- 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.
- 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.
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.