Monday, December 15, 2008

*Rant Alert

I have cone to the conclusion that my health insurance company is not in the business of insuring my health. They seem determined to ruin it. Why, you ask? Well, we have been insured by the same company for the last 15 years. Let's take a look at some of their more obnoxious dealings with us in that period of time. These are just the things off the top of my head.

  • Refusal to pay for a visit to the ER and subsequent surgery to drain a staph infection in his knee when Mr. Lime presented with extreme knee pain, noticeable inflammation, and a fever...late in the evening the Friday before a Memorial Day. We were away from home visiting family. The insurance company said he should have gone to the doctor's office in our own town instead. I told them if they could provide me with a list of doctors who have office hours at that given time I'd be more than happy to schedule our health emergencies around the insurance company's stupidity.
  • Refusal to pay for my own ER visit for a severe asthma attack in another town because that hospital was not a preferred provider. Ok, I'll just drive home 2 hours while I am turning blue to get to the hospital you like.
  • The company reorganized themselves "to provide better services" and decided we, along with about half of the other employees they were supposed to be covering should have our policies arbitrarily canceled. Yes, that was a vast improvement. It was so improved and took so long to sort of the mayhem that ensued that doctors and labs and billing offices tried to avoid having to see us unless we were at death's door because they knew as soon as they saw our insurance card they'd have months of wrangling to get their claims paid.
  • Changed the chiropractic coverage to pretty much only cover the visits when I am so bad I can't walk. They won't deal with adjustments related to migraines. They will pay for a $30/month daily preventative prescription and a single $35 pill with known side effects if the other medicine doesn't prevent the migraine (a dose which may need to be repeated on successive days) but they won't pay $35 for a single chiropractic adjustment which has no negative side effects and won't have to be repeated for days on end. How's that for cost effective?
  • Refused to pay for the Med-Evac when I fell off the zipline even though our local ER had no trauma center and the EMTs suspected multiple fractures, I was at risk for spinal injury (and have a history of spine problems), I was allergic to every pain med they had on their rig, and the local hospital told the EMTs to call the helicopter.
  • The company decided just last year after 14 years of coverage that the new privacy laws don't allow them to speak to me about claims regarding my husband or children. I'm only on the policy as the spouse. I've only been the spouse for the entire time we've been covered. I'm the only person in this family who has any idea at all how to get these buffoons to use the half dozen brain cells that they possess to process our claims. I had to prove my children are minors and have my husband sign a ream of papers giving me permission to deal with them on his behalf. This is the man who doesn't even think to give his prescription card to the pharmacist when he has a prescription filled and they ask for it. He stands there like a deer in the headlights. He's an intelligent man, he just doesn't have any idea what to do in this situation. Oh, I get it now! The company figures if they cut out the one person who stands up to them they'll never have to pay ANY claims to us.
  • Refusal to pay ANY of Calypso's claims because they decided she was no longer a dependent. Of course, no one at the company was smart enough to figure out how to rectify that computer glitch for ages.
Which leads me to their latest example of gross incompetence....
  • I discovered when I went to refill a the migraine prescription (remember $35/pill times 9 pills equals wallet-induced migraine) that the insurance company had arbitrarily reset my deductible for the year to $0. Uh, it's December. I met my deductible for the year ages and ages ago. The pharmacy tells me to call the insurance company. Oh joy of joys. Then Calypso has a sinus infection so I take her to the doctor who then tells us we have a balance due because the insurance company denied the claims for visits in the last month when Diana and Isaac both went in for illnesses and I went in for my yearly AND had my mammogram. The one thing the doctor's office, the pharmacy, and the health insurance company are in agreement about is that I should just pay out of pocket and I will get reimbursed when the company gets things straightened out.
Yeah, it's Christmas, the budget is already tight, the pressure tank for our well is dying (we are just hoping it's only the pressure tank and NOT the well pump itself) and they want us to cough up over $700 in office visits and medications alone and wait for the insurance company to get its act together.

I

don't

think so.

I'm not worried because I know it will eventually work out. I am just sick of having to deal with these idiots coming up with knew ways to avoid actually providing coverage. It bugs the crap out of me and it infuriates me to think that there could be some critically ill people out there having to fight this same fight at this time of year.

Ok, rant finished.

We now return you to your regularly scheduled blog and something silly to offer a bit of perspective.


32 comments:

G-Man said...

Gloomy Christmas seems to be today's theme all right....
GREAT RANT!!!

G-Man said...

GIN, EUCHRE, And CANASTA!!!!

Desmond Jones said...

Oof! I so sympathize with you, Lime. I've taken to calling our health-insurance provider 'The No-Isurance Company', because they work WAY harder to deny claims than they ever do to provide us with what they said they would provide us. . .

But hey, this was YOUR rant. . .

