One such encounter went like this:
Me: “Hi. I’m calling about my daughter’s ambulance and hospital charges. I haven’t been able to reach my grievance coordinator about the appeal.”
Representative: “I can help you.”
**Me: **(Genuinely excited.) “Great!”
Representative: “Oh, I see your daughter turned 18. I can’t discuss her information with you.”
Me: “I sent a release of information form by mail, fax and email. I also faxed our conservatorship papers.”
Representative: “I’m sorry, it’s not on file. What office did you send it to?”
Me: (I give the information.)
Representative: “That’s the wrong fax number. Let me give you the correct one.”
Me: “I’m not inventing numbers out of the ether. This is the third new fax number I’ve been given. Are the address and email inaccurate too?”
Representative: “I’m sorry, but I can’t discuss your daughter’s claims with you without this information. Can you put her on the phone to give verbal consent?”
**Me: **“I can’t put her on the phone. She’s currently in a treatment center and has no access to a phone, which is why I have a conservatorship to help with her medical care.”
Representative: “I’m sorry, ma’am. There’s nothing I can do without the forms or her verbal consent.”
Me: “Who do you think pays the insurance premium and all her providers? I’m just trying to settle her claims, and I don’t know what we owe without access.”
Representative: “I can only answer general questions.”
Me: “OK. From the bills I’ve received, we’re being charged out-of-network fees for the ambulance, ER, ER doctor and hospital.”
Representative: “Was this out of state?”
**Me: **“Yes.”
Representative: “Hang on, I have to transfer you.”
I was on hold for another 15 minutes, and then got cut off. I called back, was transferred twice and then repeated a version of the above conversation before resuming — with a grievance coordinator!
Grievance coordinator: “The ambulance and ER facility were both out of state and out of network.”
Me: “A treatment center called for an ambulance. I wasn’t given a choice of who responded or where they took her.”
Grievance coordinator: “They used out-of-network providers.”
Me: “They dialed 911. No one stops to ask the closest ambulance what their network status is.”
Grievance coordinator: “They did transfer her to an in-network hospital, but the physicians were not participating providers.”
**Me: **“Under the No Surprises Act, insurance must cover all providers in the case of an emergency, whether they are in network or not — even if out of state.”
(There was a long silence.)
Me: “Are you still there?”
Grievance coordinator: “Yes, ma’am. Once you get the conservatorship papers to us, we can look at those claims. Is there anything else I can help you with?”
Me: “Apparently not.”
When I started my first “real” job, where I got health insurance, it was an absolute nightmare trying to find a therapist through their network. I remember having to call them to figure out if they would cover visits to a specialist in trauma. Sat on hold for an hour and 45 minutes, just to get some random woman who would NOT give me any information until I told her “why” I needed to see a therapist.
After trying unsuccessfully to skip past the question, she kept asking, so I said fine, and trauma dumped all over her. I’ll save you the details, but I could tell she was shaken once I finished. After all that bullshit, she still couldn’t even tell me if the provider was covered or not, and instead sent me a 90 page non-searchable PDF listing a bunch of random therapists in random order located all over the state (which was negative help). I was so upset I just hung up on her.
Medicare for all. Health insurance is a scam that bankrupts Americans, puts barriers between you and care, and actively harms all of us collectively.
It is so fucking bullshit in every way. I cannot comprehend why someone would have a problem with single-payer, which is so much better by comparison than what we have to do now.
The only thing I can think is “but I might wind up with slightly less coverage than my work currently provides,” which is also practically impossible for all but the very upper crust…
“Death panels!” the conservatives shouted. “The government will have death panels!”
The rubes ate it up, not realizing they had death panels the entire time and paid more for them.
Seriously. The real Obama Death Panel is a lone worker mass-clicking “not covered” all the way down a spreadsheet that has your care as a line items.
I also like doing this juxtaposition:
Repubs under Obama: “death panels are going to kill our grandmas.”
Repubs under Donald: “sacrifice all grandmas to the rising line.”
And the only death panels were all the insurance company death panels that already existed all along the way
rubes
I call them Rubels
Not to mention the part of the bill they were referring to was paying doctors for end of life counseling, like living wills, which help people die with comfort and dignity.
in most 1st world countries literally none of this ever happens.
insurance is the biggest scam of all fucking time. and we get to spend time arguing about gay books in the library
in most 1st world countries
The US isn’t a 1st world country. It just cosplays as one.
we get to spend time arguing about gay books in the library
Congratulations! You’ve pointed to the exact reason why we’re stuck arguing about gay books! If right wingers didn’t have absolute bat shit social issues to bitch about they’d be joining us in bitching about the real issues we face!
Can’t have that! Propagandists, sing me a tune!
Don’t even think about asking about the extraterrestrials.
