Thursday, November 06, 2008

health insurance shmealth insurance

I don't know if this is typical and we've just been lucky thus far, but we're having serious issues with our health insurance. In the last 6 months, they've tried to deny claim after claim after claim. Sometimes the letters say that our policy ended (when it didn't), sometimes it says that services aren't covered (when they are), or today, they said they'd already paid the claim (definitely not).

It is becoming infuriating and frustrating, because I often have to sit on the phone for hours with them trying to argue my way through to payment. The other day they claimed that because my name was misspelled on my insurance card, they weren't going to pay for bloodwork ordered by my OB's office. Mind you, I've notified them 3 times about the fact that my name is misspelled on the card, and they never thought it was a crucial fact until now.

When we were in Florida visiting my inlaws, I had to rush Gabe to an emergency clinic because he had a massive ear infection and started throwing up and screaming while clutching his ear (turns out his ear drum ruptured). No one in Florida would take our particular insurance because they said they were never willing to pay the claims. I had to call the insurance company and spend hours on the phone getting an authorization for us to visit a clinic, and they gave me a claim number so I could submit the receipts and get paid for the two visits (one urgent, one follow-up). Today's letter informed me that they already paid me for these two visits, even though they most definitely, assuredly, have not. I think I would notice if I had those $300 I paid out of pocket.

I am so annoyed! Is this typical? Or is this because of the bad economy? Are the insurance companies trying to get away with not paying for standard claims to save money? I'm just so stinking tired of this, and if one member of our family wasn't staying home (i.e., me), I'm not sure who would have time to make these calls. By the way, this is a very common health insurance, not some podunk random one. It is probably one of the largest in the country. So why is this happening and what can I do to stop it? I'm already dreading the nonsense that is going to result after I have this baby. We're probably going to get billed for $500,000 or something similarly insane. Ugh.


chris said...

We have had the same problem with our insurance too! And it is a big well known company.

Kristy said...

Your state should have an Insurance Commissioner. Call them and file a complaint. My mom used to work for the commissioner in Georgia and their office would call the insurance company on the patient's behalf if something shady was going on. It'll involve some paperwork and more talking on the phone but they should be able to help. Good luck!

Anonymous said...

Sounds like Unitedhealthcare. We had the very same problems for two years running. It seemed as if they thought that making it difficult would frustrate you into paying the bill. Finally my employer became annoyed, too, and changed. Thank goodness.

Keep at it.

KarenM in NC

Chatty said...

Unfortunately I think this is par for the course with Insurance Companies. You know my Mom handles benefits in her school district and she is CONSTANTLY haggling on behalf of teachers and administrators, not to mention the battles she's had with the insurance companies on behalf of my grandparents.

I can ask for her opinion on the fastest way to cut the BS, she's kind of an expert in this field.

Anonymous said...

Is it through dh's work? I assume so since you're not talking about finding new insurance. Talk to his hr people. They often have much more pull than you, since they speak for the whole company. And if they can't make things better, they can always switch to a different company. Even though you handle it from home, some of their employees are probably using work time to handle it, and it works out best for them to make you all happy (although it might take some convincing for them to realize that).

Kai said...

Same thing with mine. I gave up and either just don't go to the doctor or if I do just pay for it myself. I work two jobs and just don't have the stamina to deal.

ccw said...

I wish I could say this doesn't sound familiar but our insurance was this way for years. I had to fight and lose over where my OB sent my cervical tissue after a colposcopy. I'm still not sure when I was supposed to ask what lab it would be sent to.

When Mr. MFBA lost his job he chose the lower paying of his two best offers solely because of the insurance. It has been worth its weight in gold.

I hope you are able to sort things out before you have the baby.

Accidental housewife said...

Yeah, be there still going through it. About a year ago I went to a endocrinologist because I was having some "issues" that we thought could be thyroid. Only the Endocrinologist decided that I was suffering from pituitary dwarfism and actually wrote that in my chart. My health ins. was up for renewal and they dropped me like a hot potato. I am far from a dwarf nor does my MRI show any abnormaility in the size of the gland. WTF! Now I am uninsurable because of what some Dr. said.