From Health magazine
Health insurance companies like to keep secrets. And they like to save money. Example: You have surgery, and weeks later you get a bill for using an out-of-network anesthesiologist. Ridiculous, right? You didn’t choose who put you under, so you shouldn’t have to pay extra. But your insurer sent the bill anyway, hoping you wouldn’t notice.
Fighting back against this kind of trickery—and winning—is a lot easier than you think, says Kevin Flynn, the president of Healthcare Advocates, a Philadelphia-based firm that helps patients wrangle with their health plans. We checked with Flynn and other insurance-industry insiders, lawyers, doctors, and regulators to uncover nine little-known ways to get the health coverage you deserve—for less. How to Get Your Medical Insurer to Cover Alternative Medicine Treatments
Don’t pay if you don’t have a say
When you purposely see an out-of-network doctor, your plan usually makes it clear that it’ll cost you. But when you have surgery, the hospital chooses the anesthesiologist. If you get that annoying “out-of-network” bill, Flynn says, draft a strongly worded letter stating you had no say about the anesthesiologist—in-network or otherwise—and, therefore, won’t pay any additional fees.
“If you don’t have direct control, you are not liable,” Flynn says, adding that this tactic is likely to work every time, but few consumers know about it. How the Costs of Diabetes Add Up—and How to Save
You may be eligible for more coverage
Depending on your state, you could be eligible for more benefits than your plan is telling you about. Take Maryland, for instance. Health plans operating there must pay for expensive infertility coverage. But one state over, in Virginia, they don’t. It’s unlikely that your plan is trumpeting info about state-mandated coverage, though. It’s up to you to get the scoop.
One good place to check is Families USA, a consumer group that keeps tabs on state rules, suggests Kevin Lembo, Connecticut’s official health-care advocate for consumers. Another option: Contact your state’s insurance commissioner.
Next page: When to advocate, when to hesitate
Comments (141)
A lot of times the reasons health insurance claims are denied is because the companies employ uneducated claims processors to handle the vast amount of claims. A lot of claims are processed automatically by a computer. Claims are denied not as a scam but because employees are not thorough in their work and are racing to reach benchmarks of claims processed per hour.
I already had insurance, I was approached by two agents trying to get me to change my insurance. I told them i didn’t want to because i was diagnosed with high cholesterol and i had a heart cat. done and was told by my doctor that there was a very mild blockage in one artery nothing serious i was to take a baby aspirin a day. but i really felt like i shouldn’t change ins. at that time. they told me that there company probably would not put a rider on me because i wasn’t even on medication except a baby aspirin i had been on cholesterol med but had been off of it for over a year i was told by the agents that it would not be a problem that half the world had a colestial problem and that the premium might be a little higher they also told me that the insurance that i had at that time was giving people a had time about paying their claims. they told us that they could save us some money and our other insurance was having and increase a couple of times a year. so when they assured me that the most problem i would have was maybe a 12 month rider if they even did that. we went ahead and changed. i went to the Dr. a little over a year after having the insurance, my Dr. scheduled a stress test for my because of my past history with the minor blockage.I was all set up to have this done when i was told by my DR’S office that my insurance would not pay that i had a 24 month rider on me so i waited over 3 years before going back for the test. After over three years i thought everything was fine, my Dr set me up to have another stress test which showed that there was no more blockage than i had almost 7 years earlier he did not understand why they had this kind of rider on me in the first place. let me go back to April because of the situation with the insurance i am now taking stress pills and my blood pressure went up, the other day i received a letter saying they would not pay the office visit because guess what they say in my policy there is exclusion and limitation that excludes benefits for mental and emotional disorders . I know i dont have a mental problem and wasn’t sure what they meant by emotional disorders so i called and was told that they didn’t know why the claim was denied i told the person the only thing i could guess was that now i was taking stress pills and that was a lot to do with them refusing to pay my claims i was totally honest with their agents . I had know idea any insurance companies had that kind of riders. i have known of people seriously ill that have not had riders on them the way i have. the whole problem was we just wanted to make sure everything ws alright. except my blood pressure went up and now i am on blood pressure pills and stress pills what a laugh you take out insurance so you can go to the Dr. before any bad happens and to try to keep yourself from becoming sick or to catch a problem before it does become serious and now you are in worse shape because of your insurance company
The “Key” is to check your policy. if you are applying for a new policy make sure there is no rider before accepting. Never cancel an existing policy until you have verified that the new one does not have any exceptions or riders. I believe in most states the law “requires” you be made aware of a rider on a policy. Always read the fine print. Always remember Caveat Emptor “Let the buyer beware”.
I second Anita Bonghit’s comment. Also, I don’t think the insurance company is the villian here. Did you contact the agent that told you one thing that ended up being inaccurate. If something goes wrong like that they should be the first people you call for help. If they don’t help you go the insurance commision for you state. But if the agent is a good one, and they made an honest mistake, they can fix it, if you go to them right away for help. If you wait three years or however long you did it makes it hard to fix things. When you buy something at walmart and take it out of the package only to find it doesn’t work do you take it back for a refund or an exchange the next day? Or do you let it sit in your closet for three years and then return it? Its amazing the lines I see at the return counter of walmart yet when the same thing happens to people and their health insurance they roll over and become helpless. Wake up and act like a customer of your health insurance company.
The agent has nothing to do with your denial of coverage. If you want to point fingers, point them at the insurance company’s Underwriters. They are following the rules set by the insurer.
Reading a policy? What a laugh, even lawyers struggle with their legalese. I dare you to find a person of average intelligence that can wade thru that maze of double negatives and where as what for. Get real!
The deciders are the underwriters, and they don’t talk to the insured. The don’t tell the agent before hand either. I am an agent, and I can tell you we are at the mercy of the UW dept. We are told to submit the app and they will get back to us.
Irene:
Unfortunately you fell victim to unscrupulous agents. Let me pose a question to you and all the readers if you got into a car accident and then either bought insurance or switched carriers do you think/expect the insurance company that you did not have a policy with when the accident occurred to pay to fix your car. Same applies to health insurance just common sense. You need to contact the insurance commissioner where you reside and file a formal complaint against the agent that sold you the policy. I would also contact an attorney and find out if the agent has anErrors and Omissions policy, you may get relief there. The term rider is misleading what it actually means is that after the term, 24 months in your case you may then REQUEST to have the rider removed, if you do not make the request then it stays in place, again an insurance professional obviously did not advice/consult with you. One of the most knowledgeable companies out there is insurancequotegiant.com Their philosophy is let us tell you what is wrong with every policy you are looking at, then you pick ther cup of hemlock you want to drink from. Anyone who tries to sell/tell you they have the PERFECT policy is not being truthfull. ll policies have shortcomings it isbetter to know exactly what you are paying for, before you have to use your policy.
Mark
All this crap would go away if we had national health insurance. Cut out the insurance companies (let’s just call them money changers since they do not actually provide health care…just profit from money ). For what we spend on health care, we should be the healthiest people on Earth.
I was diagnosed with MS in October 2007.
Now my insurance refuses to pay, because of pre-exsisting conditions.
There are no pre- exsisting conditions in my case. it is just a lot of lies!
Is there a chance for me without getting bankrupt?
Yes, get the heck away from the medical system.
Montell Williams has MS and is doing great, as our millions of others that found HEALTH instead of PILLS.
Trust me, if everyone woke up to the scam that “health” and medicine is in America, we would be healthier and happier.
Instead, we are begging the government to make it worse.
