let these people know that you have some serious questions about it.  Pay up if you have to but do it at your own speed. So long as you send something every month, they can't do much about it.  I've written to several doctors out of town over the years after getting surprise bills from them when I have no idea who or what they are. I tell them that I don't pay for some neurologist to stick his head in the door to remind me that I have epilepsy when I'm hospitalized for a TIA attack. He and others gave up on me.

Anyway, I wrote letters to more than one facility over the years.....including by the way, the creep doctor in Dallas that sent me a bill for $150 for calling my doctor here so he could write me a presciption for the pills that were lost in my luggage on the way to the 2005 CH convention...I think. I sent him a letter explaining what I though about it and a check for $20 telling that I thought it would cover a phone call and that for most of my life, doctors have been glad to help out out a visitor from out of town. It seemed to work as I haven't heard from him in four years. I have no shame whatsoever dealing with them. It's we who are on the shitty end of this system.

As for pre-existing conditions and the like, it gets worse every day. Insurers like to down-code all the time which means that they spend a lot of money looking for ways to eliminate the number of  procedures that cost them money rather than help out those that have paid into the system all these years.

I'm very sorry about all your troubles and hope that you get some better news from the system and of course about your health.

Stick around.

Charlie (I do go on, don't I?  Shocked)




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deltadarlin
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Re: health care...dazed, confused, scared...help!
Reply #2 - Aug 8th, 2009 at 9:34am
 
Jon,
You do have rights under Federal Law.  Although this is a website for an auditing company, the front page lists what you can/need to do.

As far as the insurance denying claims, they must give you a written reason why.

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jon019
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Re: health care...dazed, confused, scared...help!
Reply #3 - Aug 8th, 2009 at 11:43am
 
Thank you Charlie...that gives me the energy and determination boost I needed!!

Carolyn.....what an excellent website...just learned a WHOLE LOT
I needed to know...thank you!!

Best,

Jon
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deltadarlin
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Re: health care...dazed, confused, scared...help!
Reply #4 - Aug 8th, 2009 at 7:24pm
 
Glad I could help.t remember, *you* are your own best advocate and many times, they depend on your perceived *ignorance* to get away with things.

Anything I can do, let me know.

Carolyn
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Kirk
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Re: health care...dazed, confused, scared...help!
Reply #5 - Aug 9th, 2009 at 10:49am
 
   Have you ever been in the armed forces? You have some pretty good resources there if you were. Feel free to contact me if you want.

Smiley
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jon019
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Re: health care...dazed, confused, scared...help!
Reply #6 - Aug 9th, 2009 at 12:47pm
 
Hi Kirk,

I have the ultimate respect, regard, and gratitude for those who served or are serving now...but, no...never had the privilege myself...

Best,

Jon
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purpleydog
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Re: health care...dazed, confused, scared...help!
Reply #7 - Aug 9th, 2009 at 2:38pm
 
Jon, any bills you get for procedures that weren't done, send a letter to the medical office disputing the charges, and why. You can write a generic letter, and keep it on your computer, and just insert the issue at hand. They will have to respond, in writing, and when they admit they screwed up, send a copy to your insurance, so they can recoup their payment. Also, you have to dispute the charges in writing, this way, they have to respond in a certain amount of time.

Some insurance companies have a lifetime cap on what they will spend for an individual, so any billing mistakes you catch will help. Get a contact at your insurance to talk to, and talk to no one else. This way, they can't play the "I don't know who you spoke with" game.

You can appeal any claim denied by your insurance. Also, get copies of your medical records. You will need to sign a release, then tell them you will be in to pick them up in a couple of days. Get copies of all records from here forward. Don't let anyone blow you off on this.

As Carolyn said, you are your own best advocate, however, you may want to have someone to do this for you. They will need to be able to have access to your medical records, you'll need to sign a release, and possibly see a lawyer to have papers drawn up for this access.

I hope everything goes easier in the future for you. You are in my thoughts.   Smiley
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Linda_Howell
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Re: health care...dazed, confused, scared...help!
Reply #8 - Aug 9th, 2009 at 6:09pm
 
I wish so badly I could help you with your original question Jon.

     HOWEVER.....

Quote:
I would be happy to debate/discuss politics, religion, and sex (the BIG three) with ANYONE, face to face...just not on an internet forum...I'm not smart enough or articulate enough to do that...


