Insurance Hassles

[tobagotwo]

I don't know about anyone else, but I'm having significant difficulties with getting my insurance company to assist, rather than impede my progress toward this surgery.

They're supposed to be able to set up "case management" to assist, but, although my PCP has requested it, they still haven't done anything towards it.

My insurance company keeps changing who is allowed to do what, and bullying places into canceling my appointments. I have a network-choice plan, which means I can have things done "out of network" at a somewhat higher cost, but my insurance company just tells "out-of-network" places that they're "not authorized" to do the work and scares them off. I just lost my carotid echo appointment at THE SAME PLACE that did my echocardiogram. This sets me back another two weeks. Wish I could split my attention and take them on for this. I guess that's what they count on - no one has the time and energy to go after them meaningfully.

Not to mention what it does to my blood pressure...

Am I the only one having issues with this?

 

[Tony]

Hi,

My problems are insignificant compared with yours, but I do have an appreciation of what you are going through.

Some desk jockey at my insurance company is putting his nose between my doctor and my pharmacist. He is refusing to pay the pharmacist for a prescription, asking for a substitute, not a generic, without knowing anything of my background or of the 8 months of trials with medications to arrive at an acceptable dosage for me.

Lucky for me (so far) my doctor is not putting up with that crap.

Good Luck

 

[Abbanabba]

That is criminal!! How on earth can they get away with that..?!!

I really can't give you any advice, but I really hope you can get something resolved SOON. Do you think it would help to write to the head of the company (..or branch..) stating your dissatisfaction and threatening legal action if they don't stop jeapordising your life immediately? I appreciate you might not actually have the time/energy/funds to do this, but it might make them sit up and take notice.

Good luck.

Anna : )

 

[terry40]

Hi Fellow NJ resident,

Hi Fellow NJ resident,

My problem with insurance came after surgery, when My husband company changed plans.

Don't let them get away with this, no matter how frustrating, keep a log of phone calls, letters, emails, refusals, broken appointments etc.

There is a law suit going on right now between Cooper Hospital in Camden and Horizon B/C & B/S, because the insurance company will not pay claims/bills.

Overall, I think we all getting tired of insurance companies controling our healthcare.

Keep us update, best of luck,

Terry40

 

[Birky]

insurance

insurance

I am an Ins. agent but on the healthcare issues I totally agree that companies have gotten totally out of control. I would assume that if you have a PPO and the institution etc. was in the network, then you should be able to go there and get done what you need. I have BC and didn't have a problem since the hospitals and Dr.'s are in the network. If we go out of network, then we pay a lot more out of pocket. We do not have to call for pre-certification on anything. I know that some programs do require this. I found all the participating providers can be found on their Website. I went in there and printed them out. I can't say enough how good they paid my claim. What I found agreeable is that we have to pay the 10% of what they actually pay the provider and this brings down our percentage quite a bit. There is no reasonable and customary since the amount is areed with the provider. My Dr. here now charges from $97 to $120 for an office call. See him about 15 minutes at the Max. The cost of Malpractice Insurance has skyrocketed in Illinois and this then goes over to the patients and insurance companies. Vicious cycle. Keep notes on all your conversations etc. with the company. Make sure you get names of reps that you are talking to you. Good luck ,