Another Grrrr: Just spent 3 hours dealing with our health insurance company

[Suzanne in ABQ]

This is a regular occurrence lately.  In the past 2-3 year, we haven't had a single claim go through properly.  Every single one has a problem, either with the referral, or the authorization, or the procedure code, or the status of the doctor (whether they're in network or not), or the claims person (or robot) didn't notice that there really is an authorization number for this claim.  Every time one of us goes to the doctor, I have to spend 2-4 hours on the phone getting the claim paid.

 

It didn't used to be like this.  In 25 years, I only had one problem.  Now it is every single time.

 

How do people manage this kind of stuff if they both work?  It's insane.

 

 

(For those who read my earlier rant about the credit score system, thanks for joining me on another one.  It's not been the day I planned.)

[Lawana]

I hear you! I have spent my share of time on the phone with insurance this past year.

[Seasider]

How do people manage this kind of stuff if they both work? It's insane.

 

 

(....It's not been the day I planned.)

This is what leaves me shaking my head.

 

Says Seasider, who just returned from dashing out to overnight a document that was suddenly required for a legal transaction. That wasn't in today's plan.

[Splash]

Living alongside a lot of families with chronic and rare diseases I have seen it definitely takes a toll.  I worked for six hours one day and another four hours that same week this summer trying to get daughters medication administered.  Nurse quit, they didn't tell me or schedule anyone else, I had to call.  They decided it could wait until Monday (of course it was Friday)  It could not wait until Monday, it must be given every 14-15 days or disease activity could start up again.  I called insurance company, nursing company, doctors office then finally the drug company that makes the drug (they have on staff nurses who get things done).  I started at 10;00.  By 4pm I had a nurse and two EMT's at my house to administer the medication. On following Monday it was several more hours following up with all the different people and getting a plan in place for the next time. Then add in all the time for the appointments, therapies, etc.  I looked at working this year part time, very part time but reality is finding the time and the added stress wasn't worth the little money I'd make.  Though I'd enjoy being a dyslexia tutor, reality is most families would want after school appointments which is when I schedule my daughter's appointments. Parents have commented that they lose jobs over how much time off they need to take care of their child with illness.   I will say that our insurance company has been pretty helpful for the most part, we have a case manager there who helps us figure things out but it's  just vert time consuming.  

 

I'm sorry your insurance company is making you jump through so many hoops.  Our doctor says that often they deny automatically then when you call they make the changes.

 

Kimberly

[Anne in CA]

To be honest I think they do count on people being too busy to deal with it. I remember my FIL taking three vacation days to deal with Cigna about an operation they should have covered for my MIL and were refusing. He built up the best paper trail he could on his lunch hour and then took off a Mon, Wed, Fri to make them pay. It was worth more that 20K, so it was worth his time, but he is a super smart person and it took him a long time to figure this out. I wonder not only what working people do in these cases, but people who are not MENSA material when the company is just determined to steal. 

[Lawana]

To be honest I think they do count on people being too busy to deal with it. I remember my FIL taking three vacation days to deal with Cigna about an operation they should have covered for my MIL and were refusing. He built up the best paper trail he could on his lunch hour and then took off a Mon, Wed, Fri to make them pay. It was worth more that 20K, so it was worth his time, but he is a super smart person and it took him a long time to figure this out. I wonder not only what working people do in these cases, but people who are not MENSA material when the company is just determined to steal.

I have had a claim paid out of network when it should have been covered as in network because it was an emergency admit. The first phone call I was told it was covered correctly. I freaked out and posted here and the knowledgeable hivers informed me that one of the provisions of the ACA was that emergency admissions be covered at in network rates. When I took that little nugget of wisdom back to the insurance people, they were like, "Oh, it was an emergency? Well sure, that should be covered as in network." The difference between what was paid initially and what was ultimately paid? $33,000.

 

And only because I sought out answers and presented them to the insurance company. They would have been happy for me to be on the hook for that amount. Grrrrrr.