I am a 26 year old cancer patient. I’ve been fighting for 2 and a half years. My health insurance company has attempted to deny over 75,00 in health care costs. Fight them and comment on my blog http://baldiesblog.blogspot.com/
I just have had different experiences. In the last 2 yrs. I have had 5 surgeries and have felt nothing but total respect, interest and support from the 3 different doctors. Two were knee replacements and 2 were plastic surgeon where even the plastic surgeon encouraged me to not have any more surgery for a while even though I am a quick easy healer with minimal pain. I know he was looking out after my health and I took it as real concern. However, I have also had appointments with doctors where I never returned because of their manner. Often there is that cocky attitude. I did have an anesthesiologist who definitely didnot want to answer my questions and just blew me off. My doctor later apologized for his behavior.
Why do the money hungry Ins. companys always go after the old and sick, we have paid our Ins. cost for many years, knowing at some time in the future it would be needed, and then we have a GREEDY Ins. company trying to take it away from us.
(What a Shame )
Insurance companies don’t “go after” anyone. Do your research, and if you don’t understand your policy and how it works, find someone who can help explain it to you. Be proactive and know what you’re paying (or not paying) for before you blame someone else.
one word of advice..read your policy and know what is covered and what is not.. education is your best weapon
you think these are bad try the horror stories of dealing with the VA.Like dad died in Oct 08 on 28 and the VA took back his Oct retirement check real fast out of his bank account.Oh an you only get 300 dollars for cremation an wait 2 to 3 months for name plaque on head stone all this for a Bronze star an Purple Heart Vet.thank you VA
That’s really shocking. When my dad passed away in Feb. of this year, we had no problems with the VA; not even regarding his headstone. I guess it depends on which state you live in.
Please accept my deepest sympathy for the death of your partiot father at the hands of our VA and unconcerned military. This needs to change.
Our 40 year old son fought in Desert Storm yet has no insurance for his many illnesses. We are bankrupt helping him.
God bless you and your precious father.
Every vet has health insurance and the liberty to use it or not.
I just purchased a health insurance plan from a company called Vital One Health, they have honest agents helping you rather than trying to make a commission, I had a pleasant experience, look them up at vitalonehealth.com
This soundslike an ad for vital one to me.Isn’t this just another trick of the insurance companies,posting an advertisment to look like a testimonial? Do people really fall for this crap or do these companies think we’re stupid?
Wow. Just – wow. We don’t have these kind of problems here in Canada with our Universal Health Care. We simply don’t. There are no “fishing expeditions” or “secret techniques” to skirt around the Health Insurers Policies. There just isn’t. NOBODY is denied care, NOBODY loses their house, and EVERYBODY is covered. Is our system perfect? Of course not – if it were a perfect world, nobody would get sick. A word to the wise – whatever info the Republicans or Health Insurers are feeding you about the “evil socialism of Canadian Health Care” is total BULLSH!T.
Not all Canadians are as happy as you.
And it is not just REPUBLICANS that don’t want this massive, government growth to take off.
They aren’t “reforming” anything. They are getting ready to steal more money from the middle class to gift their cronies in Big Pharm and the AMA.
the writer of this blog must have not been listening to the Canadian news yesterday when their own Minister of Health publicly stated that the Canadian health care system had serious problems and was on the verge of collapse, citing the need to consider changing the Canadian social medicine system to include private care competition.
Wow, seems like the “young uns” at the Obama WH are hiring posting folks to add positive comments about the Canadian plan! It is no secret that Canadian nationals are crossing the southern border to get operations in the evil ol’ USA because by the time they would be “allowed” (by the bureaucrats) to be treated in Canada, the condition would be getting increasingly worse or the issue would clear itself up, because the person was deceased! Sneaky, sneaky, sneaky, sneaky.
It seems like you haven’t had to use your health care system there in Canada. One of my Canadian friends is a doctor who came to the US because his mother wasn’t able to get the treatment she needed. She eventually died from her disease, which would have been treated quickly here in the States.
Yeah and if it was so great why do Canadians come to the U.S. and pay CASH out of pocket for health care? Yet with all the cronies Obama has they cant come up with any facts to refute this! Report that to your Obama snitch website!
My snowbird Canadian neighbor was diagnosed with prostrate cancer, and his first appointment with an oncologist was a mere 7 months after his diagnosis. Is this what we want in the USA??? I’ve headbutted with insurance companies over the years, but I’ve never experienced anything even close to what my neighbor did…
Paul, it’s PROSTATE, without the additional “r.”
PAUL: I do not beleive a word of you are claiming!
This article is a clear illustration of the problem. People who have insurance try to get more benefits, including tests that are not medically indicated, while insurance companies cancel and rescind policies. The number of uninsured is rapidly growing, but those who still have insurance delude themselves that they will be covered for the next illness and focus on getting more benefits out of the system.
You should always fight for the best healthcare and I think these are all good recommendations except for the “To get tested, talk up your symptoms” example. You should never lie to your doctor about symptoms. Getting “more” testing is not always a good idea. Especially when it comes to invasive tests (such as colonoscopies) which can and do have serious (and rarely fatal) complications.
-Family Physician (Southeast PENN)
That was my thoughts exactly. How irresponsible is it to be involved in a conspiracy to commit fraud. Yes, Fraud! If you lie inorder to get an insurance company to pay for something they are not contractually obligated to pay for you have commited fraud. Suz Redfearn and Health magazine Should be ashamed
If it’s commiting fraud without getting caught, especially to a health insurance company that you have been paying premiums, then by all means be logical….. committing fraud is a much easier sentance then suffering painfully until you die without coverage…..
It’s actually insurance fraud to misrepresent your symptoms just to get a procedure/coverage, and it can land you in jail.
Well, your first two items were quite informative. Then I got to item 3, ‘Talk up your symptoms’. Wow. This is SO wrong on so many levels and frankly it is extremely irresponsible of you to post this as a health tip.
From a purely health related side, do you really want to LIE to your doctor about what is wrong with you? Diagnosis is an incredibly delicate science / art. If you mix in false information, you are asking for trouble.
Secondly, why do you think health care in America costs so much? One reason is because pushy ‘know it all’ people demand proceedures they don’t need and / or doctors know the easiest way to get rid of a patient is to right a prescription for a med or proceedure. Thanks for contributing to this…
Or just move to Canada.
As a bonus, you need not fear stray bullets…
Point number 1 is rather misleading – For every health insurance policy I have seen, the doctors are typically paid directly by the members and also directly by the insurers. If you have a dispute with your insurance company’s processing of a claim, you should definitely contact them about it.
However, if you do not pay the doctor at all, there is an extremely good chance the anesthesiologist / hospital will send you to collections. (The insurance companies do not request payment from you – that’s why you pay premiums) The best bet is to pay the bill and follow up with a formal appeal to your insurance company – else you may permanently stain your credit rating. To quote the article “If you don’t have direct control, you are not liable,” Flynn says, adding that this tack is likely to work every time, but few consumers know about it.” End Quote This is an outright lie. Insurance companies will allow a usual and customary rate – but the out of network doctor can, and (most likely will) pursue you for the portion that is not covered. This is terrible misinformation.
Try and get the usual and customary rate raised with your insurance company via an appeal. But not paying the medical bills will only hurt you and your financial future, no one else.
This seems like a whole lot of bulls**t to have to go through. I can’t believe our health care system has come to this. I can’t even get insurance, so basically if anything bad happens to me my life is over, or I’m dead… and there’s nothing I can do about it.
For those of you that don’t make enough money but require health insurance, there is Medicaid/Medicare. It’s not always the best doctors/offices/clinics but it is healthcare. Beggars cant be choosers.
Yeah…because you’ve been on either right? What do the people do when they make enough NOT to qualify for either program but not enough to pay for coverage?
Honest people who do jobs “SOME” people think they are too good for? I guess their beggars right?
