Insurance Angst
This has been going on for us for three years now since my husband was diagnosed with colon cancer. In the beginning, Anthem (then Blue Cross) refused to pay for the Avastin in my husband's chemotherapy regimen. That was a BIG problem and our bills ran up to $100,000 before the issue was resolved in our favor through an appeal to PERS (we lost in the Blue Cross/Anthem in-house appeal which preceded the PERS appeal). Then the problem was coverage for a $75 per month blood test our oncologist uses to monitor my husband for recurrence. With some regularity, there are problems with coverage for CT and PET scans. Now, it is something else.
I think I'm a fairly intelligent person, but the insurance representatives with whom I have to deal, play such purposeful games in an effort to deny coverage and discourage me from pursuing claims that it infuriates me. It is almost like they are selecting from a menu of possible off-putting answers:
a) We can't pay because we need more (and more and more) medical records. (This happens repeatedly despite the fact that they have paid for the same procedure before and after the date of the service in question. That was the case today.) Each time they need more records, more and more time passes before payment is finally made to the doctors, hospitals, labs, etc. that provide service to my husband. We suffer the anxiety of seeing our bills mount and our providers, understandably, are anxious for payment.
b) We can't pay because the arcane coding on the claim is incorrect.
c) We can't pay because the procedure was not pre-approved (although I have the pre-approval letter in my hand when I'm talking to them!)
d)We can't pay because our dog ate your claim papers (OK. I made that one up!)
Today, I was told that a 13-month-old bill couldn't be paid because one part of the three part bill was under review. When I (once again) asked that the bill be split to permit payment for the undisputed services, I was told that it would take 10 days to achieve. Did I mention that I originally requested that the bill be split on August 31? Later, when I called the lab involved in this dispute and asked if they could simply re-bill the services (separating the disputed test from the other tests that are not disputed), I was told that Anthem would deny the re-billing as a duplicate billing. Talk about a Catch 22.
Here is an article about the abusive practices of the insurance companies in my state. Our insurance company denies more than 27% of the claims submitted to them.
Link
The last three years (since my husband's diagnosis) have been devastating for me. I can't tell you how much time I have had to spend dealing with insurance coverage issues. That is, of course, time I could have been spending caring for my husband.
Why am I writing this? I know that you can't solve my problem, but I guess I would like a sympathetic ear. It is cathartic. I have been reduced to tears about my husband's health. I don't need to be reduced to tears about our insurance (non) coverage.
Hatshepsut
Comments
-
I thought
I thought doctors/hospitals/nursing homes were supposed to handle such insurance problems. I've handled a few minor problems with my insurance (not PERS) and also a few on my mother's behalf (Ohio PERS system with insurer Aetna), but mostly local health providers have insurance expertise enough not to offer services unless they know in advance that insurers will pay. It's only when things go awry for some reason that I've had to become personally involved with insurance people. So I just wonder what's wrong with your doctors' office staff procedures that forces you to go through all this.
--Greg0 -
The Politics of Insurance
Hi Hatshepsut
You've got a sympathetic ear right here, honey
That is alot for you to be going through - and I agree it must some kind of game and they must be paid for what they don't pay - we can't get a total handle on everything either.
We've got payments set up to several hospitals and facilities, some scheduled for more than 3 years to try and pay.
There are untold thousands of dollars owed and I just can't keep the fires put out quick enough - I just pay what I can every month and the people that work with us, get the money.
You are a brave and courageous lady and I've loved reading your posts - you have a style that is so unique and you are quite analytical - I'm sad you are both going through this, and I now have learned another side of you - one that tells me that you hurt too and are not immune to the feelings that we all have - just like you told me in my surgery post the other night.
I had a nurse tell me one time - "Craig, don't worry about the bills, you just worry about getting better." I bit my tongue but I thought "what planet are you on lady?"
I can't pay the bills, it all goes away very quickly - sadly, many people even in the medical profession just do not get it.
It is sad that we have to concern ourselves with this when our goal should be the fight - but Life does not work this way it seems. With all that we have to pay in premiums, deductibles, and co-pays, you think it would be easier.