Uh, not . . that there are any, it . . that is, if there were any there would certainly be information that . . uh . . about, uh, that. Which there isn’t! Ha ha! Nope. Anyway. Let’s finish getting these taxpayer funded Ten Commandments installations put up, hand me that hammer will ya
In lots of third world ones too. Here in Brazil there’s no such thing as “paying for ambulance” if you are in a health plan or using public health systems.
Conservatives love to say free market works, shop for best price, blah blah… When you are having a heart attack, you don’t stop 911 from sending help until you shop around for the best ambulance service… You take the closest one, go to the closest hospital, and get service from the doctor on call.
Fuck insurance, we should have Medicare for all by now.
Conservatives are all liars. I mean, you know that. But the academic theory of the free market valuing things correctly requires an assumption that people can go without the goods and services being valued. It’s not even a misrepresentation on this one. It’s just a straight-up lie.
On top of that, shop for best price? During the one month of open enrollment where it’s allowed? What if the providers all leave the network halfway through the year, as regularly happens? They have literally made it impossible to shop around for the best price.
Courts should find insurance companies liable for billing mistakes that you have to spend your time and resources to correct. Compensation should be 100 dollars a minute.
Brilliant. Unfortunately the insurance lobby owns Congress.
Hey - we should get our own lobby and outbribe them
Kickback congress for 1% of those fees.
Thank you for the information on the “no surprises act”, didn’t know that was a thing.
Also, south park actually did a skit like this, but I feel like it’s in bad taste given the seriousness of what OP is going through.
Name and shame - it does absolutely no good to post your experience without the insurance company name.
Health Net pulled constant bullshit with me. The company regularly refused payment on claims, saying they weren’t covered after previously paying for the same service under the plan. Health Net even went so far to refuse payment on a claim when they had provided prior approval for the appointment in writing. They would refuse payment on things that were clearly covered and I had to read them the policy to even get them to look at the denial. Health Net literally trashed prior authorization requests my doctor sent in and it took 4 months and personally faxing the request myself to get them to admit they were throwing the faxes away. The list goes on and on.
After major surgery I often spent 10+ hours per week on the phone with them because Health Net would deny so many claims. Getting rid of that crappy insurance company was a major relief.
Doesn’t matter, it’s all of them. My family has had United Healthcare, Cigna, and Anthem in the past 6 years and they’re all equally bad. We’ve had so many issues with coverage for both of my autistic children and mental health care.
The system is designed to screw you unless you have hours of time to question every bill. Luckily my wife doesn’t have a job so she can make all of these calls. In most cases we got everything resolved, but after my wife basically made this her daytime job calling about the bills and learning about how billing and coding works.
After our experience, I’m confident that no one knows what they are doing. It’s all guesswork. From the doctors, to their office billing people, to the insurance. It’s all fucked.
Doesn’t matter, it’s all of them.
It’s the majority of them, but there are exceptions. I switched to Blue Shield (not Blue Cross or one of the combined companies in some states) and had almost zero problems. They paid my claims accurately the vast majority of the time and fixed the occasional problem with relatively little fuss. The Blue Shield reps also knew their stuff and I never once had to explain my policy to them.
Health Net is deliberately designed from the bottom up to refuse legitimate claims and to fight tooth and nail when customers demand they follow their own contract. IMO Health Net should be shut down.
…my wife basically made this her daytime job calling about the bills and learning about how billing and coding works.
I had to do the same, despite recovering from surgery. To make matters worse, after I hit the maximum out of pocket amount the medical centers continued to send bills showing I owed a balance. It took nearly a year and repeated escalation to their executive and legal departments to get them to provide refunds. Calls, faxes and certified letters were completely ignored.
Corporate America has become quasi-legal and well-funded organized crime.
I had to do the same, despite recovering from surgery. To make matters worse, after I hit the maximum out of pocket amount the medical centers continued to send bills showing I owed a balance. It took nearly a year and repeated escalation to their executive and legal departments to get them to provide refunds. Calls, faxes and certified letters were completely ignored.
Yup, we always hit our deductible within about 2-3 months due to my kid’s therapy, yet we still get full bills from all of our providers even though we should be 90-100% covered at that point. You call the insurance, they say the provider billed it wrong, you call the provider’s office and they refuse that they did anything wrong and tell you to call your insurance. It’s a never ending cycle.
The worst of the medical centers that knowingly overcharged me was USC Keck in L.A. They completely ignored calls, emails, faxes and certified letters for nearly a year - never once responding to anything. The scumbags actually sent my account to collections despite my having a zero balance because they flatly refused to credit my overpayments. I’ve learned to refuse payment of any medical bill before making absolutely sure I owe the company what they are billing, and that can take months.