Narrow minds – narrow minds…remember some day this could be any of us. I met a VP who lost his job and is a cashier at Target now…bet he thought the same thing you some others here do.
Hope you never need help…I mean didn’t Scrooge point out there were orphanages and houses for the poor? Lead by example only applies when it means showing our children what selfish b******s we can be right?
I don’t make enough money and need insurance. I do not qualify for medicare/medicaid because according to their guidelines I make 20 dollars too much a month.
There are people out there like me who fall through the cracks. Obamacare is not the answer. I don’t know about anyone else, but I don’t want the socialist heath care plan that is being proposed.
Um, Terry, you say that you don’t want a “socialist health care plan,” yet apparently you’ve applied for Medicare/Medicaid and been turned down. Remember–that’s a government-run program. Are you confused much? So, you’re saying it would be okay if you could be on Medicare/Medicaid, but if not, you don’t want universal healthcare? I really don’t know how to figure your stance on this issue out. It seems to me that it’s confused individuals like yourself who are playing obstructionists in this very important matter.
I have lived and worked both here and abroad in human resources and information technology. I have experienced the medical systems firsthand and in some cases a very close secondhand. In summary my observation is this: those that live in socialized medicine system are healthy and live long productive lives. I was treated in Britain, France and the Netherlands for various injuries and health problems and EVERY experience was equal or superior to that of US medicine – it just cost less. I know that a system that forks in a bunch of my dough for PROFIT, for MARKETING, for BLOATED EXECUTIVE SALARIES is going to cost more. IS it likely to be better?
“To get tested, talk up your symptoms.”
In short, lie.
I guess you’re screwing the insurance company, but in the end that costs everybody money.
>> To get tested, talk up your symptoms.
This is exactly what is wrong with the current health care system. “$675″ dollars just so you can have “peace of mind” is ridiculous since it raises the costs for everyone else. If you don’t really have symptoms that indicate a problem, than why are you burdening the system?
Making up symptoms (to get a colonoscopy) as described in the article is really fraudulant. While I certainly I agree that there is compelling evidence that routine screening of people over the age of 50 years prevents the development of colon cancer, there is also significant risk to doing the proceedure in asymptomatic patients who are not 50 years of age including colon perforation, gastrointestinal bleeding, and anesthetic complications. Made up complaints are likely to get you tests that have the potential to do more harm than good.
Ira, MD
>> Doctors are often wowed by the latest and greatest >> drugs, which tend to be the most expensive.
Right, which is why doctors need to be questioned by insurance plans in other areas also. Just because a person graduated from medical school doesn’t make them omniscient.
For example, insurance companies should disqualify certain tests if current best practice indicates the particular test doesn’t benefit a patient displaying the constellation of symptoms that have been reported. Allowing an expensive test just to give a patient “peace of mind” doesn’t serve anyone’s interest and takes money out of the system that could benefit others in more dire need of care
When I arrived in Australia, my cousin advised me to get private health insurance and subscribe to the ambulance service. So I did. My ambulance sub meant no extra cost for the few times I needed an ambulance. Even though I started paying about $100/month 25 years ago for middle level cover with $500 deductable and started paying for for top cover and no decuctable about 10 years ago (recently raised to $179/month), I have some doubt that the insurance company has made a big profit from placing a policy with me. I’ve had many expensive medical interventions and my insurance company has paid out big. Between Medicare and my insurance, I can be confident that I can get the care I need without worrying if I can afford it or waiting in a queue for a year or more. Considering that I couldn’t get insurance in the USA and couldn’t afford the medical bills, i probably will never be able to afford to visit the USA again to see family much less be able to live there again. It’s a good thing I like Australia.
Demacrats and Gov. health care: I’ve heard lots of horror stories about government care–that you could go to the hospital/doctor saying you have this or that condition, and be turned away because it isn’t that “serious” or “necessary”, that you DON’T GET THE NECESSARY TESTS in many cases which are life saving…strange we don’t seem to hear about many of these stories… Also, my husband could be on medicade/medicare but I’m afraid he won’t get the benefits/care as with my insurance policy at work. How do we find out before making such decisions which policy will cover your CANCER treatments, etc. or other very expensive surgeries/conditions? Will Medicade just pay EVERYTHING? This could ruin a person financially. Pls help> Linda
Lind — Medicade and Medicare are just like all insurance plans…they have a listing of what is covered and what is not, all you have to so is ask. Don’t let fear prevent you from taking advantage of a benifit for which you are qualified. I personally have never heard of Medicare/Medicaid patients being denied treatment by medicare/Medicaid. Finding a doctor to treat you is a different issue. Check with your local doctors and hospitals to see who will accept new patients if your doctor won’t accept Medicare/Medicaid. You can also ask your doctor to reccomend someone.
all of these insurance companies are just asking for Obamacare and will be out of business . George Soros and Progressive insurance will take all the business and we will be DEAD. Wake up people.
i am on medicare and have insurance through my former employer. my comments concern: medicare B deductible 290.00/ medicare D deductible 295.00/ monthly insurance payments 30.00 per month (a very low amount). the stinking donut hole swallows me whole after 2700.00 in COSTS of my meds. (not what i copay but the actual COST of my meds). ops, i almost forgot, i “donate” 96.40 each month to medicare. now here it is september 1st and i am drowning in the stinking donut hole and cannot pay for my medication COST again this year. do i cut my pills in half or do i just not take them at all and hope for the best. (i am a diabetic with high blood pressure and cholesterol) i do use generic meds where available and order thru the mail (cheaper) but this doesnt solve the problem. my insurance does not allow me to use WAL MART for my generics (10.00) but theirs is sooooo expensive. i sure do not know the answer but i cannot pay 150.00 a month premium each month which is what one of our better known insurance companies charges. this doesnt even include rx coverage. ANSWER IS ??????
Have you contacted drug companies to see if you can get medication free? Some companies have programs which help people who can not afford their medication; ask your doctor. You can try to get a loan from family or friends to help get you past this point. And I don’t understand what you mean by your insurance company won’t allow you to get yours meds from Walmart? That doesn’t make sense. I would double check that and maybe talk to a patient advocate. Good luck.
If you know the name of the drug you are using, try going to the manufacturer’s website. Many expensive name brand drugs offer copay assistance plans. I suppose they cannot get us to try them without a little help.
The drug company who offers free meds do not offer it to people with ANY kind of coverage. That’s one of their first questions on the application. But I completely understand not being able to afford meds. Maybe the doctor’s office can offer samples of some of the name brand drugs?
Jean
Try filling the generic prescriptions at WalMart for the reduced price and do not submit to medicare. Use the medicare coverage for the other more expensive prescriptions that do not qualify for the reduced price. I use WalMart and they do this for me and it saves a lot over the course of a year. What sounded like a good deal (medicare covered prescriptions) sometimes doesn’t actually save you that much in the long run. You might also discuss with your physician the cost of your medication to see if you would do as well on a generic medication or one that is less expensive.
Jean -
First of all, companies do offer discounts even if you have insurance. One of my cholesterol medications was $75 until my doctor gave me a discount card that knocked it down to $5 a month.
If you ahve hospital costs – ask you if you can apply for Charity Care. If you’re income is lower – hospitals tend to have program to help – sort of like financial aid.
Just so you know Diabetes mdications are on the $4/$10 list at WalMart – whether you have insurance or not. Also talk to the pharmacist – sometimes they can make recommendations to take back to your doctor. My mother’s kept proscribing new improved drugs until we talked to him about cost and then he found us things on the $4 list that did the same they were just earlier versions.
Don’t cut your pills in half. Talk to Walmart first. I’m not sure what your on – but there are cheaper alternatives.