It's a game to them...but not to us.
I'm on your side - I'm glad you could unload some of this tonight. I'm sorry they are making it rough.
I enjoyed your perspective on my post - say Hi to Misty for me
-Craig0 -
Cadillacs and EdselsPGLGreg said:I thought
I thought doctors/hospitals/nursing homes were supposed to handle such insurance problems. I've handled a few minor problems with my insurance (not PERS) and also a few on my mother's behalf (Ohio PERS system with insurer Aetna), but mostly local health providers have insurance expertise enough not to offer services unless they know in advance that insurers will pay. It's only when things go awry for some reason that I've had to become personally involved with insurance people. So I just wonder what's wrong with your doctors' office staff procedures that forces you to go through all this.
--Greg
Sundance:
Thank you for your words of support and for your continuing kindness.
PGLGreg:
Long ago, I learned the folly of trying to define the life experiences of others exclusively through the narrow prism of my own life experiences.
That said, I'm glad that your experience with your insurance company (and your mother's insurance company) has been good. It must be a real relief for your family not to have to fight money/insurance issues at the same time you are fighting cancer. Would that that had been the case for us.
Unfortunately, our experience has been dramatically different from your experience. Judging from existing research, the news and the link I posted, too many Americans are (unfortunately) experiencing coverage gaps, rescission of their policies, and insurance malpractice more similar to our experience than to your experience. However we deal with insurance reform, these kinds of insurance practices need to end.
My husband receives his care at a major California cancer center. My family's coverage issues are not (as you speculate) confined to one office staff. We have had problems with coverage of bills for our oncologist, our radiologist, our medical lab, our hospital and on and on. Our problems cannot by any means be blamed upon one office's inept staff (our's wasn't inept, by the way). To give one example, Anthem's issue with Avastin coverage was not about pre-authorization; they flat-out refused to cover Avastin for my husband's stage IV colon cancer. Go figure!
I remember being asked by a nurse when my husband was first diagnosed if we had good insurance. I told her we had a cadillac of a plan. We had never had insurance coverage issues and, naively, I believed that to be true.
My cautionary tale to you: Never think it can't happen to you. It can.
Hatshepsut0 -
InsuranceHatshepsut said:Cadillacs and Edsels
Sundance:
Thank you for your words of support and for your continuing kindness.
PGLGreg:
Long ago, I learned the folly of trying to define the life experiences of others exclusively through the narrow prism of my own life experiences.
That said, I'm glad that your experience with your insurance company (and your mother's insurance company) has been good. It must be a real relief for your family not to have to fight money/insurance issues at the same time you are fighting cancer. Would that that had been the case for us.
Unfortunately, our experience has been dramatically different from your experience. Judging from existing research, the news and the link I posted, too many Americans are (unfortunately) experiencing coverage gaps, rescission of their policies, and insurance malpractice more similar to our experience than to your experience. However we deal with insurance reform, these kinds of insurance practices need to end.
My husband receives his care at a major California cancer center. My family's coverage issues are not (as you speculate) confined to one office staff. We have had problems with coverage of bills for our oncologist, our radiologist, our medical lab, our hospital and on and on. Our problems cannot by any means be blamed upon one office's inept staff (our's wasn't inept, by the way). To give one example, Anthem's issue with Avastin coverage was not about pre-authorization; they flat-out refused to cover Avastin for my husband's stage IV colon cancer. Go figure!
I remember being asked by a nurse when my husband was first diagnosed if we had good insurance. I told her we had a cadillac of a plan. We had never had insurance coverage issues and, naively, I believed that to be true.
My cautionary tale to you: Never think it can't happen to you. It can.
Hatshepsut
Dear Hatshepsut,
I really appreciate your thoughts on "the folly of trying to define ones life experiences". I have had many of your experiences over the last 30 years with many different insurance companies and medical facilities. I am so glad that this is a place where we can come and share our inner most thoughts, feelings, emotions,frustrations etc. and receive the needed response. None of us has exactly the same journey yet we have a common thread woven thru each of . Understanding isn't always possible but compassion and support is. I'm kinda rambling here, wish I was gifted as you are in expressing myself. Thank you for always sharing from the heart, keep it up. I will be praying for you. Stress isn't something that we are supposed to be dealing with, how unfortunate it is that you have to go thru this with the insurance companies.
