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Thread: My Insurance Company Should Jump Off A Very High Cliff

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    Default My Insurance Company Should Jump Off A Very High Cliff

    Because I got my recent CT scan preauthorized as medically necessary, and they still denied the claim.

    I had my doctor's office send supporting justification for the scan, and they denied it again.

    I am counting the seconds until I can get back on the phone with them. The sad thing is, I have had lots of claims denied, and I always win when I challenge them, but it often takes a lot of work, time, and heavy reliance on my legal skills. What happens to all the people who get claims denied who don't have the resources/time/threat of lawsuits that I have to get the decision overturned? I feel like a lot of chronically ill people are probably getting screwed over.

    Gross.

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    Quote Originally Posted by Derrie View Post
    Because I got my recent CT scan preauthorized as medically necessary, and they still denied the claim.

    I had my doctor's office send supporting justification for the scan, and they denied it again.

    I am counting the seconds until I can get back on the phone with them. The sad thing is, I have had lots of claims denied, and I always win when I challenge them, but it often takes a lot of work, time, and heavy reliance on my legal skills. What happens to all the people who get claims denied who don't have the resources/time/threat of lawsuits that I have to get the decision overturned? I feel like a lot of chronically ill people are probably getting screwed over.Gross.
    Not sure what you do for a living, but you having legal skills might open up possibilities for you to help people.

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    Quote Originally Posted by Manderson View Post
    Not sure what you do for a living, but you having legal skills might open up possibilities for you to help people.
    I'm a lawyer. My practice area is not at all related to healthcare law, but the more I deal with insurance companies and our broken healthcare system here in the U.S., the more I think that in the future I may branch out. Reading stories like those of Jennifer Jaff, an advocate for chronically ill people who recently died (see http://www.nytimes.com/2012/09/24/he...ies-at-55.html) are really inspiring. She wrote a fantastic amicus ("friend of the court") brief in the recent Supreme Court Affordable Care Act case.

    But I digress. Little does my insurance company know that by messing with me, they are helping to train THEIR WORST ENEMY.

    Sorry, guys, I am just pissed today. Denying a prior-authorized claim is ridiculous. What is the point of prior authorization if the claim gets denied anyway?! Jerks.

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    But I digress. Little does my insurance company know that by messing with me, they are helping to train THEIR WORST ENEMY.

    Yep!

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    I can totally relate..I am a nurse practitioner and having to navigate the medical/insurance maze is challenging to me, and I always think "How would a non-medical person even know where to begin?" It is a broken, nightmarish system. It's hard to be ill and spend precious energy fighting the system. Good luck!

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    You get em girl!!!
    Mari

    Success is not final, failure is not fatal: it is the courage to continue that counts.

    ~Winston Churchill~







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    I agree with Mari. Go get 'em!

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    My mother is going through insurance battles all the time for me, because it all goes over my head. To make a long story short, because my brothers TWO insurances only covered one of their dentist visits six months ago I can not be seen for my Sjogrens because there is a balance on the account. It was for a routine cleaning, and they covered one of my brothers and not the other even though they both have the same two insurances, and both were seen on the same day. Makes sense right?
    "A bad cold wouldn't be so annoying if it weren't for the advice of our friends."~ Kin Hubbard

    Diagnosed: SLE, Raynauds, Interstitial Lung Disease, GERD, Myositis, Vasculitis, Fibromyalgia, Possible Sjogrens.
    Medications: 400mg Plaquenil, 2000mg Cellcept, 60mg Nifedipine, Nitroglycerin Patch, 20mg Prilosec, Trazadone, 8mg Medrol, 81mg Asprin.

    My old profile on here http://forum.wehavelupus.com/member.php?22042-ritzbit

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    Some of these companies seem to deny initially, knowing full-well that they're in the wrong, knowing that there's probably more than a few of the folks that are denied that won't know to try to "fight" them - if they even pay attention to their records... scandalous, really. I've had it happen with my "big-name" medical insurance, and thankfully, it just takes a phone call. But that's a phone call I shouldn't *have* to make...
    "There but for the grace of God, go I."
    "... His mercy endureth for ever."

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    Yes, I've had it happen a couple of times and wound up paying for CT scans out-of-pocket when we had an HMO in Texas.
    With the PPO that we have now, there is so much out-of-pocket deductible that I've just refused to get any more MRIs or CT scans.
    And to think, I have what is considered "good" insurance that is for government employees (my hubby).
    It is a very broken healthcare system.
    Hugs,
    Marla

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