Situation simular: Better to not have Insurance, I’ve learned thru 18 mon. COBRA\$354.00 mo\Individual. Never sick\used my BCBS plan until WORK related STRESS left me jobless\$0.retirement\$0.savings_account and really sick! Go to Coupons.com and print up to 75% off each prescription (Fred’s Plan, too) and paid $37.00 instead of COBRA & $120.00 co-pay, save Rx! Many other good deals 4 YOU with membership AARP.com/over50, Food Stamps $253.00 mo (only after I was left with NO money, I REALLY MEAND $0.00 after working 38 yrs. Never drept of enrolling in Gov Programs, however I am finding this situation is much less expensive after I became 250% Proverty Level. LOL
Check out a Medicare Advantage policy offered through all of the top carriers. No exclusion for pre-existing conditions, they cover the deductibles for Part A & D; in exchange for a small premium. You have the choice of an HMO or PPO.
Most of the time the problem is that people don’t know their own policies and call their insurance company after they have services done. By than it’s too late. Learn more about your policy. And if you have coverage through your employer, talk to them about benefits you don’t have. Most of the time, your employer chooses what is covered and not covered, and the insurance company goes by those guidelines.
My question is this – I have had 4 epidural steriod injections for Sciatica – none of which worked. My insurance wouldn’t pay because its “pain management” and the attorneys I work for didn’t want that a something included in coverage. However, on the last one, the doctor got it paid – after I paid for it – so why did insurance all of a sudden pay for it?
Probably filed under a different code. Have you talked to your doctor?
I do not like this article at ALL! You should lie to your doctor to get a colonoscopy covered? In most situations, if your doctor bills something which is not legitimate, there could be fraud allegations. State legislation is great to get additional coverage, but what the article does not tell you is many employer groups are self-funded which means those rules do not apply. If you are having an issue with pre-existing, you need to do some research. Do a web search for HIPAA guidelines. The federal law states in most cases you can have a pre-existing waiting period waived with previous creditable coverage of 18 months, with a break of no more than 63 days. If you are put under for a service and the hospital gives you out-of-network doctors, call your insurance plans. Most plans have built in clauses which will allow them to be paid at the in-network level. Just remember, even if they do, you may be billed the difference between what your plan allows versus what you are billed. Before you hire an advocate, take out your insurance card and call customer service. They should tell you what you need to know and they will document your call. In fact, you could probably ask for a reference number on your call. The best advocate for your health is you so ASK QUESTIONS! If you are the one liable to receive the bill, it really needs to be you taking care of it. And if all else fails, ask about appealing a decision on a claim or benefit, or get the number for your state’s local board of insurance.
this is why we should support the President’s healthcare reform. Give the insurance companies a run for their money. Competition is good for the consumers. I was once told one insurance company tells their customer svc agents to say that a claim was never received, so the doctors’ offices will have to resubmit. This is their way of buying time, for when that insurance company didn’t have money to pay the claims.
And public option would be worse again because?
These aren’t “secrets” like some sort smart way to keep a man in Cosmo or a trick to making your silverware sparkle, these are business practices designed to make money at the expense of the sick. Charging you for out-of-network, when they know they don’t have the right to? Lying about not covering certain things the law requires so they don’t have to pay? Executives looking through your medical records to try to kick you off the insurance you paid for when you become pregnant without a full disclosure as to why they want to do that? Who’s running the death panel again?
I don’t know why more Americans aren’t fed up.
I know everyone likes to lump all health insurance companies into one big blob, however before you try any of the above mentioned tactics you may want to make sure that you are dealing with a full insurance company and NOT a third party administrator (TPA). Big difference: If your employer provides their own insurance it is the employer who decides what is covered and not covered, not some giant insurance corporation. The TPA is strictly responsible for handling the paperwork according to the employer’s rules & federal laws. All too often we have people call that assume that since we deal with their health insurance we have this unlimited funding and can pick and choose what to pay vs what not to. This is not the case; it’s your job that pays out of pocket for every covered penny for you and every other employee. Just be sure you know what kind of insurance you are dealing with before raising a ruckus; it might save you time to go straight to your HR department.
America, the world’s best health care with the world’s worst access.
there is a company that takes people with pre-existing condition, with low payment… it’s not insurance but a discount membership
If Canadian healthcare is soooooo WONDERFUL why do so many of them cross the border to have surgery because they don’t want to die waiting for their number to be called in Canada. When I took my cousin to Mexico to have her teeth pulled why did I run into numerous Canadians there having surgery complaining the wait time is extreme for healthcare in CANADA!!!! I bet a idiot in support of ObamaCARE wrote the note extoling the virtues of Socialistic medicine and not a CANADIAN!!!!
i highly doubt the validity of your story.
LOL YOU!! go to MEXICO! Why not stay in the US for dental care?
To Darlene: Not only do relatively few Canadians & other nationalities come to the US 1) because they don’t have to; 2) because even when Canadians come over the border, their Provincial Health System still picks up the bill. In many instances they even pay for transportation and hotels.
If you go to the Mayo Clinic site, you will find that Shona did not have cancer. She had a pituitary cyst. While it affected her vision, it was not life-threatening when she coam South. Also, if you check the stats on those who do come to the US, most of them are NOT from Canada
If you have hospital stats to back up your claim, cite them. But I worked at Memorial Sloan-Kettering for a short while. Even with an international coordinating office, most of the referrals were domestic US. Countries such as Canada monitor their patients better than we do. Per a CBC reporter, the wait for surgery varies with the patient’s condition. That means that if Shona had stayed in Canada, she would have had a similar operation in Canada shortly before, or at most shortly after her US procedure date.
Let’s see if I understand your comment Darlene. You extoll the virtues of the american health care system over the canadian one by inference. Yet you also tell us how you go to mexico to have dental work done. A bit of a irony or does your cousin not share your belief in the virtue of the american health care system.
You also state that you ran into “numerous” canadians going to mexico to have surgery performed.I wonder exactly what numerous means ? 2,5,27,2000 ?
Did they all go because the health care system in mexico is better than the united states’ system as well as canada’s ?
Having lived on the border for 20 years i can confirm that there a quite a few canadians that frequent the place. I’ve never seen a dentist’s office in mexico that also performed surgery and i’ve never been in any mexican hospitals where dentists practice. So did you go hang out at the hospital while waiting for your cousin’s treatment at the dentist to be completed. Just wondering where these numerous canadians awaiting surgery in mexico could be found. As i have hinted, i’ve met and talked with many canadians in mexico.. Oddly enough not a single one mentioned that they were awaiting surgery.
I will say that you may be right about one thing. An idiot, who may or may not support obamacare,
(whatever that nebulous phrase means) very well could have written the reply extolling the virtues of the system you seem to detest.
All ican say to that is that i would rather deal with an idiot than with a liar.
I think i see a little right wing conservative kool-aid on your chin. Would you like a napkin ?
And in case you don’t know, there is no long form hawaiian birth certificate.
sounds like most should read their plan before buying it.90% dems crying and promoting the annoited ones plan
sad that you are openly suggesting people lie about their symptoms in order to get a test they may not need? What is this world truly coming to? i am not an advocate for the insurance industry but this sort of nonsense is why we are partly in a healthcare crisis…
Socialist medicine rules, In Australia healthcare is free accessible, and FREE. Drugs have a co pay of 28 dollars, Doctors a Co pay of 20 dollars, but hospitals and everything given in them is FREE. Go the socialist medicine, you all here well all I can say is good luck, Im off to get my up to date FREE healthcare, and not have to argue with insurance companies or anyone else I just get cared for.