Blessings to you,
Debbie (gramma)0 -
insurance
Yes you have a sympathetic ear here! I hate to bring up politics, but this is one issue the president is trying to address in his health care reform bill, the abusive practices of the insurance companies. He wants to make it illegal for them to continue these practices. I have, through my cancer journey, eventually had to go on medicaid, then our state's medicaid went to managed care plans, have had to jump through many hoops and have to travel some distances to receive the same care, tests, and so on I used to be able to get in my hometown. I have went from living a somewhat comfortable (through working a good full time job) life, to being broke, on the verge of bankruptcy, and depending on food stamps to even eat. The insurance system in our country needs a major wakeup call! As it stands now, I am uninsureable when and if I am able to return to the workforce. Hatshepsut, I know you will keep fighting the insurance company, you have no choice, I just hate that you have to expend all that energy and go through the stress, yes it does take away from what you have for your family. All the best.
Pam0 -
Same Insurance
We have the same insurance. Because we live in a rural county, we have little choice through the PERS system. I had similar problems during the first two years when my husbands coverage was handled by them. It took me three hours on the phone to get his Xeloda approved even though he had already had it approved when going through chemo the first time. Luckily, our attorney won his Workers' Comp case, and they have to provide his care. We have also had problems with them. Fortunately, our attorney now handles any real problems. It's amazing how things get done more efficiently when they know she is watching. (They've been fined for not doing things in a timely manner.) It just shows that they can cut through some of the red tape if they want to. His case is now handled by a supervisor who has actually called us on a Saturday and after hours to let us know she's handling any little glitch. It's nice, but I can sure empathize with you and hope I don't get sick. Then I'll be back fighting Anthem/Blue Cross. Fay0 -
Hatshepsut
I'm sorry to hear about all of the trouble that you have had with your insurance company. It is too often the case. The seem to use what I call "Circular Logic" and most people call "The old run around". I was fortunate when I was first diagnosed that I had my brother work as my medical pit bull. I also benefited from knowing a co-worker who's sister was a VIP at Sloan so if we had trouble with insurance or anything else, we'd contact him and problems were eliminated. I do remember having trouble having my insurance (United Health Care) and coverage for Erbitux. They balked at giving me coverage. I'm pretty sure my brother (or maybe it was me after watching him work) writing them a letter basically saying that "it's the Erbitux or I'm dead so cover me!" and it worked. Probably something else was done on my behalf because I don't really think they give a lab-rats **** about me a person, I am a liability to them because of how much I've cost them. I also have a group called "Cancer Resource Center" (?) that works in conjunction with UHC and picked up things to make them be covered. It's done behind the scenes for me so I do not know the day to day things they are doing. I just know that my coverage has been good. Now, my STD (short term disability - not sexually transmitted disease) has been a different story. I used to use all my sick/personal/vacation days for chemo and recovery from days. I was told I could use the STD for that instead. One year I used it with no problems at all. Last October I opened a claim and got a letter on August 14th saying that I could only be covered from Oct 08 to the end of Feb 09. WTF did it take them another 6 months to let me know they do not want to pay be for time used from March through August. This is an issue that is ongoing but again, my employer has been great and they are paying me and (trying) to straighten out the case.
