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What a timely thread! In early August, I had to get some emergency surgery. It wasn't urgent enough that I couldn't get a pre-approval, but was urgent enough that I found out I needed it just a few days before I had it (found out July 28, had surgery August 3). I went to a facility that is 100% in-network, with the facility, department, and all personnel covered in-network by my plan. I should be good, right? On August 27, they mailed out a letter asking me whether I had other insurance, or whether I am eligible for Medicare (AKA, "Can we have somebody else pay out on this $95,000 claim?"). It didn't arrive until September 9, at which point, I responded using their web site within five minutes of opening the letter. On September 10, they denied my claim for "not responding to their inquiry". Never mind that I did respond, the mail is unpredictable these days, and they have my phone number to call me directly about important poo poo. So, now, I get to deal with their outsourced customer service bullshit (customer service is literally carved out to a third party, and my actual insurance company refuses to talk to me directly about anything, ever) to get them to process my claim. Oh, and the hours for the outsourced support are only M-F during business hours. And I'm on the west coast. gently caress this lovely system. The whole thing needs to burn. Edit: Looking at the explanation of "benefits", they actually denied the claim on September 8. Before I got their stupid letter. Kreeblah has issued a correction as of 19:43 on Sep 15, 2021 |
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Sep 13, 2021 00:45
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| # ¿ May 18, 2024 14:17 |
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Oh, this is even better. I called the third-party support today, and they couldn't find my claim. I sent them the EOB so that they could take a look at it and try to track it down, and it turns out they hadn't been sent the info yet (apparently that takes like a week after the insurance company processes it). But the person I spoke to pointed out that the date on the EOB indicated that they denied my claim the same day that the post office delivered the letter asking for info (AKA, before I ever received their request).
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Sep 13, 2021 17:41
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I took a look at their API on my insurance company's web site for responding to their inquiry. Responding with a “no” to other insurance is recorded as a “yes” if you later request the data back, and it’s not clear whether responding with a “no” to their request about Medicare eligibility is properly recorded. It seems to be in some places, but not others. It's literally impossible for me to submit a response in a way which will cause them to pay out a claim. And good loving luck to me in getting anybody to understand what the gently caress I'm talking about.
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Sep 15, 2021 18:48
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Pittsburgh Fentanyl Cloud posted:lol that's so they can deny and send you a letter asking you to verify that you have no other insurance. My insurerr five years ago did that to me even though I verified that I had no other insurance in response to a previous request. And I worked for them. That's exactly what they're trying to pull. They sent one of those letters and it arrived on September 9, but by that time, they'd already denied my claim the previous day for not responding to it. It's a claim for $93,282.44, so it's not like it's something I'm just gonna give up on (and, even if it was for something small, this sort of thing just pisses me off more).
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Sep 15, 2021 19:50
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Cow Bell posted:a year or two ago i was working at a grocery store and my garbage rear end health plan was something ridiculous like 10% of my weekly check in a premium and also had a massive deductible. i don't know if that insurance ever paid for a single thing. In a sane world, the fact that there are people who pay a significant amount of their income every month for a plan which would bankrupt them before it paid out should be all the proof that anybody needs that this poo poo doesn't loving work. Of course, if we were in a sane world, we'd have a real healthcare system, so . . .
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Sep 21, 2021 05:28
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It's open enrollment time! Oh, boy! Time to see how my employer's gonna gently caress me this year! Hey, why does this coverage detail here say I need to refer to the official plan documents for this aspect of the plan instead of just giving me the info on the web site like they do with everything else? Oh, well. I'm sure reading a several hundred page legal jargon thing will be fine. Can't seem to find it, though, for any year, let alone 2023. Well, no problem. The open enrollment people have a helpful support team which I'm sure knows all about what a "plan document" is and wont just try to direct me to the crap I've already seen. Oh, what's this? They completely ignore my request for the plan documents and keep referring me to summary plan descriptions, which some of the support people claim don't exist yet but others insist do? This sure seems like a well-oiled machine. And, look! The footer when they send messages back (from the folks I tried contacting that way) even has this! quote:Please Note: The information above is intended to provide guidance about the benefit plans presently sponsored by EMPLOYER. If there is any difference between this guidance and the terms of the official plan documents, the terms of the plan documents will govern. Sure wish I could review those legally controlling documents to help me make my decision that I'll be stuck with for the next calendar year!
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Nov 5, 2022 02:47
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I fully expect there's a sentence buried in there to that effect, yes.
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Nov 5, 2022 02:55
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I got an EOB from my health insurance company saying that they rejected almost $10k of stuff because "Medical necessity was not established because required documentation was not received within the allotted time frame." So, I sent a message to the billing department at the hospital and apparently they're still working on it, because they haven't actually prepared a bill yet. Did the hospital gently caress up a pre-auth and they'll try to stick me for $10k that I don't have? Are they really just getting documents together and it'll all work out with the insurance company paying $2.43 plus a box of Cracker Jacks to settle the bill thanks to their negotiated rate that I don't get if they deny the claim? Who knows! I loving hate this lovely, broken system. It needs to burn to the ground.
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Nov 22, 2023 21:19
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OK, so, now my insurance is saying that they're denying some of my claims because the time my doctor spent working on researching stuff outside of the actual visit and consulting with other doctors and poo poo (also, outside of the actual visit) originated from a telemedicine appointment and not a physical appointment. The actual appointment is covered, but not the hundreds of dollars of extra billed time, according to them, even though the same questions and work would have had to be done no matter whether I'd been there in person or not. Burn this country to the loving ground. Kreeblah has issued a correction as of 22:11 on Dec 13, 2023 |
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Dec 13, 2023 22:09
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| # ¿ May 18, 2024 14:17 |
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Nocturtle posted:Moving to the US from Canada as an adult and trying to understand the healthcare system was an experience. A real abrupt transition between a model where you go to the doctor when you're sick/need a checkup to a complex system of insurance plans, provider networks, deductibles and random large bills in the mail for non-covered expenses. Haven't even had to deal with any really serious health issues yet, looking forward to learning all the ways coverage can be denied. I've been doing some thinking on this lately, and I realized something. I spend a lot of time thinking about how we should make healthcare free at the point of service for everybody, so nobody has to worry about a loving thing when it comes to going for care. Have an issue? Go in to see somebody. Have an emergency? Call an ambulance. Your doctor writes a prescription? Go get it. And I realized that I have a really hard time imagining what that would be like. I can think through the details all I want (and it's 100% obvious we have the resources to make it work if there were the will to do it), but the actual experience of it . . . that's kind of unimaginable to me. I've been dealing with this broken loving system for so long that it's hard to really imagine . . . just being able to go to the doctor and not having to wonder about the 500 mystery bills showing up later. I have to think I'm not alone in this. This system has probably ground a lot of people down to the point of believing that something better is just impossible. In conclusion, Kreeblah posted:Burn this country to the loving ground.
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Feb 8, 2024 20:05
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