primitives in vogue

[franksolich]

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x6461250

Oh my.

The_Casual_Observer  (1000+ posts)        Fri Sep-04-09 02:24 AM
Original message
 
"Payment denied, illness was not life threatening"

We received this notice in lieu of payment on an emergency room visit from my "insurance company".

There is nothing in my "policy" that states this condition of payment, it's new & a fabrication.

I expect that this is now in vogue & will be standard industry practice if it isn't already.

The gigantic primitive:

Systematic Chaos  (1000+ posts)      Fri Sep-04-09 02:30 AM
Response to Original message
 
1. Send them a certified letter giving them one opportunity to make this right, or else you'll sue.

There are LOTS of lawyers out of work right now, or faced with the specter of it due to the economy. One of them might take your case pro bono, and you might win.

By the way, the gigantic primitive's lost a few more pounds.  If he keeps this up, pretty soon the gigantic primitive can dust off the resume and apply for jobs, so as to take some of the burden off his wife.

Fumesucker (1000+ posts)        Fri Sep-04-09 02:32 AM
Response to Original message
 
2. Just wait until you are *mandated* to buy private insurance..

You think this scum bites now?

You ain't seen nothin' yet.

dgibby  (1000+ posts)        Fri Sep-04-09 02:33 AM
Response to Reply #2
 
4. Sadly, I fear you may be right.

laughingliberal  (236 posts)      Fri Sep-04-09 02:41 AM
Response to Original message
 
5. I battled with a couple of companies here

Lots of frustrating runarounds. Both times I got results when I told them I would be taking my case to the state insurance commissioner. Make sure you write down the reference numbers for any calls you have made and tell them you will be providing them to the commissioner. It would be good to mention in your call to the company that you are not a doctor and have no way of knowing if your symptoms are indicative of a life threatening condition before going in to have them checked.

The_Casual_Observer  (1000+ posts)        Fri Sep-04-09 03:10 AM
Response to Reply #6
 
8. The excuse was pure evil genius, it showed me the future, where this is headed. It's like everything else in my life anymore, they are all closing ranks to squeeze every ****ing dime out of me before I'm totally used up & croak.

JCMach1  (1000+ posts)        Fri Sep-04-09 03:11 AM
Response to Original message
 
9. I remember having to always fight some billing detail with BCBS

This is standard operating practice.

Most people give-up, so it's just money in the bank for them.

laughingliberal  (236 posts)      Fri Sep-04-09 03:31 AM
Response to Reply #9
 
10. That is exactly right

They count on wearing you down. If they can't outright avoid paying they will try to delay it until their current quarter is up so it still shows as revenue on their balance sheets. Do NOT give up. DO call and make a fuss. Then DO contact the state insurance commissioner. I had a 'customer service rep' one day tell me, "Ma'am we're just going in circles and getting nowhere with this." I said, "Well, your company owes me $1300 and I'm going to get it one way or the other. If it means I have to cost your company that much money in labor by taking up their employees' time listening to me bitch about it I will. Sooner or later it will be easier for you to pay this claim."

JCMach1  (1000+ posts)        Fri Sep-04-09 05:54 AM
Response to Reply #10
 
13. Right... on the average it would take me 3 calls to get the issue 'cleared' up ... at least until it happens again...

safeinOhio  (1000+ posts)      Fri Sep-04-09 05:30 AM
Response to Original message
 
12. BC/BS will not pay ER bills unless I am held over night.

I now tell the hospital that unless I am held over night they will not get paid.

unblock (1000+ posts)        Fri Sep-04-09 06:34 AM
Response to Original message
 
15. er's are for "acute care". where are you supposed to go with a broken arm?

of course insurance companies are simply throwing hurdles in your path to make you jump over.

it costs them nothing to deny and at worst it delays payment so where's the downside for them to do this crap?

The grouchy old primitive:

NNN0LHI  (1000+ posts)      Fri Sep-04-09 07:01 AM
Response to Reply #15
 
19. Broken bones are considered "life threatening" with my insurance

I think they are all that way?

unblock (1000+ posts)        Fri Sep-04-09 07:26 AM
Response to Reply #19

20. the point is they're not.

well a mid-femur fracture certainly is, and a infection following a compound fracture could become life-threatening, but a simple fracture is not life-threatening in a medical sense. it is, however, an emergency that should be handled in the e.r.

only an insurance company would make up crap excuses like that in order to delay payment.

ejpoeta  (1000+ posts)        Fri Sep-04-09 06:34 AM
Response to Original message
 
16. they want to make you fight them for it. most people will just walk away and figure

ok... they won't cover it. this is what they want. the fewer claims they have to pay out, the more money in their pockets.

NNN0LHI  (1000+ posts)      Fri Sep-04-09 06:58 AM
Response to Original message
 
18. This policy isn't new with my insurance

Its been that way for me since the early 1970's that I know of.

[Flame]

I didn't row over to the island myself...just read the comments here, but did the DUmmy OP ever state what the ER trip was for?  Maybe it WASN'T life threatening.

And I've never had an ER trip turned down...of course, I have only been to the ER 6 times in the past 16 years.

Actually, come to think of it, I've never had an insurance claim for medical care turned down.

[delilahmused]

Our insurance states pretty clearly that it pays 50% of emergency room visits unless you're admitted, then it pays the whole dang thing. It's in the benefits book my husband's company sends to employees and also on their web page. That's why, unless it's a REAL emergency (which I haven't had for years) I simply go to an urgent care clinic or wait until the morning when I can get an appointment with my doctor. Only have to pay my copay, I get the care I need and I'm on my way.

Cindie

[The Village Idiot]

Our insurance states pretty clearly that it pays 50% of emergency room visits unless you're admitted, then it pays the whole dang thing. It's in the benefits book my husband's company sends to employees and also on their web page. That's why, unless it's a REAL emergency (which I haven't had for years) I simply go to an urgent care clinic or wait until the morning when I can get an appointment with my doctor. Only have to pay my copay, I get the care I need and I'm on my way.

Cindie

Some companies when you get in a car wreck they send a person out to see the car and find out what happened, they used to do this for medical insurance too didn't they?