Hatshepsut, a sensible person would think that you, me and others have more important things to do other than to chase our tails trying to get things covered. All I can say is to be persistent which I already think you are doing. I am sorry this it too often the case
-phil0 -
Thank you.PhillieG said:Hatshepsut
I'm sorry to hear about all of the trouble that you have had with your insurance company. It is too often the case. The seem to use what I call "Circular Logic" and most people call "The old run around". I was fortunate when I was first diagnosed that I had my brother work as my medical pit bull. I also benefited from knowing a co-worker who's sister was a VIP at Sloan so if we had trouble with insurance or anything else, we'd contact him and problems were eliminated. I do remember having trouble having my insurance (United Health Care) and coverage for Erbitux. They balked at giving me coverage. I'm pretty sure my brother (or maybe it was me after watching him work) writing them a letter basically saying that "it's the Erbitux or I'm dead so cover me!" and it worked. Probably something else was done on my behalf because I don't really think they give a lab-rats **** about me a person, I am a liability to them because of how much I've cost them. I also have a group called "Cancer Resource Center" (?) that works in conjunction with UHC and picked up things to make them be covered. It's done behind the scenes for me so I do not know the day to day things they are doing. I just know that my coverage has been good. Now, my STD (short term disability - not sexually transmitted disease) has been a different story. I used to use all my sick/personal/vacation days for chemo and recovery from days. I was told I could use the STD for that instead. One year I used it with no problems at all. Last October I opened a claim and got a letter on August 14th saying that I could only be covered from Oct 08 to the end of Feb 09. WTF did it take them another 6 months to let me know they do not want to pay be for time used from March through August. This is an issue that is ongoing but again, my employer has been great and they are paying me and (trying) to straighten out the case.
Hatshepsut, a sensible person would think that you, me and others have more important things to do other than to chase our tails trying to get things covered. All I can say is to be persistent which I already think you are doing. I am sorry this it too often the case
-phil
Debbie, Pam, Fay and Phil:
Thank you for taking the time to write me supportive notes.
I always feel like the village idiot after one of my insurance calls.
I'm truly sorry that you, too, are having insurance battles. In a sensible world, it would seem that battling cancer is enough of a challenge.
Hatshepsut0 -
Hello, this sort of thing
Hello, this sort of thing infuriates me, as I'm sure it does you. It is more than enough of a challenge to deal with the emotional and physical issues of battling cancer, let alone having to fight nonsensical battles with insurance administrators. Their job is to make money for the company by making it difficult to reimburse a claim. In my opinion, this is immoral.
I had similar difficulties when I was living in Chicago and covered by an HMO. We had to fight the HMO to reimburse some blood work (less than $200) that the primary care physician sent to a lab not under contract with the HMO. Of course, the HMO refused to pay, and it took months to get the claim settled. I am sure the HMO thought we would not bother to fight the red tape for such a small amount. This is nothing, compared to what you are going through with treatments for cancer.
I am now a Canadian citizen, and am glad these battles are now behind me. I may face other sorts of problems as my treatment evolves, but I have not seen a single bill or paid a cent since my treatment started.
Is there some sort of mechanism by which you can hire a lawyer or other professional who will oversee these problems for you. It may be worth the expense.
Best of luck,
Jeremy0 -
Anthem/Blue Cross
We have a similar situation with the same insurance. Seems SIR Spheres to them is "experimental" and they won't cover it. Aetna covers the procedure. This is total nonsense and the round around they make patients go through when they should be spending time getting better, is ridiculous! I can't agree with you more.0 -
They should be ashamed of themselves!!!
I'm sorry you have to fight their BS Lorraine but there is a reason why they are spending $1.5 million (YES $1.5 million) dollars a day fighting any kind of reform by buying politicians and paying for lying commercials.
It is not about our health, it never has been, it is all about big business and making money. The sad think is it looks like they are going to get what they want AGAIN and it will just get worse. You say it can't get any worse, just wait.
I still don't understand why anyone in our country agrees that it is okay for a company and people to make money off of sick people. Capitalism at it's worst!!!
Lisa P.0 -
Insurance sucks!scouty said:They should be ashamed of themselves!!!
I'm sorry you have to fight their BS Lorraine but there is a reason why they are spending $1.5 million (YES $1.5 million) dollars a day fighting any kind of reform by buying politicians and paying for lying commercials.
It is not about our health, it never has been, it is all about big business and making money. The sad think is it looks like they are going to get what they want AGAIN and it will just get worse. You say it can't get any worse, just wait.
I still don't understand why anyone in our country agrees that it is okay for a company and people to make money off of sick people. Capitalism at it's worst!!!
Lisa P.
