I FINALLY beat the insurance company!

[Horse with no Name]

Yeah me!:eyes:
They authorized surgery for me a YEAR ago. When it was done, they denied it.
After filing a complaint with the state board of insurance (unsuccessful--piece of shit state sponsored piece of rot agency), after TWO appeals...FINALLY I have persuaded them to pay it.
Who knows? I guess when I started mentioning that it HAD to be illegal to deny something after it was authorized, and mentioning that why they had INDEED sent me a letter stating that the surgery would be paid for, they FINALLY decided in all of their benevolent wisdom, that yes indeed, they would certainly pay for the surgery.
And it only took me a year!

I would like to COMPLIMENT this fine system of healthcare in this country and the wonderful job the insurance bureaucracy does in doling out healthcare. Thank GOD I am not in a socialized system that would have made me wait 30 days before doing the procedure (uh well, wait, it took 45 days to get the initial authorization that they declined after-the-fact--but who is counting!), and would like to thank this wonderful system that did not allow the government to come between me and provider (if you don't count the fact that I had to file with the state insurance board--they aren't REALLY government, are they? And who did NOTHING after it was filed--because they aren't an "enforcement" agency, just a place to deposit complaints and make you feel like they give a shit when the insurance companies fuck you over). Not to mention my doctor who went a year without payment without harassing me (this was absolutely true--he had a copy of the authorization too).

What a fine medical system we have in this country! Thank God for the free market!

[yourout]

1. Another example of why anything less than a strong public option is unacceptable..

Single payer would be best but if it doesnt have at least a strong public option then they should do nothing at all.

[SoCalDem]

2. Now, check your FICO score & your credit rating.

My son had a lawsuit pending, due to an auto accident, and the hospital bill went unpaid for quite a while.

That showed up on his credit report, and it's been a real pain in the ass for him, trying to get it all cleared up.. He and his lawyers have been working on this for over a year now..and it still keeps popping up

[Ilsa]

4. Good advice. I wonder if the surgeon was paid, also, and if he or she

might have filed with the credit agencies over a delinquent bill.

[glowing]

6. You know, car insurance would most likely decrease with a public option.

No one would be fighting over who has to pay the medical bills. the only thing you'd really need to cover is if the accident caused injuries that wouldn't allow the person to work or become diabled. That would be another savings to the American consumer.. people don't even think about that angle.

[lildreamer316]

16. Great point!! n/t

[glowing]

18. Thanks.. I was just thinking that because car ins. increased again.

[xchrom]

3. recommend

[LuvNewcastle]

5. K&R

[Warpy]

7. I share your pain

I got into an argument with a hospital over a bill which had obviously been heavily padded: phantom services, unbundled labs, upcoded service, the whole deal. I called them on it. They stonewalled. I told them to pound sand, they sent it to collection, I told the collection agency what was going on and recommended they turf it back to the hospital and contacted the state AG office with copies of the dispute to Medicare to alert them that the place was engaging in fraud.

They not only caved after the first nasty letter from the AG's office, they settled for less than 10% of what I actually owed, even after I said I didn't want a free ride, just a fair one, and said what the bill should have been.

Medicare investigated them and they were sold six months later. The outfit who owns them now is for profit but honest.

Moral: never stonewall anybody who is fighting back. Some of us out here are nurses with extremely bad attitudes who can make a shitstorm rain down and the rest are tenacious enough to ruin their days for a very long time.

Congratulations on your win. It's just a shame the system is so bad we have to fight for what we've already paid for, that the insurance companies are out to cheat us out of everything they can.

Those are the "corporate persons" who are in need of the death penalty.

[Tracer]

9. Warpy -- you've got the knowlege to question a bill.

What about people who don't?

I've gotten a stack of bills that just say a price. Any old price, it seems.

No breakdown whatsoever. How is one supposed to figure that out?

(At least my doc's office sends out bills broken down to the very last .10 charge for saline)

[Warpy]

10. I've been toying with the idea of opening a service for uninsured folks

to show them how to question the legitimacy of the bills they're getting, but taking money from people already under severe financial stress seems to be a very hazy ethical thing. I've advised friends and family on how to get care and fight insurance companies for benefits when they're on the mend and how to fight hospital billing departments and everybody's won so far.

Always demand an itemized bill and don't pay until you get one. Some places will reduce the charges on the spot. I think most people who fight will have at least a partial win, even if they don't have a clue what's going on.

[Horse with no Name]

11. I had surgery at one of the HCA/Columbia facilities that stole all the money from Medicare

many years ago.
I had a day surgery with an overnight stay.
The bill was close to $30k (circa 1995).
I asked for an itemized statement.
They sent it and I was charged for all kinds of shit intraoperatively--a Swan Ganz tray, Chest X-ray, etc.
I questioned the bill. They told me it was correct.
I told them that I think I would have realized that I had a Swan put in after surgery--and informed them there wasn't even a hole where it could have gone if they had just put it in and taken it out. I also questioned why I had a CXR intraoperatively when I had one immediately preoperatively.
They fought me tooth and nail on the bill--ended up removing about $5k (not nearly enough), but the insurance company paid everything, so I wasn't out any money.
It's all a scam.:(

[Warpy]

12. It's not all a scam, but the scammers are out there

The net is making it harder to get away with it. Had you had no medical knowledge, looking up "Swan Ganz catheter" on the net would have provided you with enough to realize, "Hey, I didn't have one of those stupid things!" and beat them.

The hospital I fought has changed owners twice but my records there are still flagged. I had my corneal transplant there, paying up front. Not only did I get the up front discount, I also got a nice rebate check about a month later. They know they are not going to beat me out of a dime. The others in town have all been honest, at least so far.

We'll see what this week's bill looks like. 2 days of intensive care can't have been cheap.

[scheming daemons]

8. Hopefully with a stick

[Vinca]

13. You ought to file a small claims suit against them and

sue for the hours of work it took to get your approved surgery claim paid.

[mnhtnbb]

14. You should write up your experience as an opinion piece and submit it

to your regional newspaper.

Good for you for hanging in there!

Hope your recovery is complete.

[mwooldri]

15. Again makes me think I'm dead lucky...

Congrats you were able to get this sorted out.

My employer *is* my insurance, I had a similar situation and the insurance carrier (who will remain nameless) misprocessed a claim. Went through their process, no dice. Went through HR, got what I wanted - carrier processed the claim. Next open enrollment period, switched carriers. But still insured through my employer.

Mark.

[AzNick]

17. You drew a line in the sand nt