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We're insured through my husband's employer. Until a recent merger, we had our bumps, but bills got paid. Now we're insured through (un)United Healthcare. I think their mission statement should be as follows:
Confuse the customer and redirect them at all times. Recommend they seek state medical assistance programs for their disabled child that is covered under said insurance policy. Put coverage in writing, but deny all claims until they're appealed at least 3 times. Never pay any claim that has been pre-approved. When the customer is in debt collection over our failure to pay pre-approved claims, redirect them to someone else who cannot help, then forward them to the disconnect line. Make sure you state that supervisors are not available, ever, and hang up on the customer when they show the hint of frustration. Our number one goal is to make money, not pay claims - ever.
The above has been our life since March 2007. Our son has a variety of global delays from an extremely premature birth (23.6wk surviving twin). He is now 3.5yo, and just learning to walk. He has severe oral aversion, does not eat, and due to lack of use, rarely swallows anymore.
Prior to changing insurance, we had therapy for Speech, Occupational & Physical therapy. Speech included oral motor (eating) and verbal motor (talking) therapy. Currently, he has verbal motor and Physical. Physical therapy is a major regression in structure - he's only learned to walk by our working with him - not from any advice or guidance from therapy. The speech therapist won't even attempt feeding therapy, or give us suggestions at home. She was supposed to start throat stimiluation therapy (to help him remember how to swallow), but has since withdrawn from that - despite drs orders to go forward with it. Their occupational therapist (who is new) is a complete nutjob. I wouldn't even trust him with her. Wouldn't you know it - in a one hour drive radius - this therapy group is the only group approved under our insurance (and I drive 30-35 min just to get to them). We can go to one of their satellite offices over an hour away if I want to switch. Did I mention that none of this even matters since only the first few claims have even been paid since we started going there in April? Yes, the therapy group is going to drop us soon because of it - we already received our warning letter.
Then there's is physical needs... We had a walker on loan to us that had to be returned when we lost our old therapy group (5 min away, no less). So our son went 2 months without a walker, and used a broken/duct-taped one at school while insurance decided if is was necessary.
Then there's his feeding needs. We can use a vendor that charges 3-4 times retail price, and have to pay 20% copay - or we can use an unapproved vendor (who charges retail) and nearly buy the items out of pocket for less than our copay. Did I mention that his food alone costs around $600/mo? then there's feeding bags, syringes, g-tubes, the list goes on. Thank god we own his feeding pump, and I stocked up on food before the insurance change - or during the 1.5mos it took to get approval to even reorder food - he would have starved to death. Should I bother mentioning that after jumping through hoops, getting DH's benefits admin involved, etc that they still denied the first claim - then gave us a 6mo pre-approval, after that we have to be re-approved.
Oh yes, and then 3 pre-approved surgeries, one for one son, two for the other (with special needs)... None have been paid. Surgeries occurred in March, April & May.
Then there's the problem with finding providers. It seems that none of the drs in the area want to carry United HC patients, not even entire health systems. It's one of the reasons why we have to drive past a hospital not even 10 minutes away, and go over to the next town - 35-40 min away to see a dr. That makes sense, right? what happens during an emergency? Well, they told us they'd pay the bill if it was an emergency - somehow I doubt that will ever happen.
So here we are, sorting through the mound of drs bills - trying to find out how many debt collectors are going to call this week. Wondering if some day we'll have to file bankruptcy over bills that our policy clearly states are covered expenses.
So someone please tell me - what's wrong with a single payer healthcare system again? Because I'd take it in a heartbeat. As for universal healthcare... Bring it on. My child has been on 2 waitlists for a neurlogist, and still hasn't seen one. the first wait was for a year, the second 7mo. Our health insurance changed a month before our appointment, so I had to cancel it. Guess what - we're on another wait list. My son is 3.5yo, and we're still trying to find out if he has mild CP or some other syndrome. We know he has something, but can't even see a dr to tell us what.
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