Has anyone else had problems with their insurance companies rejecting claims?

We don't have those problems in Havana. Our healthcare needs are taken care of promptly.

Ok, so I really didn't intend this as a political thread. I just wanted to rant.

Cheers.

To honestly answer the subject title, no, I haven't had problems w/my insurance carrier denying claims.

However, I have been "treated" in the same manner as you. I have chronic tendonitis and I always got the usual "take Naproxen and rest" bs. It's the "treat the symptoms, not the cause mentality."

Currently my insurace provider and I are in conflict. Their computer system has some set limits that seem weird like my one pill a day Rx for 30 pills refillx5 can only be issued every 34 days. Of course the most frequent comment I get is "That's what's in the computer" followed by " The computer is showing that's the correct dosage allotment, sir". When I asked why I'm supposed to take 88.24% of a pill when the RX says take one a day one "trained customer interaction specialist" said "leap year might be the cause of that sir".

I have to travel all over the world. I entered a malaria area and had to take malaria pills. I also needed a yellow fever shot, and got innoculated against hepatitis. I didn't really expect the insurance company to cover the yellow fever shot because it's so uncommon, but the malaria pills (~$100) and the hepatitis series (which is given to newborns now) I had hoped to get covered. They denied the whole claim and refused to pay any of it. Their rationale: even though hepatitis innoculation has become standard for kids, it is not standard for adults unless they have come into contact with it (say, via food prep). Malaria pills were refused for a similar reason.

I got pissed and took it up a level. They wouldn't budge. I asked the rep if they would pay for my care if I GOT malaria or hepatitis, and they indicated that this was covered -- but taking preventions to NOT get sick was not. This is the problem with our health care system..

Appeal it. You should have information on how to appeal in your policy booklet. If you dont call the insurance company.

I realize insurance companies have a ton of horror stories, yours being a rather mild one at that.

However, I'd like to share a GOOD story about my insurance company...

Over the months of June and July of this year, I failed a claims for the following medical issues:

over 12 doctor's visits

about 8 blood tests

a urinalysis

two different hepatitis vaccines

about 80 sleeping pills

iron supplements

several phone visits with my doctor...

I was dealing with mono, anemia, slight sleep deprivation and pink eye all at the same time.

Total cost for everything: under fifty dollars.

Thanks BlueCross!!!

Cuban wrote:

However, I have been "treated" in the same manner as you. I have chronic tendonitis and I always got the usual "take Naproxen and rest" bs. It's the "treat the symptoms, not the cause mentality."

And what is the cause....most likely running! if a doctor told you to stop running, you'd throw a fit.

the "cause" is that your body isn't made for running. sorry to break it to you, but there are only a few lucky people who can handle large training loads without having injuries.

you're not one of them. listen to your doctor.

dang son.. wrote:

I realize insurance companies have a ton of horror stories, yours being a rather mild one at that.

I think in the end I was out about $800. I have the money, but what pisses me off is that my employer pays almost $10,000 a year for insurance for me, and every claim is a fight.

Oddly enough, they did cover a new pair of orthotics for me last year.

Cuban wrote:

However, I have been "treated" in the same manner as you. I have chronic tendonitis and I always got the usual "take Naproxen and rest" bs. It's the "treat the symptoms, not the cause mentality."

Stop making sense!!! wrote:

And what is the cause....most likely running! if a doctor told you to stop running, you'd throw a fit.

You're somewhat right. I did "throw a fit" initially, but I have since quit running. It was hard at first, but now I wish I would chosen a different hobby from the beginning.

the "cause" is that your body isn't made for running. sorry to break it to you, but there are only a few lucky people who can handle large training loads without having injuries.

you're not one of them. listen to your doctor.

Again, you're right. I'm in my mid twenties and feel like my body is falling apart. I get pains just going for a 2 mile walk.

I fell on a run, then went to the ER to get some pretty serious cuts cleaned up. (Among other things, I had a "divot" missing from my elbow that took weeks to heal.) I needed a tetanus shot and a painkilling shot.

Total cost to me, thanks to Blue Cross: approximately $500. The American health insurance industry is one massive scam.

Yeah, I used to have BlueCross and was much happier with them. I wish I had the option of switching back right now.

I'm definately going to appeal the rejection.

I've never had any test/procedure rejected by United Healthcare, and I've taken my fair share of spills over the past year. I've actually been pretty amazed at the extent of the coverage... although my employer is probably paying through the roof in premiums.

Ol Grumpus wrote:

I fell on a run, then went to the ER to get some pretty serious cuts cleaned up. (Among other things, I had a "divot" missing from my elbow that took weeks to heal.) I needed a tetanus shot and a painkilling shot.

Total cost to me, thanks to Blue Cross: approximately $500. The American health insurance industry is one massive scam.

I'm curious if this was for the ER and 2 shots, or if this was part of a deductible and if it happened again you'd pay a lot less?

This country has been spoiled by years of every bandaid being covered by employer-provided insurance. Someone has a $15 copay on their pills and they raise holy hell and scream for socialized medicine. Learn about it first...60% of income going straight to taxes, long waiting periods for anything short of life-threatening emergencies, and outright blocking of access to many types of care. For example in many European countries they don't treat serious cancers, you either pay out of pocket or die. They consider it too expensive to treat one cancer when the money could treat 5 diabetes patients. Your life is just a number.

I've been a little displeased with the cost of healthcare for my family this year. However it encourages me not to abuse the system, unlike the hoards of medicare patients flocking to my wife's ER to fake pain and get narcotics on the taxpayer's dime.

I've heard tell that there are insurance companies that reject almost all claims, hoping the "insured" lets it drop. They wouldn't do that, would they?

