[Madame_X]

#1019872

The statements for my hospital stay (where I was dx with Graves) are starting to arrive and all of them are coming up "treatment denied."

Mr. Daschle is looking for stories related to health insurance; if he gets enough of them, he will, I believe, go to bat for all of us so that health insurance carriers will stop getting away with murder and highway robbery.

So far, my insurance carrier is not paying for any of my treatment. So far, I was denied for a chest xray, three in house visits from my primary care MD and an echocardiogram and expenses related to that.

[LynneB54]

#1074701

Hi Madame X,

I obviously don’t know what your particular insurance company will cover – but I can tell you from experience that it’s worth phone calls and letters to them to get them to explain why coverage is being denied. When my daughter was 12 she was extremely sick and was referred to an orthopedic rehab hospital. The insurance company’s doctor said she was "too sick to benefit from being in the hospital". I guess they thought she should stay home until she either recovered or died, but either way – they didn’t want to pay for her care. My husband and I fought them, and my daughter was admitted to the hospital, where she stayed for 4 weeks. My son also had a tumor removed at age 5 and the insurance didn’t want to cover that, either.

The lesson I learned from the cases with my children is that it is possible to fight the insurance company and win, but you have to be persistent. Document all phone calls and get the person’s name each time you call. Write letters. Trust me – it works. They may not pay the whole amount, but they should tell you exactly why they are denying each claim. Don’t be afraid to ask for a supervsor. Enlist your doctor’s help as well; they’re used to this.

There has to be a better way. I’m tired of being held hostage to my insurance company’s whims on what they will and won’t pay for!

Best of luck to you!!
Lynne

[Madame_X]

#1074702

Thanks, Lynne.

I remember when there was really no red tape. None of this "denied" stuff ever happened. ” title=”Sad” />

[cathycnm]

#1074703

I am fortunate to have a great HMO – they rarely blink at any of this stuff. And they have a great health risk assessment program with management plans. My only wish was more focus on common womens illnesses – thyroid and osteoporosis. However – this year they did start offering TSHs as part of the health screening labs and the questionaire does now ask about osteoporosis.

As a physician once pointed out to me – the US is the only country in the world with a healthcare industry. Others have healthcare systems. The benefits are that we develop things sooner because companies can sell winning drugs or equipement for a profit. The downside is all the insurance red tape. I would definately follow up with them. Cathy

[cltthompson]

#1074704

Have you read Daschle’s comments on health care, I don’t know that he will help us, he believes that there are certain requirements a person must meet in order to be treated. For instance, life expectancy, if it is determined that yours is short, NO MEDICAL TREATMENT. Sorry.

[Madame_X]

#1074705

We’re *not getting him* anyway so it’s to no avail.

Right now, I have Cobra through my former company. $500 a month.

And here is the kicker: the company is not doing well financially. They have been floundering for quite awhile and it’s a tiny company (only 5 employees, including the 2 owners) to boot.

If they go under, there goes my Cobra.

And is it true that if you have a preexisting condition it is tough to get onto an individual plan you want to pay for yourself? We have a state omsbudsman that I wrote to when I was having trouble getting Cobra from the company (a whole other thread in itself) maybe he will know.

[Kimberly]

#1074706

Madame X wrote: And is it true that if you have a preexisting condition it is tough to get onto an individual plan you want to pay for yourself? We have a state omsbudsman that I wrote to when I was having trouble getting Cobra from the company (a whole other thread in itself) maybe he will know.

My understanding is that if you don’t lapse into more than 59 consecutive days without coverage, that no one can *deny* you insurance coverage. The kicker, though, is that the cost can be ridiculous. I know another single woman with a pre-existing condition who is paying $1,000 per month for individual coverage.

You might consider comparison shopping on individual plans now, just to make sure you have a "Plan B" before the worst happens. The insurance company you are with now might be a good place to start.

Good luck!
Kimberly

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