I don’t want to sound like a commercial for Health Advocates, but they helped me with a “simple” billing problem. The insurance company asked the provider to return ONE payment check back to them since it was an underpayment and they issued a replacement check for the correct amount. The provider returned the replacement check by mistake. Of course, no one at the provider nor the two insurance companies involved could track down the returned 2nd check. Meanwhile, my account with the provider looks like I have been a deadbeat and they said that I am ultimately responsible for my account. HA understood this kind of mess and explained the screw ups made by both the twp insurance companies involved; my insurer, Horizon BCBS of NJ, Blue Cross of California (which acts like a clearing house for other BC/BS insurance companies) and the provider Palo Alto Medical Foundation. It took 19 MONTHS to clear up a $115 missing check which was ultimately reissued. Fortunately, HA is a benefit from my company and I don’t know how much this service would cost if I had to pay this myself. Sure, maybe my “mistake” was one-off, but this shows that our current system needs some serious overhauling.
I am an upper extremity amputee through a traumatic injury at work. I have tried pricing health coverage for myself, sans amputee costs since they are covered by worker’s comp. The rates for my 30-year-old active, healthy self are almost double those for my 34yearold not-so-healthy brother. What gives?
I can’t see how this article doesn’t show how obvious it is that health care decisions cannot be connected to for-profit insurance companies. Why should an individual have to look up special rights they have in their state? Why should they have to hire (or indirectly pay) patient’s advocates to make the insurance companies pay for things they medically should be paying for?
As a US citizen living in a country with mostly-socialized health care (Japan), I assure you that the system can work. If I feel that I need a colonoscopy, I will receive one, and while I will have to pay some of the cost myself, it will be a tiny fraction of what one would pay in the U.S. The entire U.S. system is broken, an artifact of New Deal and post-WWII policies (governmental and private sector) that made sense at the time but simply don’t work anymore. Only radical change has any hope of success.
AARO
Please defined what Socialized medecine is?
100% of the times, if you have the time and patience to read your policy you will not enroll in any health insurance, Since Health Care is for profit and is operated by Criminals in the USA you have no choice, you must pay the mafia.
IF UNIVERSAL HEALTHCARE IS SO BAD, WHY IS THE UNITED STATES THE ONLY ONE THAT DOESN’T HAVE IT ?
Which country with Universal healthcare has 300 million citizens? Also, ask a Canadian or a Frenchman: a) how much dispobale income they have after taxes and b) of the total tax bill, how much is strictly to pay for Universal Healthcare? It is likened to having to pay higher auto insurance rates for “uninsured/and or “under-insured” motorists.
because we are the leader of the FREE world and we intend to stay that way!
This article is nuts! So, you should trump up your symptoms to have tests done you may not need? That is exactly what is wrong with insurance and healthcare. How about calling your plan and asking what benefits you have for both a medical and a routine colonoscopy. Most plans have benefits for both. Pre-existing conditions can vary per plan. Educate yourself. Do a quick websearch for HIPAA guidelines. In most cases, if you have creditable coverage for 18 months without a break in coverage of more the 63 days you may be able to have it waived. If you feel you need a test your doctor was not wanting to do, you should convince them? So, on one hand we are to trust our doctors and on the other we should lie to them and ask for procedures we do not need? Where is the sense in that? For those of you on high dollar drugs, try going to the manufacturer’s website. Most have coupons and copay assistance programs. Writing letters is great, but if you are really concerned about your call not getting documented ask your customer service representative for a reference number. They will have it. And the bit about Maryland and the infertility coverage, well, you better check first to see if your plan is a self-funded employer group plan. If it is, they are exempt from a lot of state mandated laws. Do yourself a favor since YOU will be the one with the bill and call your insurance company before you go in for costly procedures. If it is your surgery, your insurance, then it will in the end be YOUR bill. And last, if your claims are denied and you cannot get an answer, ask your insurance company if they offer an appeal of benefits. Some may actually surprise you. We need to stop asking insurance and doctors to look out for every aspect of our health. It is always someone else’s problem. Advocate for yourself. America is in big trouble when we expect anyone to cover or allow everything. Look at what you have in the bank. Can you buy everything you want? No, of course not. No one ever asks if insurance companies cannot spend the money to cover these expensive procedures, where is our ecomominally stunted country supposed to get the money? Oh wait, must be someone else’s concern.
Given all this, given that FOR PROFIT insurance companies deliberately and consciously try to deceive us and deny benefits we are entitled to, given the stories of anguish and suffering that appear in the comments, why, why, why are so many crazies up in arms about health care reform?
At a minimum, a NON-PROFIT agency sponsored and funded by the government will keep these crooks honest, to the extent you can do that. A much better solution is to have a full-on government based insurer to actively compete with existing insurance companies. Only when you start hurting their finances will they pay attention.
No one does ANYTHING unless they are made to, this is why we have a police force. The same is true for companies, that is why we have regulators. Yes, there are insurance regulators but they are not the solution. Why? BECAUSE THEY CAN BE LOBBIED! Only competitive HEAT will make these jerks straighten up.
I can’t believe this article is telling patients to “talk up their symptoms” in order to get a test for “peace of mind.” Not only is this fraud, but then this would go into your medical record. Next thing you know, you’ve been tagged as having GI disease. But you don’t, cause you lied. And this is the fault of the insurance companies, how?
Another poster stated that the best defense is knowing and understanding your policy. This is absolutely true. You need to be aware of the coverage you have to avoid a surprise bill down the road.
If something, such as massage therapy, is listed in your certificate of coverage/exclusions list as not covered, then you shouldn’t whinge and whine when the bill doesn’t get paid. Most insurance policies spell out what is and is not covered pretty clearly.
Some of this information is good. But other parts of it are just blatant reasons that insurance costs are so high. Lie to your doctor so you can get and expensive test because you had a friend with an issue??? This is irresponsible writing on the author’s part!!
Horrable Advice: “Pretend to have blood in your stool”… Great way to get denied if you ever want to get Private Health insurance.. Make up a bunch of ailments to get tests done!
So many problems with private health insurance companies, and people are worried about the government having a bit more to do with their health care? Almost in the same breath they will worry about Medicare being taken away but it is a government health care program! And a good one! People knock the Canadian system on the basis of propaganda put out by these same private insurers. Talk to a Canadian! In a recent survey asking Canadians what was the best thing about being Canadian, about 75% replied THE HEALTH CARE SYSTEM! They love it!
I so agree with you!
“Talk to a Canadian! In a recent survey asking Canadians what was the best thing about being Canadian, about 75% replied THE HEALTH CARE SYSTEM! They love it!”
Please cite the survey and where the results were published so we can at least check the methodology.
Thanks
RICK: HERE IT IS>> BUT I’LL BET… YOU WIIL SAY ….IT IS CRAP!
http://www.hcic-sssc.ca/index_e.asp
Just a couple of tidbits to add to this:
1. Holistic providers (i.e., Doctor of Osteopathy, etc.) are your better bet over seeing the MDs. The MDs are generally the ones that are pushed by and support Big Pharma, thus causing you more expense in medications that you may not even need or are more harmful than hurtful to you. Holistic providers cherish the human body and it’s ability to heal itself more than MDs do, and use natural means to help you heal and are generally 5-10 times less expensive than using prescription drugs. Empower yourself.
2. Regarding Big Pharma, keep in mind for every pill you take there are about 10-15 side effects that come with it. If most people would just take back control of their lives and make the right health choices in life they wouldn’t have to BE so dependent on these drugs that just end up throwing money down the drain along with their health. Period. Take stock of yourself, moderate and taper off your bad habits until they are diminished, and up the exercise and healthy eating and you won’t have to worry about paying so much!!