Cocotte said...

Oh I hear you on this! My current struggle is getting them to pay for my mammogram I had done in Oct. It says right on the "Benefits" page that annual mammograms are included at 100% of coverage. So, why is mine paying $0, you ask? They are claiming it wasn't "billed as routine" even though it was my annual one, done routinely every year. GAAAHHHH!!!

Stay tough on them, Lime! That's their M.O.....they think people will just give up and pay.

Ella said...

and what's worse is you actually have the energy (ha! don't shoot me) to deal with their crap and still fight them. think about all those who are unable to stand up for them selves and really take it up the rear from these insurance companies. makes my tummy hurt...oh wait - it better not - insurance won't PAY FOR IT!

furiousBall said...

health insurance has now become that boyfriend/girlfriend/spouse/parent that questions if everything is truly ER-worthy

Moannie said...

Heck! I've only been away from you all for five days and I come back to THIS! Talk about making your tummy hurt, I get so angry EVERYTHING hurts. Angry that you all have this problem, angry that the companies are happy enough to take your money yet quibble and point to the small print when it is time for them to pay up. Angry that Socialised Medicine is still considered communisism, angry that people are in pain and even dying for lack of treatment. We may have long waiting lists [unless for emergencies]staffing problems and the usual administration headaches, but no-one is turned away untreated because of lack of funds.
I am so sorry. Give them hell.

lime said...

gman, way to check mate them all

desmond, yes, i'd like to do some number crunching on how much money they spend denying claims. as for my chiropractic thing...they are spending more money by denying my adequate chiro coverage.

cocotte, you are exactly right, they make money because people are afraid to fight them. not THIS girl, let me tell ya.

ella, my point exactly. if you or an immediate family member is critically ill you are in no frame of mind to dog some ins co, to get the service they owe you.

furiousball, eesh, you got that right.

moannie, i should clarify that at no time were we turned away from a doctor's office or hospital. we were just told we'd wind up footing the bill. and you better believe i'll give em hell. thanks.

Suldog said...

Ugh. That company deserves your foot up their collective ass. You want us all to come down there and beat 'em up? I'm sure many of us would be willing.

Cooper said...

Here's an amusing thought. the spousal unit and I pay close to $2000 annually in "contributions" to health plan costs. Health insurance has covered about $600 worth of costs this year. Why am I paying anything? I can save a net $1400 but NOT having health insurance (OK, we've been lucky not to have anything catastrophic happen this year, granted). This is one of the greatest scams known to man....the collusion of the legal and insurance industries.

where's my thorazine, dammit....

MyUtopia said...

I hear ya, I spent three months fighting for mine to pay for having Noah. It was sooo ridiculous.

S said...

I hear you loud and clear.
I have NO chiro coverage.
Guess where I have been two times already and expected a dozen more....
Yep.
The xray of my spine looks like Lombard Street.....ack! All those years of sewing and sleeping on my stomach...Im paying through pain and my wallet.
My doctor handed me a bunch o drugs and sent me on my way.
I knew I was going to end up at the chiro but I didnt wanna spend the $$.
Imagine, work my ASS off sewing and end up spending it all to fix what sewing does to me.....
ARGH!

Marmoset......

VE said...

So I take it you weren't invited to their big spa resort retreat either?

Fred said...

Hope you fell better now. It was a great rant.

I used to be in the business of selecting health care companies and the stinking truth is that they're all bad. It was depressing to deal with them on the management side.

Speaking of depressing...the top prescriptions where I worked were anti-depressants and birth control.

(M)ary said...

Here in Indiana if we have continuing issues with our insurance company we can make a complaint to the Indiana government office of insurance.

I looked it up and I believe your state has a similar department:

http://www.ins.state.pa.us/ins/site/default.asp

Good luck!I am sure that office is full of red tape too but maybe they can be helpful if you want to convince your insurance to pay for the ER visits and the medi-vac which seem like they should be covered by insurance.

misticblu said...

Amen! I have the insurance commissioners office on speed dial.

lime said...

suldog, oooh that is a very tempting offer

cooper, well...i am one of those who certainly had need for the catastrophic coverage a few years ago, but yes, for the healthy folks it does seem a rip off.

myutopia, took me almost to the first birthday to sort out the bills from my first child.

s, oh girl, i really feel your pain, in so many ways. i hope you are soon getting some improvement.

ve, no, i definitely wasn't. unless it was the one that went to the spa specializing in high colonics. yeah, the ins co has hosed me in a big way

fred, that sounds like a truly depressing job.

mary, well the good news is all the old rants were eventually settled to my satisfaction. in one instance yes, i had to threaten to call the PA dept of insurance. with the company that insured me while i was overseas i DID call the texas dept of insurance who then added me to the 15 page, single-spaced, double-sided list of co-plaintiffs in a class action suit against that company. thanks for a very practical suggestion though.

misticblu, lol, atta girl!