THAT statement alone makes you FAR more  intelligent and articulate than you will ever know.  In my book.... as well as many many others book.   Kiss
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monty
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Re: health care...dazed, confused, scared...help!
Reply #9 - Aug 10th, 2009 at 6:39pm
 
jon019 wrote on Aug 7th, 2009 at 10:46pm:
Costs (and I'm only at the beginning of this nightmare) for the current condition are over $20,000...so far. The insurance carrier has DENIED 50% of that, covered 25% and left me to handle the other 25% (possibly 75%). If I didn't have savings...I would be destitute...Even my old standby of getting the insurance broker to intercede is useless as he will not return phone calls (he will regret THAT, as I will make his life miserable if need be, but, sigh, another battle I have little energy for...)


You may have to work with your doctors on this. While many assume that people with insurance are entitled to medically appropriate treatment, that is not true. You are only entitled to medically appropriate care that your insurance company will approve, unless you are willing to pay out of pocket.  You didn't say why they denied 50% of the bill outright - is there a high limitation (cap on copay and deductibles)?? 

Is there another treatment that is also considered effective, that your insurance company will cover?  Talk to your doctor.   I have had a doctor write prescriptions that are not really covered, when another effective medicine is.  I have also had my doctor order tests that are not covered ... I had to ask him to be more considerate and check first.

Would a call from your doctor to the insurance company explaining the situation make a difference? Maybe.  Talk to your doctor. 

Ideally, one would not have to talk to one's doctor about these logistical matters ... but we do.  The doc may have other ideas, and if he/she doesn't understand the financial/insurance picture, it may cost more.
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jon019
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Re: health care...dazed, confused, scared...help!
Reply #10 - Aug 10th, 2009 at 9:07pm
 
Hi Monty...thanks for the comments...see mine below...



monty wrote on Aug 10th, 2009 at 6:39pm:
jon019 wrote on Aug 7th, 2009 at 10:46pm:
Costs (and I'm only at the beginning of this nightmare) for the current condition are over $20,000...so far. The insurance carrier has DENIED 50% of that, covered 25% and left me to handle the other 25% (possibly 75%). If I didn't have savings...I would be destitute...Even my old standby of getting the insurance broker to intercede is useless as he will not return phone calls (he will regret THAT, as I will make his life miserable if need be, but, sigh, another battle I have little energy for...)


You may have to work with your doctors on this. While many assume that people with insurance are entitled to medically appropriate treatment, that is not true. You are only entitled to medically appropriate care that your insurance company will approve, unless you are willing to pay out of pocket.  You didn't say why they denied 50% of the bill outright - is there a high limitation (cap on copay and deductibles)??  

Doc prescribed a PET/CT scan...my understanding that it is best way to determine where cancer has spread to...and therefore most appropriate treatment. Also very expensive. Insurance co said they would not approve test at this particular facility...but WOULD at several others...list of which they provided. Initial provider graciously made appt for me (at their competition, no less!).

5 minutes before that appt, test the facility called to say insurance was denying. I called ins co...they said NOT true...all they needed was an authorization from my treating physician. I pointed out they had ALREADY approved, and I was going to their own directed test facility.
THAT met deaf ears. I called the facility back and they said...well, it HAS been denied...and here's the person and co (an outsourced "approval" co employed by the ins co).

At this point I am a COMPLETE mess...what to do now???? Wait a month and tear my own guts out...or find out what's going on inside. I chose to go through with the test and fight it out later...that's where I am now....and I don't trust a single word from this ins co.



Is there another treatment that is also considered effective, that your insurance company will cover?  Talk to your doctor.   I have had a doctor write prescriptions that are not really covered, when another effective medicine is.  I have also had my doctor order tests that are not covered ... I had to ask him to be more considerate and check first.

NONE of the other multiple tests and procedures I have been through are anything but STANDARD for my condition. I KNOW...I checked on multiple sites, including National Cancer Insitute (NIH). Have read my ins policy several times (now that there is some interesting and confusing reading). Sure didn't understand IT...and I totally understand the  "process"...where ins co approves "standard and typical" charges...or whatever the phrase is. So far, each of those has been covered for what they consider "ok", then 90% of that...out of pocket for each has been 50%.  So ok, that's the policy, like I said mediocre...but I'm still thinking they are playing me...each of those tests and procedures were at "approved" facilities...



Would a call from your doctor to the insurance company explaining the situation make a difference? Maybe.  Talk to your doctor.  

Ideally, one would not have to talk to one's doctor about these logistical matters ... but we do.  The doc may have other ideas, and if he/she doesn't understand the financial/insurance picture, it may cost more.  

Wise counsel and I shall be more wise in the future...thanks man! The battle begins and the previous battle for ch coverage only encourages me....sigh...I guess I should have expected it...naively thought there was someone with a soul and heart administering this...I WILL NOT let this affect my view of my fellow man...just don't ask about health ins vampires...