[TravelingChris]

For years I used to spend hours and hours with insurance and trying to get appointments. Then when we were in Europe, I didn't need to anymore. When we came back to the US, I told my husband that I was done getting pre-authorizations and waiting forever for the base medical operators to answer and schedule appointments. I went to paying more out of pocket but we had a low catastrophic limit so the 1500 I had to pay was well worth my time. Now we have a 3000 catastrophic limit but we have supplemental insurance so really it is very little we have to pay. But I still deal with hassles though not with insurance companies- with medical providers who don't file claims correctly. My daughter's hospital stay and ambulance ride were all filed incorrectly. I had to pretend to be her and call all the different providers-hospital, ambulance, er doctors, hospitalist, etc. She doesn't have the time to do it since she is a full time college student and waiting for the people to answer is often a half hour or more venture.

 

I am the official insurance person in my family since I have dealt with it for so long and also I have the time. But it isn't fun at all.

[JFSinIL]

Straightening out his sort of mess is a large part of what hubby did as an attorney here in Illinois for decades.  Good thing he had the experience, as after our car crash almost three years ago if it wasn't one thing it was another dealing with insurance.  The first hospital we were rushed to via ambulances was out of network.  The trauma center I was airlifted to was out of network, as were the doctors etc. who saved my life.  I was there two weeks (it was an hour drive to nearest in-network place and I was not a candidate to be moved for a while).  Hubby had his work (from his hospital bed at home) cut out for him dealing with BCBS and their reluctance to admit they had to pay the out-of-network stuff at in-network rates since it was an EMERGENCY and they had NO in-network hospitals in the area in which we got mangled.  They even tried for a while to insist the in-network rate in case of an emergency meant they only had to pay as much as Medicaid would, which is a pittance. Lucky for us hubby had over 20 years dealing with Illinois insurance law, and BCBS ( a different department) were folks he had dealt with a long time (event to the extent of being invited to the annual BCBS holiday party in Chicago each year).  Yet they tried to con us into thinking we had to pay more then we had to, etc.

 

Don't get me started on how we were so careful to select a rehab place for me (2.5 weeks there) that was in-network.....only to then have the rehab place decide they'd rather put a lien on our eventual insurance settlement than bill BCBS and accept the in-network rate.  That was $60,000 right there.  Hubby is a clever lawyer and eventually finagled someone at rehab into submitting a bill to BCBS and it got paid before anyone higher up could stop it. :-)

 

Folks should not have to pay a lawyer to help them deal with insurance.  If hubby had not been one already, we could not have afforded a lawyer. 

Edited March 3, 2017 by JFSinIL

[Anne in CA]

Straightening out his sort of mess is a large part of what hubby did as an attorney here in Illinois for decades.  Good thing he had the experience, as after our car crash almost three years ago if it wasn't one thing it was another dealing with insurance.  The first hospital we were rushed to via ambulances was out of network.  The trauma center I was airlifted to was out of network, as were the doctors etc. who saved my life.  I was there two weeks (it was an hour drive to nearest in-network place and I was not a candidate to be moved for a while).  Hubby had his work (from his hospital bed at home) cut out for him dealing with BCBS and their reluctance to admit they had to pay the out-of-network stuff at in-network rates since it was an EMERGENCY and they had NO in-network hospitals in the area in which we got mangled.  They even tried for a while to insist the in-network rate in case of an emergency meant they only had to pay as much as Medicaid would, which is a pittance. Lucky for us hubby had over 20 years dealing with Illinois insurance law, and BCBS ( a different department) were folks he had dealt with a long time (event to the extent of being invited to the annual BCBS holiday party in Chicago each year).  Yet they tried to con us into thinking we had to pay more then we had to, etc.

