 |
 | Home | Contact Us | FAQ | Search & Site Map | Link to Us |
 | Sign In | Join | Other 45 Sites in Network |
| HomeDiscussion GroupsGeneral TopicsCat AnecdotesHealth and BehaviorRescue CatKB.com Contact UsLink To UsSearch & Site Map |
Cat Forum / Cat Anecdotes / May 2006aaaargh! stupid insurance company!
My acupuncturist's wife / secretary has been working on trying to get my claim to my insurance company -- they gave her the wrong routing numbers or something. Anyway, finally it goes through, and what does my *lovely* insurance company do? 1) First visit -- rejected because supposedly they don't know if I am covered by another insurance policy. That's right, the same issue I had to call them about multiple times earlier this year. F**KERS! No, nothing has changed, you worthless piles of excrement. 2) Subsequent visits -- rejected as not covered. Even though they claimed to cover acupuncture. I guess I can look forward to yet another "fun" conversation with these @$$holes. Of course, the person I talk to on the phone is just some employee, not the decision maker, so I don't even get the satisfaction of yelling at anyone -- I'll just be polite and try to get it resolved. If there's a deity, s/he would give me 10 minutes alone in a room with one of the people who sets these policies for this farking insurance company.  Signaturemonique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca > I guess I can look forward to yet another "fun" conversation with > these @$$holes. Of course, the person I talk to on the phone is just > some employee, not the decision maker, so I don't even get the > satisfaction of yelling at anyone -- I'll just be polite and try to > get it resolved. I worked for many years in a hospital insurance department, and I can tell you that most insurance companies are quite professional - if the contract says to pay the claim, they don't quibble and nickel-and-dime you. But the few who do really give all insurance companies a bad name. My advice is to keep a thorough log of every contact with the insurance company. Date, time, who you spoke to, a clear synopsis of what was said. Then later you call and instead of saying, 'Well, I talked to someone there a while back and he said...' you can say, 'I spoke to <name> on <date> at <time> and was told...'. Believe me, they will pay much better attention. Chak SignatureThere is danger from all men. The only maxim of a free government ought to be to trust no man living with power to endanger the public liberty. --John Adams > I worked for many years in a hospital insurance department, and I > can tell you that most insurance companies are quite professional - > if the contract says to pay the claim, they don't quibble and > nickel-and-dime you. But the few who do really give all insurance > companies a bad name. I don't know if this particular company is incompetent or malicious. Either way, it's incredibly frustrating. > My advice is to keep a thorough log of every contact with the > insurance company. Date, time, who you spoke to, a clear synopsis [quoted text clipped - 3 lines] ><name> on <date> at <time> and was told...'. Believe me, they will >pay much better attention. That is true. I forgot to get a name today. But to be honest, usually things are straightened out with the first phone call after I get the EOB. The problem is that I've had to make that phone call for every one of my service providers at least once a year, and often several times. It's ridiculous. And I still wonder how many people never get their full coverage because they're too overwhelmed to stand up for their rights. Ah well. DH's company was just bought, so one way or another we'll probably have a different insurance company soon. Should be interesting. Signaturemonique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca > My acupuncturist's wife / secretary has been working on trying to > get my claim to my insurance company -- they gave her the wrong [quoted text clipped - 23 lines] > -- > monique, who spoils Oscar unmercifully Hang in there Monique. I've been round-and-round with insurance companies before, and after all the fretting and worrying I did, they always paid. Even when I was told sometimes they would not. It will all get ironed out, but you're probably in for a lot of phone time and hassle, which you don't need. I'm very upset with mine also; they've decided out of the clear blue sky they won't cover one of my meds. I don't think they ought to be able to change the rules in the middle of the game; I think they ought to have to make changes on Jan. 1 when we renew every year. Sherry > Hang in there Monique. I've been round-and-round with insurance > companies before, and after all the fretting and worrying I did, they > always paid. Even when I was told sometimes they would not. It will > all get ironed out, but you're probably in for a lot of phone time and > hassle, which you don't need. That's exactly it. I told DH, "I would happily pay double the insurance to not have to be on the phone all the time with these people." He just stared at me, uncomprehending. But it's not *just* the phone time, it's also the several week lag between the phone time and the next time you see the EOB. In the meantime you have no idea if the problem was really fixed or not. And I feel bad for the doctors who are waiting patiently. But even if they're willing to wait, I still get the automated statements. It's just one more thing nagging at the back of my mind, one more "make sure this gets taken care of" item. I like to pay my bills the instant I get them, so that they're out of my mind and I don't have to think about them anymore. This forces me to do the opposite. > I'm very upset with mine also; they've decided out of the clear blue > sky they won't cover one of my meds. I don't think they ought to be > able to change the rules in the middle of the game; I think they ought > to have to make changes on Jan. 1 when we renew every year. I would agree. It seems very odd that they would