This message was self-deleted by its author

[eek MD]

This message was self-deleted by its author (eek MD) on Sat Jun 23, 2012, 04:09 PM. When the original post in a discussion thread is self-deleted, the entire discussion thread is automatically locked so new replies cannot be posted.

[WingDinger]

1. When you give up, they win, and that is how they intended it.

I got insurance, then got hurt. They said since it is the first claim, they wanted all kinds of info. They were out of state, just like the Rethugs intend. So, you have an interstate fight with them. The only difference is, I was broke, and could not pay for it all. Then, when the lawyer settled the case, they offered each creditor a chunk. Most refused, as they get more from the tax writeoff. So, they likely sold the debt to debtcollectors. Collected on the writeoff, if not more, and didnt pay the original claim.

[HiPointDem]

4. so basically, health care is set up to reward finance capital.

[WingDinger]

5. Insurance is a tax scam for large corps.

They inflate their losses. Write it off. Pound the providers to lower costs, and sock it to those without the insurance advocate to fight for them. They usually pay little, you pay the real bill in copays, and they dance.

[eek MD]

7. That's what it seems like....

I've been paying premiums for the last... Oh....14 years now without a single claim. Then I finally actually NEED something, and have to pay for it all anyway. Suffice to say, I'm a bit pissy about it all.

[forthemiddle]

14. Have you actually submitted the bills to your primary insurance?

Most of the time, they will go ahead and pay it, if it is submitted properly and then receive a refund after Workman's Comp pays.
Is this insurance through your employer? If it is, go directly to your HR department and get them involved.

If you have tried all those avenues, just keep what you are doing, and hope it sorts itself out. But make yourself a pest. Call Workman's Comp once a week, call your insurance once a week, demand to know who is taking care of your claim. But the number one thing to do is make sure the claim has been submitted to your primary insurance ASAP (even if you are expecting a rejection).

Another problem you could run into, is if the claim isn't submitted but then a year or two down the road it is determined they are liable, they can, under the law, reduce payment because it was submitted so late. Some insurances start deducting 50% at the one year mark, and go up to 100% by the 18 month mark. So by the time liability is established the time may have run out. If on the other hand you at least have the initial claim submitted within that time frame, it shouldn't be a problem.

When you sign the paperwork authorizing the surgery it stated that regardless of third party liability, you are the one that is receiving the treatment, and you are the one responsible for the bill. Hindsight is of course 20/20, but you should have received confirmation of the claim from WC before having the surgery.

[elleng]

2. Very sorry.

We really do have to understand our insurance coverage, to our best ability. NOT easy! Try reading their manuals some time, but it is our responsibility.

[russspeakeasy]

3. It is a "rotten to the core" industry.

Claims processors are trained to deny all claims at least 3 times.
Someone who has more recent experience with the claims procedure/training can probably shed some more light on the latest training techniques, but it would not surprise me if it is still the same.
"DO NOT PAY, THEY'LL GO AWAY".

[Lurks Often]

11. Utter Bullshit

Provide a respectable source for your absurd "Claims processors are trained to deny all claims at least 3 times" nonsense.

I spent 18 months as a customer service rep and me and my workers worked our asses off doing our best to make sure claims got paid and paid promptly.

[Autumn]

6. Wouldn't it be wonderful if our politicians hated the

insurance companies too?

I'm sorry you are going through that. They are all heartless bastards.

[pinto]

8. Sorry to hear how you got caught in the cracks of systems coverage.

Looks like, yeah, it was a worker's comp case from the get go. Private insurance, as well as Medicare, will routinely look to worker's comp as a first payer in work related cases.

Maybe you could follow up with your employee rep, or a worker's comp rep (your employer probably sub-contracts the coverage to a group coverage plan) for some compensation. A lot of it is the "small print" stuff and, as you've found, paperwork, paperwork.

File any and all documentation you have for the record.

Hang in there.

[Odin2005]

9. Insurance is like loaning out an umbrella...

...and then demanding it back with interest when it starts raining.

They make their money by DENYING coverage.

[Ruby the Liberal]

10. Yes, that is how it works.

Everyone wants to put the onus on the other guy to pay, and Workers Comp involvement just turns the whole thing into a giant nightmare.

Your state has an oversight office for Insurance that is responsible for the regulation of every insurance company that is licensed to do business in your state. Call them (or your State house rep) and talk with them about this. They may be able to intervene and assist. Noting that this HAS to be done through the state - there is no federal oversight on insurance.

Good luck to you. I truly hate to hear stories like this.

[Egalitarian Thug]

12. This is the game they've always played, deny, delay, refuse to pay. The entire industry should

be outlawed.

We went through some cancer over the last couple of years. For the first 14 - 15 months Aetna approved PET scans every few months, first to nail the cancer down, then to make sure we got it all and that it wasn't back or popping up somewhere else. Then for no medical reason at all, they start denying them and want the doctor to use CT scans which are cheaper, but useless in this case. It wasn't until the credible threats of legal action that the test was approved again. Now we have to go through this dance every 6 months.

It is no consolation, but unless you are willing to devote yourself to a whole new career as an insurance billing expert, there is little you can do but what you're doing/have done.

[eek MD]

16. I can understand that to a point.....

If a bill is clearly supposed to ultimately be the responsibility of another entity, they're going to do everything possible to avoid paying it. The problem arises when they decide to squabble over who is responsible for paying a particular bill. The one that ends up getting stuck with it is inevitably the person without the huge team of legal resources behind them.

I'm sorry to hear about your story! Funny how when it begins to be a big drain on their bottom line they suddenly decide to start denying the claims....

Makes me wish I lived in one of those countries with a true universal health care system.

[Lurks Often]

13. That is standard

work related injuries are supposed to be covered under Workman's Comp.

Just as Medicare eligible claims need to go through Medicare before being paid by the supplemental insurance.

The health insurance company probably should not have told you to proceed with the surgery with out the letter.

You may want to speak with your HR department, your employer should be able to speed things along, failing that contacting what ever state agency oversees insurance would be the next step.

[lpbk2713]

15. Honesty is a one way street for insurance cos.

Sorry you had to pay the penalty to find that out.

[eek MD]

17. I think I've received enough answers to know that I've pretty much done everything right so far...

I'm going to delete the OP because it contains some information which is a bit personal for an open forum. Thanks for your help everyone!