 

Don't get me started on how we were so careful to select a rehab place for me (2.5 weeks there) that was in-network.....only to then have the rehab place decide they'd rather put a lien on our eventual insurance settlement than bill BCBS and accept the in-network rate.  That was $60,000 right there.  Hubby is a clever lawyer and eventually finagled someone at rehab into submitting a bill to BCBS and it got paid before anyone higher up could stop it. :-)

 

Folks should not have to pay a lawyer to help them deal with insurance.  If hubby had not been one already, we could not have afforded a lawyer. 

That is scary stuff, right there. 

[Amy in NH]

This is a regular occurrence lately. In the past 2-3 year, we haven't had a single claim go through properly. Every single one has a problem, either with the referral, or the authorization, or the procedure code, or the status of the doctor (whether they're in network or not), or the claims person (or robot) didn't notice that there really is an authorization number for this claim. Every time one of us goes to the doctor, I have to spend 2-4 hours on the phone getting the claim paid.

 

It didn't used to be like this. In 25 years, I only had one problem. Now it is every single time.

 

How do people manage this kind of stuff if they both work? It's insane.

 

 

(For those who read my earlier rant about the credit score system, thanks for joining me on another one. It's not been the day I planned.)

Contact your state insurance commissioner and submit a formal complaint.

[xixstar]

While reading this I opened two EOBs - two children had the exact same labwork done with the same diagnostics code. And the insurance states two different allowed amounts. Why?? It's a small difference, but annoying!

 

So yes. All of this is crazy and a major pain.

[Guest]

Mine is a nit, but here goes:  WHY, when I go to the same Urgent Care joint for three different UTI occasions, and give them ALLLL the driver's license identification, fill out alllll the paperwork, do I get assigned THREE different *account numbers*?  I pay online and every stinkin' time, I have to set up a new ACCOUNT.  And then, of course, because of the screwed up billing systems, I get another bill in like 4 weeks for the thing I have already paid, but I have to dig around and find out what *account* paid it?  It's insane.  I really believe that medical care costs so much because they have to hire so many people to deal with all of this.  

 

And get this:  WE ARE CASH PAY.  So insurance isn't even involved here...it's just super bad billing systems.  

[Guest]

I am there too.

The pharmacy wasn't able to fill the order and didn't tell me until I had taken the partial order. Never again do I sign until I examine the container. The counter person was smirking, but I ignored that as a personal issue. The insurance wants me to drive fifteen miles to their preferred pharmacy, transfer the prescription,call them for an override, then fill the rest of the order. The original close to my house pharmacy wants to sell me the rest of the med at the uninsured rate...which is substantial, while the med is on the AFA zero copay list and used to be on the four dollar lists. I am so tired of the rent seekers.

[mommyoffive]

Ugh that sucks so much.

 

I am sorry. 

 

 

 

 

 

[Anne in CA]

I am there too.

The pharmacy wasn't able to fill the order and didn't tell me until I had taken the partial order. Never again do I sign until I examine the container. The counter person was smirking, but I ignored that as a personal issue. The insurance wants me to drive fifteen miles to their preferred pharmacy, transfer the prescription,call them for an override, then fill the rest of the order. The original close to my house pharmacy wants to sell me the rest of the med at the uninsured rate...which is substantial, while the med is on the AFA zero copay list and used to be on the four dollar lists. I am so tired of the rent seekers.

In this case I hope you leave a FLAMING Google review for this pharmacy so others can be warned. That is so rude.

[Suzanne in ABQ]

Wow.  I wish we had a [That's insane!] button.  I'd click it for every one of these stories.  Our families health concerns are relatively minor, and I still go through hades to get them handled correctly.  I can't even imagine how people keep track of really complex issues.  I feel for you all.  

[Guest]

In this case I hope you leave a FLAMING Google review for this pharmacy so others can be warned. That is so rude.

Actually I will go to HR about this issue. The policy the insurer is following should have been made available to me and to the doctor's office. This is a waste of many people's time. The idiots at the first pharmacy are just icing on the cake - when you live where I live you do not expect the pharm tech to be professional because so many uneducated rent seekers have these jobs. Bad schools plus high col equal low quality employee pool.