go from covering something to not covering it. Were you able to ferret out an explanation? Signaturemonique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca >>> I'm very upset with mine also; they've decided out of the clear blue >> sky they won't cover one of my meds. I don't think they ought to be [quoted text clipped - 4 lines] > something to not covering it. Were you able to ferret out an > explanation? Maybe they have different people that process the claims and they have different notions on whats covered. I had similar problems before with my insurance at work. My massage therapist worked in Quebec ( just across the river). Quebec and Ontario have different rates for massage and that caused some discrepancy on my coverage. Then there were different interpretation on whether aromatherapy was covered. Some claims were accepted, and some weren't. Drove me up the wall. These hassles are one of the reasons I didn't buy my own insurance now that I am not working. Without insurance, I just decide what therapies I am willing to pay for. Don't have to border to submit an estimate for major things like dental crowns. But now as I am getting older, I decide to get insured again, in case I need costly prescriptions, at least until I am old enough to get some government subsidies. Winnie > > Hang in there Monique. I've been round-and-round with insurance > > companies before, and after all the fretting and worrying I did, they [quoted text clipped - 27 lines] > -- > monique, who spoils Oscar unmercifully Pfft. The drug is called "Folbic." It's basically B vitamins and folic acid, which is prescribed a lot for vascular patients. The insurance company says over-the-counter vitamins are "comparable." Except you'd have to take about six of them every day to equal Folbic. And that's way more expensive. But the beef I have is, they have paid for the stupid drug for five years now. Sherry > > Hang in there Monique. I've been round-and-round with insurance > > companies before, and after all the fretting and worrying I did, they [quoted text clipped - 27 lines] > -- > monique, who spoils Oscar unmercifully Pfft. The drug is called "Folbic." It's basically B vitamins and folic acid, which is prescribed a lot for vascular patients. The insurance company says over-the-counter vitamins are "comparable." Except you'd have to take about six of them every day to equal Folbic. And that's way more expensive. But the beef I have is, they have paid for the stupid drug for five years now. Sherry > Pfft. The drug is called "Folbic." It's basically B vitamins and folic > acid, which is prescribed a lot for vascular patients. The insurance > company says over-the-counter vitamins are "comparable." Except you'd > have to take about six of them every day to equal Folbic. And that's > way more expensive. But the beef I have is, they have paid for the > stupid drug for five years now. You might have grounds for appeal, if the total amount of folic acid is beyond the FDA limit for over-the-counter sales. I know that my one-milligram tablets are prescription, and ISTR the nonprescription limit is 800 micrograms or so. There are other things, such as potassium salts, where having more than a given amount in a pill requires a prescription. I would raise the argument that the FDA requires full clinical testing of tablets containing large quantities of folic acid, and, for a generic, bioequivalence testing. OTC vitamins have not gone through the formal bioequivalence comparison. You might well have the basis of an FDA complaint that your insurer is usurping FDA's bioequivalence testing rules. > > Pfft. The drug is called "Folbic." It's basically B vitamins and folic > > acid, which is prescribed a lot for vascular patients. The insurance [quoted text clipped - 14 lines] > bioequivalence comparison. You might well have the basis of an FDA > complaint that your insurer is usurping FDA's bioequivalence testing rules. The pharmacist says they can choose what they pay for and not, without any excuse at all. Which sucks. You can tell the ones they don't like. They don't like Nexium, either. They are always kicking up about it. Neither do they like to pay for Zocor--it costs me $40 instead of the normal $25 copay. I know this is not ethical, but I spend so much money on medicine, I asked the dr. if he could prescribe 80 mg., I can break them in half and they last twice as long. He did that for me. I'm about to ask him to do the same thing for DH's Mobic. We have to pay $130 a month for it. That's what makes me so angry. They will pay for *other* arthritis drugs, but not Mobic. It is like they are trying to control what the dr. prescribes. Sherry > The pharmacist says they can choose what they pay for and not, > without any excuse at all. Which sucks. You can tell the ones they [quoted text clipped - 8 lines] > not Mobic. It is like they are trying to control what the dr. > prescribes. Sherry I got a month's worth of this GI medicine today. Also $40 copay. Guess they don't like this one, either. Signaturemonique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca > The pharmacist says they can choose what they pay for and not, without > any excuse at all. Which sucks. You can tell the ones they don't like. [quoted text clipped - 8 lines] > to control what the dr. prescribes. > Sherry As I said in another post, this is what kept me from getting additional medical insurance in the past few years. Without insurance, I can choose to spend my money on whatever drugs I need and not dictated by what is covered and what is not. Of course I can still pay for drugs not covered by insurance, but it would be very costly as drugs not covered are usually expensive ones. I have a friend who spent hundreds of dollars a month on a cancer drug that was not approved yet and not covered by her insurance. This was at a time when she couldn't work and probably lived on disability insurance if she had any. She lost the battle with cancer. Winnie > > The pharmacist says they can choose