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Health Insurance
The Good, The Bad and the Ugly The
Good, the Bad and the Ugly
We all have them! The good, the bad and
the ugly experiences with health insurance companies. Let's start with
the bad! We asked you to tell us about an unpleasant or humorous health
insurance experience:
It is very unpleasant when your doctor
explains to you how badly you need certain medications and they finally
convince you that you will have to go through with this, you go to the
pharmacy and the ins denies the medication. It is very curious the only
medications they question are the very expensive ones. Is scary
sometimes as you think, oh no, am I not going to get this medication? Is
this the one that could allow me to live again and they arent going to
let me have it? Is scary sometimes. We just want to live again. -Sue S
While our insurance policy is good
about paying for chiropractic care (30 visits a year), when I tried to
get some help on my massage therapy treatments, it was considered
"maintenance" only, so all massage comes out of my pocket :-(
But, worth it nonetheless! -Nanny
I guess the most humorous thing was
claim after claim submitted for RA for at least a year and a claim was
submitted for wrist splints (per the physical therapists). Insurance
took a year to pay the claim because they didn't understand why I needed
them! -Daisy
had an unpleasant experience with my
present health insurance co. some years ago when they didn't want to pay
for my specialist visit due to my doctor being an "out of
area" doctor. I appealed their decision but was still denied as
they held to the fact that there was a specialist in that field in my
area. Upon checking the background of the named in area specialist I
found that she had only been practicing a very short time and I was not
pleased with my finding. I stayed with the same out of area specialist
that I had been using for over 15 years. Evidentally I was not the only
insurance carrier that was displeased at their policy on "out of
area" doctors. The next year at open enrollment I was notified that
the new policy now paid a good portion for the out of area doctor
visits. I felt much relief with this new policy in force. -Linda T
Unpleasant..Waiting to get approval for
Enbrel, Remicade and now Kineret, why would anyone one to take these
drugs if they weren't necessary?
I do have a humorous one in regards to my husband. My 45 yr old husband
had a heart attack while we were out of town at the lake boating and
skiing with friends. We had to have him air lifted from a small town in
Arkansas to Memphis. He suffered too from Sleep Apena. Once he had
stents placed in his arteries and we were in a room, we settled in for
some much needed sleep. Well, the sleep apena would kick in and the
nurses would come flying into the room panic stricken asking how much
pain he was in etc. We were both asleep! Finally after two or three
times we realized it was his sleep apena.Once we explained this to the
nurses, they would still come in and check on him when all of his vital
signs dropped, but they were not quite so excited. Once we were
discharged the dr wrote a prescription for the sleep apena machine and
our insurance company denied coverage. They wanted him to go to a sleep
study! The Dr even sent a letter, but the insurance company insisted he
had to go through a sleep study. So about $1,500 later.... he has the
machine! If they would have accepted the information from the hospital
and the Dr in the first place they could have saved the money, time and
effort. -Susan
When my last employer changed insurance
coverage, it took me 6 weeks to get Enbrel. When I finally blew and
called insurance company, it was not pleasant. I finally got medication
but definitely felt effects of going without for that period. It was
really just a matter of untrained people and different people answering
questions.-Bettty
When I found out the day of an
appointment for a Remicade infusion that the health insurance had decide
that I needed to have my primary care doctor's referral renewed before I
got my medicine. My rheumatologist, the infusion room at the clinic, my
primary care doctor, and the health insurance went back and forth on it
all day, delaying my medication until the next day, when I was already a
week overdue. -Stephanie
I fractured my hip and my husband
called 911 for an ambulance which I had to have my hip replaced but the
ins company didn't pay for the ambulance bill because we didn't use the
one in my plan which I didn't even know ambulance services were included
in participating providers. Medicare also denied the ambulance bill
since it wasn't a matter of life and death (just pain so bad I thought I
was dying). I did ask for a review with Medicare and they ended up
paying 80 percent. -Marena
The insurance did not want to pay for
reconstructive surgery on my jaw. They felt it was to cosmetic. Ha ha.
The doc finely got them to cover it. I have had both sides fixed once
and they are starting to go again. -Denise
People are unhuman -Margaret
#1 My husband was dying of cancer. They
sent him home with RX for me to fill for pain meds. There was NO where
to fill the RX. The meds were only available at the hospital and then
only during certain hours.
#2 I had an almost life threatening case of poison sumac and had reached
the stage where I was so swollen I could not see,was having difficulty
breathing, and my throat was closing up. They would not authorize my
being taken to and ER that was only 5 minutes away. Instead insisting I
be brought to their urgent care office which was 30 minutes away. I made
it but it was a close call, then once there they didn't know what to do
with me and twice tried to give me meds that most probably would have
killed me.
