Insurance Issues

[cindylee]

Okay everyone, I was reading through the posts about the Walkaide and how much it cost and how many people were trying to get one but could not afford it. It got me to thinking. How many of the people here have had issues with the insurance companies? Not just for one thing in particular, but with everything from PT treatments to equipment that might be helpful. In my ethics class tonight we watched that Michael Moore movie called Sicko. It brought back a lot of memories for me. And also for a lot of the things I am going through now. And then I thought of you guys. Is it safe to say that all of us have had insurance problems getting what we rightfully need to feel better? I'll be doing term paper on this, so give me some good stories. Cindy

[Joel]

Cindy:
My first surgery 12 years ago was with a local NS--this was the ONLY approved NS my insurance carrier would let me use. Later it turned out he had so many lawsuits against him, that he quit surgery! I was forced to change to a more expensive plan here at UNLV, so I could pick and choose any doctor I wantedd. Then 4 years ago, I was able to use George Jallo because I changed insurance carriers. Who knows what would have happened had I not switched carriers.
Joel

[drummer904]

Here's a story:

While i was in inpatient rehab, a wheelchair was ordered for me right before i was discharged home. It's a nice chair i guess, called a "quickie gt" (we still laugh at that). When i did leave to go home, they gave me a loaner to use since medicaid wasn't approved for me yet. so, it finally goes through, the chair gets made, i go pick it up, everything is cool. a few weeks later, the mobility company that made it sends me a bill for a $4,100 wheelchair, i just ignored it, thiking theat medicaid paid for it. then i get phone calls from them saying they denied it since medicaid put me on an hmo (i know nothing about this stuff). so i start making phone calls for days, finally someone told me that it was paid for. ok, all taken care of.
not the case.
a bolt broke on it that holds the backrest to the frame while i was going up the ramp to my front door which could have done some more damage to my situation.
so i call them up, they say Ok, we'll come pick it up and drop u off a loaner untill we fix it, should be a week at the most. that was in January and i still have the loaner. apparantly the chair never got paid for and they are holding it until it gets straightened out. ive been trying to talk to medicaid and, what a hassle. on the bright side though, i talked to a nice lady at the medicaid office and told her whats going on, so she switched me to the right hmo or medicaid thing and hopefully i'll have my other chair back next month. It's all about talking to the right person finding that person can be hard.

hope this helps, Cindy!

[shan]

My insurance wouldn't approve an MRI on my spine when I first had problems... even weeks later and with my family doctor calling them about four times to explain what he was looking for and why. My doctor KNEW that I really needed it though, and told me it turns out that it was just the outpatient MRI they wouldn't pay for. He admitted me to the hospital for pain, and did the tests as an inpatient, which they have to cover. He also ended up keeping me an extra day for high blood pressure, which got up to 182/126 when the pain was really bad, so it's a good thing I went in, I guess. I never had high blood pressure until all this started. Stupid insurance.....

[ScrapHeap]

Normally I avoid any discussion that has the words "Michael Moore" within. I don't subscribe to a single thought that he has passed on to paper or film. He makes money spreading lies and hate. His so called "facts" hold less water than Al Gore's global warming arguments. I could elaborate but I'll refrain. As I will end up having my infamous potty mouth transpose to the keyboard. Suffice it to say, in my world, MM is less than chewed gum that has found its way to a shoe bottom.

I think almost all of us have had issues w/insurance companies. They are a business and their business is risk. I.E., they gamble on collecting more from premiums than they pay out. Plus they have to cover their enormous overhead/expenses.

We have the absolute best all around health care on the planet here in the states. Consequently, it doesn't become that way from being free (no such thing really). It doesn't come cheap. The key is to know your coverage. Ask a ton of questions. It's your right to know as a paying customer. It is also your responsibility to know. If you decide you don't like the plan or the practices, change providers. I know this is an over simplification but it's true. For those of us on a Medicaid or Medicare plan only, well, we're sort of stuck. But we still need to know what we should and should not receive (as promised in writing).

I speak as a professional patient and from professional patient experiences. That includes run-ins with many a reluctant to completely cruel insurance company practices. Looking back (and forward), I realized that once I knew what/how to act, say and do, not even the largest insurance company could say no to what I paid for and they (reluctantly) agreed in writing (however small and obscure the print) to provide. As mentioned, it is a matter of knowing your rights and speaking in proper terminology to the right person (usually a case worker or their bosses).

From my experiences I was eventually offered and obtained the absolute best care available by the very same companies that initially refused to provide anything other than an inflated bill.

[supv26]

So far so good for me! I did receive a call from my insurance not too long ago but I have not a clue as to what it was for. They called me on my cell phone at work and I could not talk to them. The person gave me a call back number and a name to talk too. I called back a few hours later and all I got was a recording and I left a message. They have never returned my call.

I also received a letter once with a survey to fill out. The survey asked questions like how I was injured and who caused it. It sounded to me like they were going to try to sue someone for the cost of all my surgery and other expenses. At the bottom of the form was a comment section and I told them that this was not the cause of anyone but GOD. If they needed to sue anyone to take it up with Him! LOL

[8338]

Cindy,
Five years ago when, I went in for my first surgery back here in Buffalo the Insurance Co. picked up everything. After I discovered that the surgeon didn't get any of the tumor out, I decided to go with Dr. Jallo. Who else would I want except an expert in the field of sct's and when they're slicing your spinal cord open for the second time, you don't want a doctor who isn't familiar with these operations.
Welllllllllllllllllll.....the insurance company wouldn't cover another doctor 100% if they were out of their network. The insurance company told me to go with an othorpedic doctor!!!!! THE INSURANCE COMPANY REPS. DEFINETLY DON'T KNOW WHAT AN SCT IS! I decided to go with Dr. Jallo and the ins. company picked up some of the charges but I had to take out a home equity loan for $15,000..........but at least Dr. Jallo got it!!!!

My new insurance company pays for 1/2 of the cost of a gym for the wellness program. I go to the open gym program at the pt place so I wrote the ins. company and told them that I go to the pt for gym and without it I couldn't make it into work everyday :-) They picked up 1/2 the cost of a full years membership :-)

Us, with a sct, are in the menority so we have to educate and then fight for what we deserve!

Barb