3. rk, as an individual that has worked for a medical insurance company for several years, your comment is both true and false. Mainly lacking in info. Yes, they do employ individuals that may not be fully educated in the healthcare system, but those individuals are trained to process those claims a certain way. They are not always denied due to rushing, but because management has instructed them to do so.. based on the employers decision. Because, ultimately, it’s money out of the employers pocket that is paying for your health expenses. If you sit and think about it- it’s one giant circle. You pay the group health plan discounted amount for your share on a monthly basis, your employer pays the health insurance company, the health insurance company pays the doctor, the doctor pays the government, the government pays the people (you).. and so on. They don’t want ultra smart people working that can find the loopholes in the system because it busts their ability to capitalize on the product.
4. Most insurances (if you really study your handbooks inside and out) offer a clause where if the anesthesiologist claim is denied (or most other ancillary providers, i.e., radiologists, CRNAs, laboratories, ambulance, etc.) and you call/write in to dispute it, the insurance will pay the claim at the appropriate benefit. They don’t always, but if they are good, they will. If you run into that kind of situation, you just need to submit an appeal to your insurance company (and if that doesn’t work, take it up with your employer/HR department) and they will generally go back and reprocess the claim.
5. READ YOUR HANDBOOKS. I cannot stress this enough. KNOW what you are signing up for and what will and will not be paid. If you or your family member is terminally ill, most insurances have a cap or what is called a “lifetime maximum”, which runs out after so much money- maybe 500, 10k, 1mil, etc. Know your options if this happens: go to Medicaid, Medicare (depending on your health issue and qualifications) or seek help from your local free clinic.
6. Discount Cards. If it comes to the point where you can’t afford health insurance, but absolutely need some sort of help, you can turn to discount cards. They are not insurance, and some providers don’t take them, but they usually have a listing of “preferred providers” that they work with to take off anywhere from 20-80% off the bill, if worse should come to worse. Hey… a little help is at least something, right? And in these times most need all the help they can get.
..And onacman, the reason why the U.S. doesn’t have universal healthcare is because we are a democracy and a capitalist society that makes money off of these kinds of things. Unfortunately, because of our apathy and ignorance, our country is slowly turning into a fascist monopoly. Come on people, WAKE UP!
Talking up your symptoms should only be used if you actually HAVE the symptoms. It is insurance fraud to try to get a test done just “to put your mind at ease” by using devious tactics such as is mentioned in the article. Such fraud drives up everyone else’s insurance premiums. If you want it just for putting “your mind at ease”, pay for it yourself OUT OF YOUR OWN POCKET!
How is it that bcbsnc has let Wake medical take over all claims payment out of my control and without my consent? They receive all payments directly at the hospital.
I file claims everyday to insurance companies. In network, out of network, spend down accounts, deductibles, out of pockets, co-insurance, copays, clinical reveiw, banked hours, globalized fees, monthly, annual and lifetime maxes basically all mean PATIENT RESPONSIBILITY. I’m tired of it all!! I support Obama’s Insurance Reform Bill. Personally I feel it is time for a public option. I am an RN, Too often I see what happens to people who pay their premiums thinking they have coverage just to find out they dont! It’s all a scam!!! I’m tired of paying into it! The time has come for a public option!!!
I am also in the medical billing field and I have seen and experienced this all too often! Its time for a change. The government runs medicare and the states run medical —- we need to impliment a good healthcare program!!! Its time for americans to take care of their own!!!
*1. ..”more harmful than helpful” is what I meant to say…
Does the author of this article realize that its advocating insurance fraud by telling people to lie to their doctor in order to receive free unneeded tests. People who do things like that drive up the cost of insurance for everyone.
I worked for a very large insurance company as a customer service rep. We got complaints all the time about “out of network” anesthesiologist, pathologist or radiologist. All the member had to do is call us up and say “hey look, I didn’t choose these providers the hospital did” and we can fix the claim. But a lot of providers will acutally write off the amount that is usually written off by “in network” providers and accept what the insurance pays them. The reason they don’t go “in network” is because they aren’t actual providers who see patients in an office; they read CTs or read biopsies or administer anesthesia.
its not as easy as one little phone call!!! You make it seem so simple…I worked for a specialst and I have spent many hours on the phone just trying to get a Rep. to even talk too!!! Tell me how does a sick person deal with this? You make it seem so easy, just give us a call…Yea right if after we push buttons for an hour, and then just keep on pounding on the zero, hoping to get a “live” person…any other helpfull suggestions???
roe, if you’re a provider, make sure you have the number specifically listed for the providers to call. Pressing zero or simply saying “customer service” will get you to someone. If that doesn’t work, try Google-ing for a local # for the insurance company. If all else fails:
1. You can always write to the insurance company to complain about their automated system.
2. And if they don’t respond… you can always write to the insurance commissioner to complain about the insurance company’s automated system.
However, keep in mind that if it is a large corporation, like BCBS, there is generally always a long wait on the phones.. especially on Mondays thru Wednesdays. If you can, try to call on Thursdays or Fridays as those are generally the slower days and it’s easier to get through to someone.
The insurance company I work for has a similar phone line, so yes, I have helpful suggestion:
Dial the 800 #
Enter the ID #
Hit #
Enter the DOB
Hit #
Hit 0 to avoid the remaining choices and get directly to a rep.
Providers need to put in the NPI# and patient ID#.
Nice InsuranceGirl. Although, not all automated systems are set up that way – each company is a little different. Probably best bet for the provider to actually ASK the customer service rep what buttons to push to get through to someone next time they call, and they should do this for each insurance.
Hi everyone there.Let me tell you something about this MAFIA from health care.Hope to understand me because I am european and in Europe is not like that like here.There is free emergency room plus alot of things.Here, for example, I been in emergency room and for a CT SCAN,blood test and urine test , I receive the bill home almost 6000$.After 1 week I was back there because my pain( abdominal doesn’t end and I want just to ask the docter what I have to do and they send me another 1500$ plus 600$ for the doctor.So,THIS IS MAFIA.How much they have salary? I have less then 10000$ a year.Obama want to do something for the reat of the people( poor) but the dogs from congress plus the republicans( they are reach already from 8 years BUSH) don’t live him.Check the Europe country how they survive, no selfish like here and no more example of Canada, antwhere.Hope GOD maybe gonna change something( alot of sins here, that’s way only in America are fires and hurricanes).Thank you for reading this and sorry for my english.GOD BLESS!
Alan, if people think about the article they are reading instead of just going with it, maybe they will be smart enough and have enough honesty and integrity to NOT commit fraud with their health insurance. You’re only asking for it to bite you hard in the rearend if you do. But yeah, I think the writer of this article has a lot to think about if they are going to advocate dishonesty like this.
We need to get rid of the sen/congress they are bought and paid for by the insurance companys . If they give us what we need. in health insurance they lose millions in donations from the big insurance companys. Its al about them not the people ..and the republicians are just a bunch of religious terrorists..you cant trust any of them
My husband had cancer was being treated then I lost my job and insurance he was unable to see the doctors or have any test done they were suppose to keep an eye on a few spots in his liver I couldn’t get help any where we were turned down by medicaid american cancer society couldn’t help 1 1/2 years later I was able to get insurance thru my job he had his scan and the cancer returned by then it was in his bone and brain he passed away 6 months later at the age of 59 thank you for your help
Telling people to “talk up” their symptoms to get a test paid for is bad advice. The doctor will know if the patient needs the test. By telling the doctor he/she had bleeding in the stools and pain, that person now has created a pre-existing condition that did not exist. Let’s say the same person loses his/her insurance and then tries to get a replacement policy 18 months later. In reviewing the medical records, it shows a test for colon cancer. Even if it found nothing, it doesn’t matter. The insurance company will exclude anything to do with the colon for six/twelve/eighteen/twenty four months – depending on their underwriting guidelines. Then what happens when that person develops a problem? They have no coverage. It is pretty irresponsible for you to actually encourage people to lie to their doctors to get unnecessary testing paid for. Just another example of why people should not believe everything they read.