Wish I had a humorous experience to share. -Margot
I never really had an unpleasant
experience, or even a humorous experience. I suppose I am very lucky.
the folks at the insurance co or the employer are very business like,
and took care of any of our problems, without any difficulty -Elaine
Many years ago When my first daughter
was born, the hospital refused to release her until the bill was paid. I
had to leave the hospital, go to the bank and get the money and then go
back to the hospital for the baby. -Linda B
A few years ago I took my then infant
son (2 months old) in for his checkup and rountine shots. The insurance
paid for the doctor visit, but denied the immunizations! -Beth
I have had no pleasant health insurance
experience. My sense of humor is not sophisticated enough to find health
insurance a humorous topic. -Jennifer
I had a complete body bone scan at the
hospital. The insurance paid for the scan, but not the medication. I was
confused as to what the "medication" was, so I called BCBS...they
just said that the scan was paid for, but that they would not pay for
medications given. Then it dawned on me...the nuclear material that was
injected into me before the scan was what they were calling
"medication." I had to ask them how they would suggest the
scan be done without it! LOL They paid for it. -Anita
trying to get a copy of plan from ins.
because i am under former spouse's plan.......they say call him....the
guy refuses any communication and i have been to court more than 50
times!!!!!! it is liking getting FBI info or something! -Maggie
Not much trouble with present coverage,
except for constant threats of doctors and/or hospitals dropping my
insurance company. -Peggy
A few years ago I had many problems
with Aetnaushc because they never reimbursed me correctly for over one
year,on my monthly Rhuemy visists. It was a real nuisance for me to
follow up on because of the phone calls, letters and paper trail. I had
to be very diligent and finally got it corrected. -Maureen
months ago when my Dr. doubled my
Relafin medication. It took 3 weeks for Wal Mart and my Insurance
Company ...with my Dr. to get everything straightened out. Each one was
fighting with the other. -Carol J
Trying to understand the legal stuff of
the stuff that they cover. -Jen
I take so many meds (as I'm sure we can
all relate to)that my doctor told the office manager to schedule me for
45 minute appointments from now on because she goes over everything I
take each time as does my rheumy. Also, I had to go to urgent care the
other night during the New Year holiday and since my rheumy was going to
be gone for five days he felt I must be seen right away for a very sore
right elbow, because I am now a very "complicated" case, LOL.
-Lori
When my doctor first wanted to put me
on Remicade, the insurance company took over four months to decide
whether or not to pay for it. When they did finally decide that I really
do have arthritis and needed the Remicade, I was working a job in Texas!
-Michael
Previously with HealthNet (not anymore)
found out all of a sudden one month that none of my son's current asthma
meds were covered. With no explanation or options. -Janice
Unpleasant would be the many months it
takes for my insurance company to pay certain claims. We have two
medical clinics in my town. One clinic has a terrible billing system and
we get numerous different billing statements for one visit and it's hard
to keep track of who owes what. The other clinic I am now with has one
itemized billing statement that is quite detailed. The bottom of it
lists what the patient owes. Very simple. My insurance company seems to
pay that clinic in a more timely fashion also. Humorous would be that my
insurance company will not pay for my flu or pneumonia shot because it's
considered a routine shot, yet my rheumatologist insisted I get both
shots because of my RA condition. They said it was medically
unnecessary. -Cynthia
My most unpleasant experience is a
doctor from disability who kept me waiting 1 1/2 hours in a cold office
and treated me like I had a plague. it was totally demoralizing and
degrading -June
Well, I found out back in Sept that
most Medicare HMOs were changing their programs here in PHX AZ. I spent
next few months insurance shopping...was not a very pleasant
experience...I feel lucky to have found one I can handle.-Judy H
The $700.00 lab-work bill they billed
me for, not my insurance-definately NOT humorous LOL! -KP
Well, once, about two years ago I found
out I was being sued for a $70 charge for a yearly OBGYN visit to my
gynocologist. In my insurance information, it was very plain that once a
year a total woman's physical was covered including pap smears or
mamagrams, whatever is deemed needed for that woman at that time. Well,
as it turned out after I had notified my insurance company BC/BS of
Alabama a few times and tried to get something done about this ... I
discovered that the insurance company had already paid that charge way
back when it was rendered over seven months previous. So, what did I do?
I called the Doctor's office insurance coordinator and told her in no
uncertain terms that I was well aware of what was going on and did she
realize that she would be severely penalized and put in jail for
insurance fraud for not only trying to get me to pay something that I
did not own them, but to get me to pay something that my insurance
company had already paid them? When she heard me say ........."I
can now sue you, and have the DA assist me in suing you and your staff
for Insurance Fraud, her tone certainly changed, and I got a check in
the mail for the exact amount that she had harrassed me about for months
and months that I had kept insisting that insurance had already
paid.!!!!! Throw that word around a bit these days, and see if you don't
get someone's attention anyway!!! HA HA HA!!! But the sad thing is, some
one else would have just paid it and never thought another thing about
it. so, it isn't always the insurance company that is trying to screw
you over, sometimes it's the doctor's office staff on the financial end.
Think about it. -Lynn
son has an infection in his finger. We
were out of town at our cabin and needed to bring him to see a doctor. I
brought him to a clinic and he was treated with antibiotics. My
insurance would not cover this because it was considered out of area.
What we needed to do was take him to the emergency room of a hospital
instead. I just found this whole scenario to be stupid. The doctor bill
was far less than the trip to the ER would have been, but it was not
acceptable to them. Guess next time we will have to visit the ER for
more expensive treatment. -Sue K
I filed a claim with my previous
unsurer to reimburse me for x-rays I paid for out of pocket and they
paid the drs office instead. Luckily the drs office was good about
getting my money to me. -Waynette
I had an MRI with a company that told
me I was covered under my insurance. Guess what? I wasn't. They used to
be with my company and drop out. So, when the bill was presented to my
company, they only paid a small portion. I will add that the bill from
the MRI was the highest I have ever seen. After the payment from my
company it was still well over 2,000 dollars. It took a year and half,
but they lowered the bill and resubmitted it and my company paid it. -Royale
Trying to talk to a "real"
person can be a long and drawn out process....especially when the cat
and the kids are fighting. -Anne
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