Moosekahl said...

There is so much truth in the movie Erin Brockavich. I work in health care and still think insurance companies suck!

barman said...

I thought I had good insurance and could not understand what everyone else was talking about until...

I had the Doctor send me in to get a CAT scan. By the insurance companies rules they were suppose to pay 100 percent, instead they only paid 85 percent. It was only about $90 I owed but I fought and fought. Every time they gave me an excuse I did my research and countered and killed their excuse only to have them come up with another. The one complaint area finally told me to stop calling, that I had just called yesterday which of course I DID NOT. It never was resolved and I never paid that bill. What caused it is the insurance company switched over to a new system and the doctors office filed the claim under the old system while they were running both systems parallel. I even have the proof of them filing under the old system but it did not matter. I am with another insurance company now but I am sure they are just as bad, I just have not run into it yet.

Good luck in beating them down before they wear you down. Sure wish there was a way we could force insurance companies to do what they say they will do.

barman said...

Thanks for the video, what a wonderful little pick me up after the depressing things of late. Marmoset...

KFarmer said...

I can't stand insurance companies. My favorite of all time was when I had skin cancer and the insurance company denied payment. The doc took one look, did a biopsy, found cancer and whacked it off. I paid out of pocket because she was not a preferred provider. Oh I fought it, but eventually lost. Whatta ya do? Did I mention I can't stand insurance companies?

Hope all works out and soon~

Breazy said...

I hate insurance companies! They set their own rules for whatever the situation. I just found out, Thurday, that I had been billed $1625.00 from my gynos office after my hysterectomy last year and that the lady in charge of billing had billed wrong so all I owed was $7.48. I almost flipped out because I had not known about the $1625 charge to begin with. The big charge had been sent to a collection agency which means it went on my credit report but now that the new billing lady knows what shes doing all of that has been taken care of and removed from my credit report...goofy people I tell ya.

I hope the insurance thing works out for you!

lime said...

moose, sadly you're right. and i know a lot of healthcare providers feel the same. the insurance companies impede their ability to practice medicine.

barman, not to be a complete pessimist but it's just a matter of time before this company bones you. glad yo uliked the video.

kfarmer, kinda makes you want to whack a thing or two off the suits making these decisions, doesn't it?

breazy, oh nice, ruin your credit report with a bill you never even knew you had and shouldn't have had in the first place. that's fabulous. glad you fought it and won that battle!

NYD said...

Everyone I know has a health insurance horror story. My wife watched 'Sicko' and was horrified. I did mention that things were not exactly as Mr. Moore put them, but that he wasn't so far off the mark.

All I can say is I like my health insurance. It's saved my life once and kept me out of the poor house many times over.

I really hope that the next administration really addresses this problem.

lime said...

nyd, michael moore is a sensationlist, imho but yeah, our system is badly broken and needs fixing. i am deeply grateful that my insurance paid most of the $100K needed to surgically repair and then rehabilitate my arm when i demolished it. i just wish i didn't have to fight them every step of the way while i was trying to get well.

ciara said...

and i thought my insurance co was bad...you're dealing w company full of morons!

mssolitaire said...

I am SO sorry you're having to deal with this crap! Hang in there my dear!

Jeni said...

Health insurance -boy, that opens up one big old can of worms, doesn't it?
Because I am medicare eligible, but because it doesn't pay all that much, I have a supplemental policy which actually takes over the medicare thing somehow. Anyway, it allows for one Pap test per year -routine, ya know. However, if you need another one of those tests, due to "further testing needed because of a bad result" they are supposed to cover that. However, I've been fighting between the insurance company and the office that did the test to get this second pap test covered for the past 6 months now. Just got another bill for that test a couple days ago and as yet, haven't called to see why it was denied again. Last time, I was told my doctor's office staff didn't fill the form out properly to indicate it was a test ordered because further testing was required. Go figure what their reason will be this time. That, and they won't cover the cost of a vaccine against shingles -which my doctor recommends because I am susceptible to those damnable things after having a bout with 'em two years ago that took me the better part of 7 long, very painful months to recover. They will however, reimburse me after I shell out the $250 required for the vaccine first! Now, if I only had the $250 spare money to make that investment....

Hilary said...

Oh geesh, that just stinks. I have heard so many health insurance horror stories from you Amurikans. I hate that for you. I'll join Sully's posse if need be.

Great video to end your rant.

Cristina said...

I recently came across your blog and have been reading along. I thought I would leave my first comment. I don't know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often.


Deborah

Term Life Insurance

ArtSparker said...

Health insurance "providers" are the only businesses that seem to be doing well in the current environment... The misuse of language is particularly galling..rate change instead of rate increase, for instance.

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