The first part about the out of network anaesthesiologist. Do you write the letter to the anaesthesiologist or your insurance company?
Bryan, you write to your insurance company first. However, more than likely you will get a bill from the anesthesiologist, so you want to inform them that you are disputing it with the insurance. When you speak with the provider (the anesthesiologists billing department, most likely) about this issue, ask them to put your account on hold until you receive a response from the insurance provider. 9 times out of 10, the anesthesiologist will be paid and will send you an updated bill or contact you, but do remember to keep in contact with them until the claim is completely resolved.
Bryan, you write to your insurance company first. However, more than likely you will get a bill from the anesthesiologist, so you want to inform them that you are disputing it with the insurance. When you speak with the provider (the anesthesiologists billing department, most likely) about this issue, ask them to put your account on hold until you receive a response from the insurance provider. 9 times out of 10, the anesthesiologist will be paid and will send you an updated bill or contact you, but do remember to keep in contact with them until the claim is completely resolved.
I see that the insurance industry apologists are here in force. Nobody should have to read a damn guidebook to get health care, period. And what is implicit in those of you who say to “read the policies” etc. is that the insurance industry does not lie or intentionally deceive people, which they do. Sorry, but the reason we will have a major change in health care is because of insurance company abuses, plain and simple. It didn’t have to be this way.
I am a 25 year old student trying to get my degree in criminal justice and then a law degree. I have not had insurance for almost 6 years and I can’t afford to go to the doctor. I work as much as I can but my college is about 25 grand a year. I have student loans, pell grants from the gov to cover most of my college but by the time I pay the remaining tuition I have barely enough to pay my mortgage, bills and everything else. I don’t spend my money on clothes, beer or partying either like most students but I am still too broke to afford health care and insurance. I have never smoked, or anything like that so my rates should be reasonable right? No, not to me. I can’t afford 180 a month for insurance so what do i do? Hmm. When I am sick I just am sick, too bad. Oh a toothache? too bad, suffer through it until a month later I have saved money to go to the dentist & I need a root canal which costs too much. Then what? I dont know. Trying to save more money like I am doing now, just suffering in class with a terrible toothache. Can’t pay for a dentist visit with maybe 50 bucks to spare a week can you? What about a doctor visit? no, not at all. America’s health care industry and its people need help despretly. My rich friends have money but I do not. Honestly, it makes me want to cry knowing something could happen to me and I would be screwed. My mother will nothelp, infact she didnt even take me to the doctor much when I was a child, never the less, help me out now. I hope and pray that the president creates a health care system that helps the people, not one that works against us and takes our money,denies us service and is dishonest. Some people’s life could depend on it. I know one day when I get out of law school I am going to help people who need it, pro bono, people who have been done wrong by their insurance company and doctors. Maybe by then I can afford insurance if I pay off the $50,000 dollars I will ower for college plus the debt I will create going to law school at a university. I guess I will die trying at least because God knws I could’nt get to the doctor.
My insurance company is still pestering me for not paying for an operation on my dad that they said they did not cover. My dad died 12 days before this procedure was supposed to have been done.
My condolences to you. I so sorry that you are having to go through this with the insurance company.
contact your state’s insurance commissioner about this issue and provide all the documentation you can to him/her. I wish you the best of luck in getting this matter resolved. Hopefully sooner than later.
this does not support the people of america. HEALTHCARE for all.
look people both sides of the obamascare issue are full of crap! some simple changes to billing would help a great deal. if you go to a doctor or hospital for treatment or a testiong procedure the dr. or hospital/clinic should be the only one who bills you! i had to get a stress test done at a hospital, i got a bill from the hospital, a bill from a cardioligist, a bill from a lab, ect. ! i do not make enough to pay it all at once but i could make payments to one billing source but multipal payment arangements are not budgetable! i actualy have decent insurence but there is an annual deductable and co pay amounts i owe. one test one boill would help many, that would be a good regulation to have. oh and sorry to bust your bubbles but obama is not god. and guess what folks our government is not good or efficent at any thing it gets involved in! the job of the federal government is not to control our indervidual lifes. it is only to protect our nation from outside powers and referee desputes between sovern states ! the buerocrocy(sic) has grown to vast and has more power than it should have. we do not need it to grow any more powerful. if you want to embrace socialism or communisim please move to france or cuba! or any of the many other nations where the beleif is that the government knows best. in a free nation you are free to do as you want as ong as you do not harm anyone else. the lawyers , insurance companys , bankers, and politicians all force feed us the false beleif that they know what is best for us. bull crap. they are all suposed to be our servents especially the politicians. government stay out of healthcare. regulate the insurers and providers but do not insure or provide as the government!
Joe; Here is another example whose brain is stuck in first gear… and a freeloader … because if he is free to buy health insurance … if he gets sick and cannot pay… he expects the rest of us who have insurance to pay for his treatments .In France Health insurance is not free … neither it is a socialized medecine …. . but I do not weant to waste my time explaining it to a brain still stuck in first gear who is either incapable of understanding or refuse to do so because his brain has been so much brainwashed ..that repeated lies become the truth
sorry that the spelling and editing was bad in my prior coment but doing this from my phone not a computer.
When my husband had rectal bleeding he was given a sigmoidoscopy instead of a colonoscopy because insurance wouldn’t cover a colonoscopy at age 49. He was dead a year and a half later from colon cancer.
Oh yeah, and the anti-depressants I was given to help me get though his illness and death is now considered a pre-existing condition and my insurance went up to 751.00 a month. Thanks, Blue Cross.
If your husband had rectal bleeding the insurance should have covered a colonoscopy. I would seriously consider getting a lawyer and I would also write to the insurance commissioner of your state pronto.
Thanks George – but as you probably know the statute of limitations is only one year. I was so shell shocked by the whole ordeal, I was in no shape to handle it. I think it’s constructed that way.
Many of the comments made are true, but many are inaccurate. Health care is a huge problem for so many in this country. Could that be the reason the government is trying to help make a change. There is help available for those who need it, but unfortunately they do not know who to contact or where to go. They don’t have the knowledge or are too embarassed to ask for help. Fixing the problems with the system will not be an easy one–one type of help will not fit all.
I had surgery for atrial fib and flutter. I went to the only hospital in my state that could do both fib and flutter. I went in on a Wednesday morning at 6 a.m. and was released on Thursday afternoon about 1 p.m. The insurance company paid all but $7,000 saying that I was an outpatient and had to stay in the hospital more than 24 hours to qualify as an inpatient. It took me one and a half years of calling the hospital to get a copy of my admission and exit time in the hospital. I finally sent a certified letter to the physician asking for a verification that I was treated as an inpatient. After all this time the insurance company finally paid the entire bill. If I had been back to work during this time, I would not have had the time to pursue this case as I did. Perserverance paid off to the tune of $7,000. I feel sorry for all of the people who would not know what to do about it or else would not have the time to pursue it due to working.
