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Topic: More insurance chit (Read 248 times) |
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Lizzie2
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More insurance chit
« on: Sep 7th, 2004, 6:46pm » |
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How is it that I run into all the ways the insurance company can manage to screw you over? Sheeeeeesh
I'm not even on Aetna anymore!! Now I'm on a PPO blue cross plan...it's a good plan, really. I've been using it for as long as I can remember. Anyhow...what I found out today is that the headache center is no longer in-network for them. They are still a provider, but now I have to meet a $300 deductible before they will pay the same way they always did. The headache center apparently "changed their status" as of 7/28/04. Glad they informed the rest of us!
And then the kicker. I got a letter from Aetna saying that they paid for my 8/5/04 Amerge prescription for 18 tabs, but since they cancelled me on 7/31/04, I either have to have the pharmacy remove the charge and bill my current insurance, or I have to pay Aetna $311 or something like that.
So I took the letter I got to the pharmacy. The pharmacist even worried about trying to mess with this as it is over 1 month past the date it was filled, but...he decided to mess with it anyways. He removed the charge from Aetna, but since it was past a month since I got it filled, Blue Cross wouldn't accept it. That's just lovely. So he said instead of owing Aetna $311, I now owe Eckerd Drugs $434.49. Well, I didn't have my checkbook on me, and I don't have that kind of money on my debit card, so I went ahead and left and got my checkbook and went back and paid it.
The pharmacist told me I should have no problem getting Blue Cross to reimburse me. I told him he's wrong. First off, the script was for 18 tabs...Blue Cross only allows 9. Sure, I can get my doc to write a letter of medical necessity, but that will greatly prolong the date at which I will see the money reimbursed to me. And secondly, the insurance company will pay me what they would have paid Eckerd for the script. That would not be $434.49! That will be more like...$100. So basically, I'm eating that money because everyone else screwed up.
Once again, the insurance company, doctors, and pharmacies screwed up and I have to pay. I told him even if they gave me all of it back 5 months from now, that's not going to help me pay for groceries now!
So now I pay blue cross $340 a month for cobra, plus $300 deductible for my neuro and $434.49 for my f-ing Amerge prescription from last month. Ahhhhhhhhhhhh someone please tell me who I can kill or sue???? They shouldn't be allowed to do this. 
I'm moving to Europe.
Lizzie
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Lizzie2
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Re: More insurance chit
« Reply #1 on: Sep 7th, 2004, 9:04pm » |
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Update:
My dad said that I shouldn't have done anything when getting the Aetna bill for the Amerge because they are the ones who messed up my insurance anyways by cancelling me and then paying for the Amerge after they had cancelled me.
However, they send it to collections. So...not pay and go to jail? Or pay and get screwed over.. hmmm toughie!
So then he said I shouldn't have paid Eckerd..but that doesn't help too much because I still need other scripts from them! They'd get me somehow. He says I should stop payment on the check I gave them. Hahaha
Tomorrow I am taking my next Amerge script to Eckerd so that they can reject half of it, and then I can get my neuro's office to write a letter of medical necessity to get all 18 covered. They'll have to date it before 8/5/04 I guess! Then when I try to get reimbursed for the 18 I just paid for out of pocket, hopefully they will accept all 18 and not reject it at 9.
Anyone else have any really bright ideas on this one??
Thanks!
Lizzie 
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IndianaJohn
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Re: More insurance chit
« Reply #2 on: Sep 7th, 2004, 9:19pm » |
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Wow L2, that's awful. The only thing I can think to do would be to contact your state insurance commission and file a complaint.  Most states have an online way of filing.
So sorry that you have to deal with this crap on top of CH 
Best of Luck!
John
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Did my brains fall out or is this headache over?
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Gator
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Re: More insurance chit
« Reply #3 on: Sep 7th, 2004, 9:22pm » |
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First, send a nicely wrapped package bomb to the person at the insurance company in charge of denying claims. With that fucker dead, you send a letter to his replacement saying he could be next if he denied another claim. Since they routinely deny hundreds or thousands of claims a week, they will have a long list of suspects. Always wear gloves from the time you purchase the materials to the time you mail the packages and be sure to mail the packages and letters from out of state.