Best,

Jon


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jon019
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Re: health care...dazed, confused, scared...help!
Reply #11 - Aug 26th, 2009 at 8:47pm
 
Hello All,

Treading carefully here....ch.com is not a "jon blog" and I have no intention of turning it into such...we all got problems...

The following is an update, and some parts may be helpful to someone else...

Re the Ins Co and the PET/CT scan...it's ALMOST funny...they sent me DUPLICATE letters asking for "further" information...most of what they are asking for has NOTHING to do with the procedure or condition. It is obvious to me they are stalling and hunting for something, anything, that will allow them to deny payment. Won't work... if nothing else, ch has given me a determination and a resolve to fight the heartless bastards....

Re the hospital WRONG billing (and I am rapidly coming to the conclusion that hospital billing departments are in league with the same devil as insurance companies)...Bear with me, it is instructive.

The first person I called was an idiot...plain and simple,
and no help at all..."this is YOUR problem sir" Said I had to call the Doctor...and "nope, no idea what his number is" (their own friggin hospital!)

Figuring bad luck of the draw I tried again...the second person was clueless, polite but lame...said I had to call the clinic where the procedure was performed...

Called them.. oh my, she was rude (heavy sighs), obnoxious (and ,and, AND???), dismissive (I cannot help you SUHR!!!)....wouldn't have peed on me if I was on fire...actually kept her on the line just for the enjoyment of tormenting a soulless robot (hey, ya gotta find your fun somewhere!).

Well, I have to admit to being a little slow...but I finally got the msg. Tracked down the actual dept where the procedure was performed (surprisngly difficult, they don't wanna talk to you!). The lady there referred me back to the jerk above, but DID say, call back if you have any problems. I waited a day and called back...she was understanding (after I spilled my guts)... and FINALLY I had the name and number of the ACTUAL person who coded this bill.

Called and left a msg.....a week later and he didn't call back...SO I DID! Surprise, surprise, SURPRISE!... a REAL person. He was funny, he was understanding, he was helpful, damitol...he was a CUSTOMER SERVICE professional. Told me more than his bosses would EVER approve, said yes, they made a mistake, said it is a common occurence, said it has happened to HIM, in his own facility!, said he would FIX IT...and he DID (at least I'm trusting such)...

My advice..."Never, never, never, never give up" W. Churchill.

You all are the wind beneath my wings...that I will NEVER forget...

BTW, I DID prepare a "dispute" letter...it's all ready for the next time...just didn't think it would have ANY effect on these knotheads, based on their response...and I didn't want my credit rating sullied in the meantime...

Later,

Love,

Jon



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Charlie
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Re: health care...dazed, confused, scared...help!
Reply #12 - Aug 26th, 2009 at 9:27pm
 
Some nice work and moves, Jon. Nuke 'em until they give up.

Insurance companies always delay everything relating to services. They like to run out the clock on us. At the last moment when it's too late, they say they will look into paying for that liver that's waiting in the fridge at the hospital. This has happened many times, it's not fiction.

I learned years ago that the more questions you ask, the more chance that they will try to sound bright and come up with answers. It's human nature not to want to sound stupid. It works a good protion of the time.

Make them do the legwork. It's their fault.

Anyway, it's great that things are looking better for you.

Good luck Jon.

Charlie
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« Last Edit: Aug 27th, 2009 at 8:17am by Charlie »  

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Peppermint
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Re: health care...dazed, confused, scared...help!
Reply #13 - Aug 27th, 2009 at 10:10am
 
Good for you Jon!! Fighting an incorrect billing code is a b*tch, and especially stressful in your case.
(I will take some pointers for myself, as I am in the middle of fighting a billing code... but the hospital has since closed down  Roll Eyes so it's even harder if that's possible.)

Keep doing what you're doing, stay positive, and with prayers and diligence, hopefully this will all streamline down your road to wellness.  Thanks for the update!

Pepp  Cool
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Re: health care...dazed, confused, scared...help!
Reply #14 - Aug 27th, 2009 at 11:39am
 
Jon,  I don't have a clue as to how to go about disputing a charge like this, but I'd do precisely what you are doing.
As an aside, don't you think it would be enough that you are in for a fight with your health.........this simply adds to your burden!
Please continue to post whatever is making life harder, and let us know the good news as well. If you'll continue to do that, I, for one, promise to keep the vibes streaming for a complete recovery.
Keeping you in my thoughts, as always,
Cathi
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