Insurance companies are motivated by profit. They have a duty to their shareholders to maximize profit. Insurance companies profit by collecting more in premiums than they pay out in claims.

I can totally understand spreading risk across a large population, but why is this a proper function for the private market? If there is a place where a market approach might make sense it would be where insurance companies would be rewarded for keeping people healthy - preventative medicine, education, public health, etc. - not denying claims, raising premiums, telling doctors how to do their jobs, etc.

I am a pro-free-market/fiscal conservative, but the market has failed us when it comes to healthcare. Drug Companies are getting rich by developing and MARKETING various pills to make us "feel" better - not by curing/preventing disease. That would be a conflict of interest and would breach their duty to their shareholders if drug companies developed a pill that would make everyone healthy - nobody would need to buy any more of their products! That is a little extreme, but consider how the drug companies reacted to providing expensive AIDS drugs to Africa.

The other group getting rich are the insurance companies. I find it a horrible waste of resources and a tragedy that people in a civilized, western democracy have limited access to reasonable and necessary healthcare.

Sorry about your issue with your insurance company. You're going to have to read your policy and (very carefully) follow their rules on appealing the denial of your claim. Ultimately, you may be able to sue the carrier, but only after you have exhausted all of the remedies outlined in the policy. Good luck.

I work for a very small company so I pay for my own insurance on the open market. I switched from Blue Cross/Blue Shield last year to United Healthcare with a Health Savings Account (HSA). This seems to me to be the way to go!

I have a very high deductible: $5000 per family member since I only rely on insurance to pay for catastrophic illness/injury. Everything else gets paid by the pre-tax HSA and I never even mess with insurance claims, etc.

Me (34), my wife (35) and kids (4 & 5) only pay ~$330 per month and here's the crazy thing...if we decreased our deductible to lower than $5000, the cost of the extra monthly premium would be MORE than the difference in the yearly deductible!!! That's right, the BCBSLA and United both wanted to charge extra since they are betting that if I wanted to be able to use insurance whenever I went to the doc, that I probably would!

For example:

I Pay $330 per month premium ($3960/yr) and have a $5000 illness (not enough for insurance to kick in) = $8960 per year out of pocket MAXIMUM (and the chances of having exactly a $5000 malady is small)

Decreasing deductible to $500 causes premium to be $710 per month ($8460/yr) = Maximum out of pocket of $9020 if I have only $500 in claims each year.

If you have to buy health insurance on the open market, a high-deductible plan that pays 100% after meeting the deductible seems to be the way to go! PLUS, a HSA that you contribute as much as possible to every year gives you the ability to justify going to the doc when you need to rather than when you want to afford it (I know I put it off more if the $$$ come out of my checking account rather than the HSA)

HSA Info:

- All qualified $$$ that you spend on health care items (it's pretty liberal too!) are pre-tax whereas, if you try to deduct them on your income tax return, they have to add up to more than 7-1/2% of your income -- this alone could add up to saving up to ~$1300 per year for most plans.

- You can put up to 100% of your plan deductible per year into a HSA and you don't lose it every year like the old "MSA" plans. It rolls over and you can invest it in either a money market (~5% Yield) and later on, when you have amassed like $10000, you can invest it in a stock account with the possibility of much higher returns.

Insurance companies SUCK! Mine (also BC / BS) regularly rejects claims that they have ALREADY APPROVED! When my daughter had her wisdom teeth out, the oral surgeon's office called BCBS to find out how much they would cover. BCBS told them they would cover $1400 out of a $2100 bill. So I paid my $700, then later got a rejection notice from the insurance company. They suddenly wanted proof that my daughter is a student. Another time they suddenly wanted proof that we don't have secondary insurance, although we have NEVER had secondary insurance! They just find reasons to reject the claims, hoping you will get frustrated and give up and pay it yourself. While I fought over the secondary insurance issue, it would take an hour of being on hold and them finding the claim, then they said okay, they would pay it. Then I'd get another rejection notice. This went on for about 6 months. In the meantime, I called the doctor who kept sending me bills, explained the situation, and they said it was normal and they weren't worried -- that's just the crap you have to put up with when dealing with insurance. Lovely. And you pay out the a$$ for this crappy service .....

spaniel wrote:

Someone has a $15 copay on their pills and they raise holy hell and scream for socialized medicine. Learn about it first...60% of income going straight to taxes, long waiting periods for anything short of life-threatening emergencies, and outright blocking of access to many types of care. For example in many European countries they don't treat serious cancers, you either pay out of pocket or die. They consider it too expensive to treat one cancer when the money could treat 5 diabetes patients. Your life is just a number.

Oddly, neither France nor England nor Germany nor Canada nor the Netherlands nor Spain nor Italy have a 60% tax rate. While Germany, France, and Italy are all around 45%, the UK and Canada are only slightly above the U.S.

And in terms of waiting for seeing a doctor or a procedure, the rates are high for some countries, but equal to or even less in other countries (for instance, there is less waiting time in germany, similar wait times in france, italy, netherlands, japan.)

And yes, some European countries don't treat serious cancers, but not simply because of the cost, but because there is no survival benefit to treating them. In the U.S. we spend billions of dollars treating prostate cancer every year, even though study after study says that there is no benefit to surgery or chemo in most types of prostate cancer. so basically we waste money, put people through hell, and have worse outcomes. Makes sense to me!

no health care system is perfect. there are good parts and bad parts of every health care system. but more and more people are becoming unhappy with the way health care is run here in the united states. other countries have demonstrated that they have better outcomes, spend less money, and the customer satisfaction is higher. while it's stupid to say that we should just "become like canada", it's doubly stupid to insist that our entire way of life will suddenly crumble to the ground while we goose step around lenin's tomb if there were government run health care.