Hey, I can dream, right?
Gator
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Lizzie2
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Re: More insurance chit
« Reply #4 on: Sep 7th, 2004, 9:22pm » |
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Thanks John for reminding me of that. I have the state commissioner site bookmarked from the last time I ran into insurance BS...which was very recently! Because I switched over from one insurance to another, I wound up not contacting them, though. I should do that for this one!!! This insurance stuff is really the only thing I get stressed out over. I don't ever get stressed about school. Only insurance and all this other health care crap!! Oy...
Lizzie
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Lizzie2
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Re: More insurance chit
« Reply #5 on: Sep 7th, 2004, 9:25pm » |
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on Sep 7th, 2004, 9:22pm, Gator wrote:First, send a nicely wrapped package bomb to the person at the insurance company in charge of denying claims. With that fucker dead, you send a letter to his replacement saying he could be next if he denied another claim. Since they routinely deny hundreds or thousands of claims a week, they will have a long list of suspects. Always wear gloves from the time you purchase the materials to the time you mail the packages and be sure to mail the packages and letters from out of state.
Hey, I can dream, right?
Gator
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http://www.emporis.com/en/wm/bu/?id=117949
Here ya go!! This is about 9 blocks from where I live...
Shhhhhhhh that wasn't out loud!!!! LOL
I just wish there was a way to get them to pay like...emotional damages for all they do!! LOL ACtually, Aetna is more the problem for me than Blue Cross at this point!!
*edited cuz I forgot to post the link!*
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| « Last Edit: Sep 7th, 2004, 9:25pm by Lizzie2 » |
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Gator
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Re: More insurance chit
« Reply #6 on: Sep 7th, 2004, 9:29pm » |
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I have my own darker fantasies of the pain I would like to inflict on these not a very nice persons, especially Aetna. Dying is too quick an out for them, they must know the suffering they have caused, even feel it....
Ooops. This isn't my diary. Sorry.
Nevermind
Gator
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Lizzie2
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Re: More insurance chit
« Reply #7 on: Sep 7th, 2004, 9:32pm » |
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on Sep 7th, 2004, 9:29pm, Gator wrote:I have my own darker fantasies of the pain I would like to inflict on these not a very nice persons, especially Aetna. Dying is too quick an out for them, they must know the suffering they have caused, even feel it....
Ooops. This isn't my diary. Sorry.
Nevermind
Gator
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Awww Gator, I hear ya!! I think Aetna almost caused me a heart attack or a nervous breakdown or something. That was a few weeks ago when everything kept falling apart at once!!!
Did you read my post on "Try this one on for size!"? Teri Robert (headaches.about.com) actually contacted Aetna today and to give them a chance to explain themselves before she publishes negative info on them in her book she is writing.
Little steps at a time..we will tear down the health care monopoly/mess in America!
Lizzie
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Charlie
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Re: More insurance chit
« Reply #8 on: Sep 7th, 2004, 10:31pm » |
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Dunno. One good thing to try is sending multiple grievances. Sometimes they are on the backs of the paperwork. I got one bill fixed that way anyway.
I pay Community Blue $250 a month through my Chamber of Commerce. My dentist told me to join....about $140 a year and I'm told my BC is a bit cheaper. Pretty good so far but they can be shitty with my "formularies" there's con if I ever heard one.
Charlie 
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Cerberus
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Re: More insurance chit
« Reply #9 on: Sep 8th, 2004, 12:54am » |
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High priced pharmaceuticals got you down?
Having trouble with insurance? Ex-lover or spouse giving you the blues? Or Maybe your bosses at work are getting on your last nerve...Well, frett no more.
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Ramon
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| « Last Edit: Sep 8th, 2004, 12:59am by Cerberus » |
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Lizzie2
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Re: More insurance chit
« Reply #10 on: Sep 8th, 2004, 3:22pm » |
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Well I contacted the office manager at the headache center today. He informed me that this is a BCBS way to "save" money. NICE!!! Jefferson never changed their status with Personal Choice. He told me a similar story which happened to his daughter, so I decided to call bcbs back up!