OK, I know that I am about to get crucified here. But what ever happened to TAKE CHARGE OF YOUR OWN HEALTH… DUH! It is your God given body to maintain. It is your responsibility, not your doctor’s or insurance company’s. People, in general, eat way too much processed crap, soda, and fast food coupled with inactivity and laziness, then they wonder why they have chronic health issues. Also, we have manufacturers and non-organic farmers polluting our living environments contributing to health problems. When will we make the people responsible for bad health responsible for the high cost of bad health? We don’t need to put more money into “healthcare” which profits off from illness. We need to put the money into true health education… not sponsored by junk food manufacturers and drug companies who profit from from our ill-health. People… take charge of your own health!! Quit looking to an outside source that stands to make a profit by selling you a diet, a pill, a plan, a test to make you well. Stop watching TV ads and eat foods as close to natural as you can … and seriously question the drugs and procedures the medical establishment recommends for your health. Lastly, please advocate protection of the environment … make the companies who release the poisons into our world (and turn a profit in the process) responsible for cleaning up our world. We don’t need MORE healthcare … we need more HEALTH!
Well Julie, I guess you pass judgement on other people’s health habits when you don’t know a thing about them. My husband ate very healthy had been given a through?!? physical just months before his diagnosis.
You can do everything right and still get cancer.
probably the most sain thing I have read all day…Why cant more people use simple commen sense
Julie. I beg to differ with you. Bodies wear out, get sick, have accidents. Taking over your own health care (for most people) is never gonna happen. Nothing will change. The Insurance companies are the richest companies in the world, followed closely by big oil, and Oh yeah, the banks fit in there somewhere. You realy think they will go away quietly or gracefully? Don’t bet on it kiddo.
It’s funny reading all of these comments/suggestions like: “contact this person” “contact that person” “sue him” “sue them” “fake this” “manipulate that” etc. In Canada (along with other ALLIED countries like Britain, Germany, etc) we DON’T have to jump through ANY hoops to get results.
Universal Health Care is really simple. You get sick or injured; you go to the hospital; you get better. I have an American friend who will say “I got the bill from the hospital that delivered my newborn baby, and it’s $25,000. How much does it cost to have a baby [out of pocket] in Canada?” Nothing.
So much to digest her; just three quick observations:
1) I keep reading about Canadians coming to the U.S, for healthcare. The UCLA Center for Health Policy notes that millions of Americans — including one million from California each year, many with insurance — go to Mexico for cheaper and good quality surgeries, dentistry and pharmaceuticals.
2) People who throw around words like socialists healthcare really need to return to 8th grade history to understand the true definitions of socialism and communism and fascism (I guess that policeman who protects you is also a product of socialism: shared costs for one department regardless of income.
C) Latest report: average insurance premiums will double in ten years, far outstripping inflation and income increases. And you want more of the same?
The author of this article, its editor and its publisher should all be ashamed to print “Secret #1″ If a test is medically unnecessary and you just want it to “put your mind at ease,” then you should pay for it. Telling readers to LIE to their physicians to get the test is unethical, immoral and one of a hundred reasons why medical care costs in this country are out of control. As a health writer, you should know better.
“Don’t do anything over the phone. It takes forever and when you’re done there’s no record of it, so it didn’t happen,”
I got bit by this one yrs ago when I had a bad cycling accident on a Sunday. I called the 800 # on my ins card & they told me to go to X hospital, get checked out & have them call back w/results. ER diagnosed me w/a broken collarbone & an AC separation but when the hospital called them back they basically said:
“WHO showed up to be treated for WHAT? we have no record of this! this isn’t pre-autorized! he’s on his own!”
& I got stuck w/a $1K ER bill! normally I would have known better than to trust them/done it in writing but when you’ve just gone over your handlebars @ 20 MPH, can’t lift your arm above parallel to ground & are 3 mi from home w/a wrecked bicycle it’s not the 1st thing to cross your mind…
they deserve what they have coming…
The advice to “always ask your doctor for generics” is foolish in the extreme. Many medications CAN safely be prescribed in the generic form but many others CANNOT! I asked my new physician to prescribe the brand name of my long-time medication because the generic didn’t work very well. She impressed me with her knowledge that in my case the generic was NOT as good as the brand name! BE VERY CAREFUL with generic medications. When you renew your medications make sure you are getting the same medication you always have because in certain cases pharmacists can SWITCH to the generic and they do not always remember to give you the information! Look at your new pills and make sure they are the same color, size, shape, have the name stamped information, unless your physician has changed the dosage. You can always check with your physician’s office to make sure you are taking the right pills/medication. (I always take my new eyeglasses back to my ophthalmologist/optician to verify the prescription was filled correctly. One pair, manufactured by a large national chain, seriously mismeasured my pupil distance and the glasses were making me nauseous!)
I’m an independent contractor and I can’t get insurance, because I have a pre-existing condition.
My comment is going to upset a lot of people.
How did we (as a human race) ever grow our population into the “billions” over the eons that we walked the earth? Medical insurance didn’t exist until recently (relatively speaking). Humans are the only species on earth that have medical insurance (unless we buy it for our pets).
We are all just “peas in the pod”. When an ant dies, the colony pushes him aside and keeps working. When any of us die, at age 30 or 100, the human race as a whole hardly feels it.
The insurance industry is sickeningly corrupt, just like the legal industry, real estate industry, banking industry, and the proverbial “used car salesman”. i.e., There are ethical AND corrupt people everywhere in life. Someone earlier in this forum stated “buyer beware”. And that is simply what it all boils down to.
I think the American public should boycott the insurance industry and “take their chances”. I am 58 years old, out of work, and on the verge of having to sell my house. Age discrimination is a reality!! But I am blessed with relatively good health, there is no history of cancer in my family and my parents never set foot in a hospital until their lives were nearly over. I am blessed with good genes.
So it is easy for me to advocate a “boycott” of the industry. And I am a hypocrite because I am struggling to pay for my COBRA provided coverage. Hell, if a reasonable option is there, I will take it.
But when my 18 months of COBRA run out, I will be 60 and can’t get on Medicaid until 65. I just might have to go uninsured ( because I have a mild,non-critical blockage in one artery, which the insurance companies categorize as heart disease. But I can walk for miles, run a mile or so, etc. I am also on Lipitor for cholesterol because heart failure took my mom out in her late seventies). And if I die at 62 for lack of treatment, the rest of the ants can push me aside. LIFE goes on !!
We are NOT all created equal. Some are born with birth defects. Some of us succomb to cancer or alcoholism, or other infectious disease. Some die in infancy and some live to 100. Some are born with a silver spoon in their mouths. Others find a rusty fork up their butts.
Bottom line? With or without medical insurance, the human race will prevail…unless of course we annihilate ourselves in a nuclear holocaust. Did I hear someone say….DINOSAUR??
Wondering if someone can help me out with this one…
My mother currently has health care insurance, but also recently started to recieve medicare. I wanted to put those two together and save around 500$ a month. However the health incurance company denied her because the paper work was submitted a month too late. If it had been submitted on time she would have been automatically accepted. That was due to the run around the health insurance company had given me by transfering me from department to department, and promising calls back. It took me a while to finally reach someone who was in the right department. It seems they themselfs didnt know where to begin. Any help would be greatly appreciated.
Medical Insurance Guidelines/Laws vary from state to state. Actually, when it comes to medical insurance we are all in the same state….CONFUSION!
Each state has an office that would regulate the insurance companies operating in the state.
If you have documented call dates and names of who you spoke with (or even if not), try to call the insurance commission for your state.
No guarantees, but it is worth a shot. Good luck.
To Dr. P, John Smith, Joe, Walter Pemican, Betty and BM: Each of you has an erroneous understanding of what the words “talk up” mean. To “talk up” is to “promote, discuss enthusiastically, speak openly or speak without hesitation.” Get it? The author never said anything about lying and never implied fraud; that allegation came from the six of you! To so casually and drastically distort the meaning of a very common term in the English language reveals your agenda as well as your inability to read for comprehension or offer factual evidence. So typical.