what they pay for and not, without > > any excuse at all. Which sucks. You can tell the ones they don't like. [quoted text clipped - 23 lines] > probably lived on disability insurance if she had any. > She lost the battle with cancer. There's a delicate balance of medical and commercial interest when deciding what drugs to cover with insurance. Remember, you also have a pharmaceutical industry that grabs for market share. When a successful (patented/brand name) drug comes out, other pharmaceutical companies may introduce slight variations to go for market share, but the clinical improvement from these variations may be minimal. It/s not unreasonable for anyone doing an approved formulary (not just insurers, but hospital pharmacies don't stock as many drugs as retail pharmacies) to look at general therapeutic equivalence, and then select the cheapest in the group. It is unreasonable to require a specific drug when there are clinically significant differences. In other words, the insurers, pharmacies, and manufacturers are all gaming one another. Much more difficult are the situations where a drug may have some temporary benefit in an irreversible disease, or where the evidence of efficacy isn't clear -- and the drug is very expensive. Beyond that, it gets into a matter of social policy, largely ignored in the US, when the health budget, as a whole, can tolerate specialized drugs. I have no answer to the economics of where various genetically engineered drugs can effectively treat genetic diseases, with situations such as a cost of $100-200,000 per year to arrest Gaucher's Disease, a cost that will continue lifelong. > Pfft. The drug is called "Folbic." It's basically B vitamins and folic > acid, which is prescribed a lot for vascular patients. The insurance > company says over-the-counter vitamins are "comparable." Except you'd > have to take about six of them every day to equal Folbic. And that's > way more expensive. But the beef I have is, they have paid for the > stupid drug for five years now. [this might have be a duplicate] Tell the insurer that they may want to have a long talk with the FDA as to who in the insurer is making bioequivalence decisions. Preparations containing more than a certain amount of folic acid are prescription-only. I know my one-milligram tablets are prescription drugs, but, ISTR, the limit is 800 micrograms or so. If a drug manufacturer were to introduce a generic version of a branded folic acid preparation, it would have to go through FDA bioequivalence certification. That is less than a full clinical trial, but I suggest it's a bit more formal a determination than your insurer is allowing. > Pfft. The drug is called "Folbic." It's basically B vitamins and folic > acid, which is prescribed a lot for vascular patients. The insurance > company says over-the-counter vitamins are "comparable." Except you'd > have to take about six of them every day to equal Folbic. And that's > way more expensive. But the beef I have is, they have paid for the > stupid drug for five years now. [this might have be a duplicate] Tell the insurer that they may want to have a long talk with the FDA as to who in the insurer is making bioequivalence decisions. Preparations containing more than a certain amount of folic acid are prescription-only. I know my one-milligram tablets are prescription drugs, but, ISTR, the limit is 800 micrograms or so. If a drug manufacturer were to introduce a generic version of a branded folic acid preparation, it would have to go through FDA bioequivalence certification. That is less than a full clinical trial, but I suggest it's a bit more formal a determination than your insurer is allowing. I called them today. The lady I spoke to said that I should only be asked once a year about whether I have other insurance -- well, they seem to be stuck in some sort of loop with me, because I'm being asked that all the time. Aside from that, the EOB showed my claims as rejected because they were supposedly excluded by my plan, which isn't right. So she sent those in for reprocessing. Regardless, apparently there's a $200 deductable that applies specifically to acupuncture, so I will definitely owe the money for these visits, but instead of being marked ineligible they will be marked as applying to my deductable. *sigh* Wonder what the next round will bring. Signaturemonique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca > Regardless, apparently there's a $200 deductable that applies > specifically to acupuncture, so I will definitely owe the money for > these visits, but instead of being marked ineligible they will be > marked as applying to my deductable. Well, that's better than being LIMITED to $200! (My policy covers chiropractic treatments, but limits them to twelve visits a year - anything beyond that, I pay for.) >> Regardless, apparently there's a $200 deductable that applies >> specifically to acupuncture, so I will definitely owe the money for [quoted text clipped - 4 lines] > chiropractic treatments, but limits them to twelve visits a year - > anything beyond that, I pay for.) Well, they do limit to $1000 per year for acupuncture. There's also a separate deductable for mental health treatment. And then of course there's the regular old deductable, and I think there's a deductable for hospital stays. I wonder what else there's a deductable on. My policy also has something similar to yours for chiro. My chiro office takes this into account and has me pay an equal amount throughout the year, rather than paying nothing for the first part and a whole lot for the rest. Signaturemonique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca |
Reply to this Message |
 Sign In
 Join
 My Latest Posts My Monitored Threads My Blog My Photo Gallery My Profile My Homepage Start New Thread Enable EMail Alerts Rate this Thread
|
©2008 Advenet LLC Privacy Policy - Terms of Use
This website includes both content owned or controlled by Advenet as well as content owned or controlled by third parties.