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Games Health Insurance Companies Play?

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Crohn's Disease
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Posted 9/7/2010 9:00 PM (GMT 0)
My health insurance company seems to have a little game they like to play. It goes like this:

- I talk to them and they say, "Sure, that procedure will be covered 100% regardless of deductible." So I go ahead and pre-authorize.

- My doctor contacts them and my insurance company tells them that they will not cover the procedure until my deductible is met.

- I talk to my insurance company again, raise a little bit of #*%&, and after transferring me to a higher-up they once again say, "Our mistake, that procedure will be covered 100% regardless of deductible."

- I go ahead and get the procedure done.

- My insurance company sends me a statement informing me that they will only cover the procedure after the deductible is met.

Anybody else play this game?
Posted 9/7/2010 9:03 PM (GMT 0)
Did you by any chance write down the name of the supervisor you spoke with? If so, I would contact this person again and repeat what they told you before. Thats just not right. I have an HMO so I don't run into those types of problems luckily. Sorry you had to play this game:(
Posted 9/7/2010 9:12 PM (GMT 0)
Yep, I have everything written down and the supervisor said it's all also in their computer. I guess from now on I'll make them send me a written copy!

I'm really starting to think it's a game they play, using various tricks to get out of paying their share and only those that fight get what they're actually entitled to.
Posted 9/7/2010 9:30 PM (GMT 0)
*sigh* You don't need that sort of rubbish... not on top of your illness.
Posted 9/7/2010 9:46 PM (GMT 0)
I'll say! It's just maddening when not only do you have to fight to get healthy, but also have to fight those who are also supposed to be helping you get healthy.
Posted 9/7/2010 10:09 PM (GMT 0)
My insurance company's game is to pay for things if I have them done at the doctors office, but not at home. Things like B12 injections. Way cheaper to do at home, but go figure, they will pay for an office visit every 2 weeks, but not for the syringe and B12. Also, they won't pay for my Vit D prescription, but they will pay for other treatments that are way more expensive for bone health. Just crazy stuff. They can't think outside of their formulary, there is no common sense. And then we wonder why the insurance industry is in a mess, its because they can't think!!!
Posted 9/7/2010 10:51 PM (GMT 0)
Where are you Zanne? Vitamin D is cheap...even without insurance. I filled it and they messed up and filled 52 of the capsules and my insurance denied it because they'll only pay for a month at a time, but it was only $15..that's a years worth, so it was cheaper than if I used insurance. I also just filled 3 months of B12 and it was $4 at Walmart. They didn't fill syringes...so I'm having a friend "get" some from her work...hehe!

I hate the bills that get sent to you that should have been written off. It makes me wonder how many people pay these bills without question. Occasionally my GI's office will send me a $50 bill that was leftover after insuance payment and my copay, and all I have to do is call and they write it off. I also get these every once in a while from the hospital. I guess they just see who pays them...some people don't pay attention I guess.
Posted 9/8/2010 1:19 AM (GMT 0)
A lot of people don't realize that doctor's offices and hospitals barter with the insurance for what they'll actually charge and pay. But the patient gets a bill for the amount and is expected to pay full price. It's a bunch of BS.

I don't believe that the insurance companies do this the people on purpose, but I do believe that there's a lot of human error in the biz and each rep's interpretation of your insurance plan is different. I personally don't believe ANYTHING my insurance company tells me unless I've heard it from like 2 or 3 other reps.
Posted 9/9/2010 1:05 AM (GMT 0)
Grrrrrrrrrrrrrrr. I made a bunch more phone calls today and got lots of runaround. Somebody give me some prednisone so I can go Hulk and blame it on that.
Posted 9/9/2010 2:52 AM (GMT 0)
I actually work for a health insurance company and I can bet the customer service is outsourced through a third party. Do you have insurance through your employer? If so you should inform your hr department so they can speak to your companies account rep. Internal management employees at an insurance company have dedicated internal contacts to get these issues resolved. Also you say you have a deductible on your plan. In most cases the deductible needs to be satisfied before any benefits are paid. Some plans only have a deductible that a plies to anything outside a dr office, such as hospital, ambulatory, etc. Some include it for everything, even rx.
Posted 9/9/2010 3:42 AM (GMT 0)
According to their policy, this procedure is covered at 100% regardless of deductible. They confirmed that before I had it done (I preauthorized it beforehand). Now after the fact they're trying every trick in the book to get out of paying the whole thing.
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