The guy asked me the date of the claim, and I said 8/10/04. He asked me to hold on, and then he said, "Looks like this was charged to your deductible as an out-of-network claim, but I see your doctor is in-network. Can you hold on a minute while I put this claim through again?" SURE!!!
Me - 1, BCBS - one less but still 10,000
So then I worked on that Amerge business from yesterday. Ran into more brick walls. Still trying to think of ideas and ways so that somebody pays me that money!! Well....by the time I got of the phone with Aetna I felt like:
Me: negative 1, Aetna - 10,001.
Bah... Well I won't give up this fight..or I'll die trying!
Lizzie
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ozzy
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Re: More insurance chit
« Reply #11 on: Sep 8th, 2004, 4:44pm » |
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Liz,
On principle, I *never* pay anything that the insurance company screws up, *never*. As soon as I receive a bill from a Doctor or even the insurnce explanation of benefits, saying it was out of networ/not a provider/place is located in Mars-therefore not in-network, whatever. I call them, ask what the problem is and then call the doctor, and then back to the insurance, etc until it is solved. In some cases thsi has been going on for over a year, but every time a have resolution. Don't let them scare you with "collections" tactics. Besides 9 out 10 if you let them know that you're working on it with the involved parties, they note it and move on...
Ozzy
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| « Last Edit: Sep 8th, 2004, 4:46pm by ozzy » |
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floridian
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Lizzy,
the Blue Cross rules are so complex that most of the people at the phone center don't really know what the right answer is. It takes over a year to get fully trained (class room and on the job training) and turn over is high because salaries are low compared to the stress. Add to that the fact that the rules are constantly changing. Don't give up - with persistence, you can fix this.
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Lizzie2
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Re: More insurance chit
« Reply #13 on: Sep 8th, 2004, 11:39pm » |
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on Sep 8th, 2004, 4:53pm, floridian wrote:Lizzy,
the Blue Cross rules are so complex that most of the people at the phone center don't really know what the right answer is. It takes over a year to get fully trained (class room and on the job training) and turn over is high because salaries are low compared to the stress. Add to that the fact that the rules are constantly changing. Don't give up - with persistence, you can fix this. |
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Couldn't agree with you more, there! I had to go to the blue cross building on 19th and Market today to get a form for reimbursement of my Amerge. Well, first off as I was walking by all the employees from the building, I kept wondering how many I may have spoken to on the phone over the years. LOL I flipped my Jefferson ID around. No need to advertise that I'm the annoying patient who costs them a lot of money!! LOL
So I told the woman at the reception desk that I paid a script out of pocket and needed a claims reimbursement form. She was very nice and got the form. In return, I was nice to her because she was nice to me. hehe Well I didn't even look at the form which she folded and put into an envelope. Then later on this evening I notice it is a form for out of network claims. <sigh>
Guess I'll have to make another trip down there to get another form! They mail the forms to my permanent address which doesn't help me here in Philly!
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tsayswhy
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Re: More insurance chit
« Reply #14 on: Sep 9th, 2004, 2:25am » |
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Hello Liz
Seen this post and had to respond. I know things are a little different over the boarder but I am going thought the same thing. My insurance plan from work will not cover my prescriptions from imitrex as of right now until they receive a letter from my doctor explaining why any one would use imitrex more then twice a week. Well I was getting 3-4 hits a day 2 shots a day that’s 14 a week and 700.00 dollars later still waiting for a check.
Then my sick benefits letter came in and this is what it said a long with a bunch of other bs stuff ….the maximum normal recovery period is 3 days  and while we do not disagree that you may be experiencing some symptomatology (what ever that means) as a result to your condition however there is no indication that such symptoms are of that nature of severity to render your short term disability benefits. Talk about getting mad. It’s not about the money anymore. I am so mad at how they type the letter I guess we are full of it and cluster really don’t hurt all that bad I sent them everything they wanted including the ouch brochure on clusters. Still fighting that one too!! Your right they shouldn't be allowed to do this
tari
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