Oh, Lisa, I SO agree with you. My July 14 PET scan is still not paid. First they told me the claim had never been suhmitted while my radiology office told me they submitted it one week later and got an electronic confirmation. So, I had my radiologist resubmit and now it has been 7 weeks and still pending. I will call Monday. Meanwhile I had an "end of chemo, hopefully" CT scan last week (NED - thank God), but insurance won't pay for another PET until 10/14. Funny how they can say when they will pay for another when they haven't even bothered to pay for the previous one!
This system pretty much sucks (pardon my French)
Betsy0 -
This comment has been removed by the ModeratorBetsydoglover said:Insurance sucks!
Oh, Lisa, I SO agree with you. My July 14 PET scan is still not paid. First they told me the claim had never been suhmitted while my radiology office told me they submitted it one week later and got an electronic confirmation. So, I had my radiologist resubmit and now it has been 7 weeks and still pending. I will call Monday. Meanwhile I had an "end of chemo, hopefully" CT scan last week (NED - thank God), but insurance won't pay for another PET until 10/14. Funny how they can say when they will pay for another when they haven't even bothered to pay for the previous one!
This system pretty much sucks (pardon my French)
Betsy0 -
Best wishes to youunknown said:This comment has been removed by the Moderator
Ms. R.:
Thank you for your post and I am so very sorry that you lost your husband. I am sorry, too, that your personal tragedy has been made worse by the issues you have faced (and fought) with your insurance company.
Please don't apologize for your "rant." What happened to you should not happen to anyone who is sick in America.
I'm sorry to hear of your cancer diagnosis and hope you will be able to defeat the disease.
Hatshepsut0 -
So SorryHatshepsut said:Best wishes to you
Ms. R.:
Thank you for your post and I am so very sorry that you lost your husband. I am sorry, too, that your personal tragedy has been made worse by the issues you have faced (and fought) with your insurance company.
Please don't apologize for your "rant." What happened to you should not happen to anyone who is sick in America.
I'm sorry to hear of your cancer diagnosis and hope you will be able to defeat the disease.
Hatshepsut
Dear Mrs R,
My condolences on your husbands passing. You can "rant" whenever you want. I'm so sorry that you have gone thru so much already and now facing this journey on your own. My dear husband (37 yrs) and I have lost our home etc thru this desease but we still have each other and our family. It's hard to loose everything you've worked for but I can't even imagine losing your loved one and then experiencing this disease yourself. You are obviously a very strong person - you keep fighting. I will be praying for you and hope you feel comfortable posting on this forum. There are wonderful people here for encouragement and wisdom. Please let us know how you are doing.
God Bless You,
Debbie (gramma)0 -
Sorry mrs Rgrammadebbie said:So Sorry
Dear Mrs R,
My condolences on your husbands passing. You can "rant" whenever you want. I'm so sorry that you have gone thru so much already and now facing this journey on your own. My dear husband (37 yrs) and I have lost our home etc thru this desease but we still have each other and our family. It's hard to loose everything you've worked for but I can't even imagine losing your loved one and then experiencing this disease yourself. You are obviously a very strong person - you keep fighting. I will be praying for you and hope you feel comfortable posting on this forum. There are wonderful people here for encouragement and wisdom. Please let us know how you are doing.
God Bless You,
Debbie (gramma)
You are all right about the insurance, We had our problems too co pays everthing cost us.
And that would bring angel down so much ,Things need to get better for cancer care with insurance companys thats for sure.
And most people know here that i am losing everything too. Its a shame , our friends on this site are awsome to me and i couldn't Have gotten this far with out there encouragement and love,
michelle0 -
Angryangelsbaby said:Sorry mrs R
You are all right about the insurance, We had our problems too co pays everthing cost us.
And that would bring angel down so much ,Things need to get better for cancer care with insurance companys thats for sure.
And most people know here that i am losing everything too. Its a shame , our friends on this site are awsome to me and i couldn't Have gotten this far with out there encouragement and love,
michelle
I get so angry when I hear of those who have lost everything because of illness. Our health system in this country needs to change. I have written to my representatives in the Congress. I urge others to send their thoughts to yours as well. I won't tell you what to write, but I think we can all agree that something needs to change now. At least it made me feel that I was doing something. Fay0
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