The thing that amazes me with all of these companies is they expect you and I to be right on top of our accounts, respond to letters and calls, and pay their bills within 30 days. This despite the fact they don’t give a fuck about doing the same. My attitude has become the same as theirs: “fuck 'em, let them wait”. I get sternly worded bills with red “Past Due” printed on them every month, ignore them completely and pay when I’m ready. There’s been no downside.
Not only that but the ACA rating system for plans is completely useless because the insurance companies invent brand new plans every single year so none of them ever have any kind of rating.
health insurance companies only profit when human beings suffer. full stop.
the only people rooting for these companies is either in on the take, or hasnt suffered their ‘service’ or are too rich to care. thus proving healthcare is for the rich only
As an American, I’m legit terrified of sustaining some kind of injury or extended illness. The society we have constructed, and that we tolerate, is an absolute abomination. Let me say it again. The United States is an absolute, top to bottom, left to right shit hole. We do not value people, life, or well being in any meaningful or equitable way. This is an economy masquerading as a society.
How is this legal?
It actually isn’t, but those in charge know our legal system works so slowly. So the companies already know they just have to delay and they’ll only pay a percentage of a fine for swindling patients. And instead of being accused of robbing, their legal team will get charges lowered and the company will just change its name and start over. Until the punishment fits the crime, the rich scams will continue.
Yup. They violate HIPAA all the time, too. Rules for thee, not for me.
Bingo. Which is why they comfortably hide using the infighting of the two party system. One party has to be willing to accept they’ll be doing most of the work to fix the situation. Up until now, they wanted us believing the task is Sisyphean and impossible, the truth is we can easily catch them with their pants down.
Quick reminder: only for 4 months of the last 44 years have the Dems held the admin, house and Senate, that triumvirate that lets them do anything positive without selling everyone out for the smallest of handouts.
That’s literally not true. Obama has both the house and the Senate for the first two years of his term, and he wasted them.
joe biden has done more with a house full of republicans and a gridlocked senate. Its amazing people still think obama was at all good.
Oh you sweet summer child. As if that matters.
It’s not but since the Government refuses to enforce it’s own laws, it’s up to individuals to pursue expensive and extremely long civil cases.
RepubliQan’ts
This has been a problem for decades longer than they have been around.
Wtf?
- Are you saying health insurance scams predate conservatives?
Or
- Are you claiming conservatives are somehow not to blame for our completely fucked healthcare system despite their extreme efforts to prevent conversion to a normal healthcare system?
Or
- Are you just being a bit pedantic about the use of the word “Republican” instead of “conservative”, since our most-conservative party has changed names a few times during our nation’s history?
If #1 or #2 is your meaning, allow me to debate your position.
Conservatives (including conservative neo-liberals) are the direct fucking cause of this situation. If they were removed from the equation, we would at least be on par with one of the 30 other developed nations. We are the ONLY developed nation on earth without healthcare, and the reason for it is conservative cockroaches doing the bidding of the billionaire class. That is the only reason.
The cure to our health woes is the eradication of conservatism. It really, truly is as simple as that. If we were able to cure the plague of conservatism, we would be rewarded with a normal civilization that includes a healthcare system.
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Yes, they are. They don’t care about their customers, just the premiums they can rake in without paying out on.
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Being the person who pays the bills does not and should not grant that person access to another person’s medical records, even if that person is a parent. I get that you submitted the authorization in this case, but I am speaking generally in response to your comment which seemed to imply that third parties should be given medical information if they are the ones paying the bill.
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As someone who is taking Kaiser Permanente to court over their refusal to release documents, let me confirm that grievance coordinators are the most useless wastes of oxygen ever to steal air on this planet. Even having your lawyer send them the actual text of the law they are currently violating, they will refuse to do anything not explicitly outlined and approved by their policy. Fuck the law. Fuck common sense. If it’s not policy, it doesn’t matter.
Ignoring the law is a more profitable strategy then following it. Unless this changes, then healthcare companies will continue screwing people over.
If the fine for breaking the law is not high enough, the fine becomes the cost of doing business.
I worked for a company who went with a cut rate insurance provider one year who basically denied or screwed up every claim. This required calls, faxes and hours wasted any time anyone had a medical procedure. The kicker was that the insurance company hours were the same as our company hours so all of this had to happen during company time. They went with a proper provider the next year.
Any important conversation I like recording it. I know you can do this on Android, idk about iphones.
Just be sure to check if you’re in a one-party or two-party consent state. If it’s a two-party consent state you’ll need their permission to record the call.
Just call them up and make it clear that you are mentally unstable enough that you might go to the person’s you are talking to home. If they are afraid of what you might do paperwork gets done fast.
Be creative with it. Last time the insurance denied one of my daughter’s claims I accused the adjuster of getting off sexually on the act, in graphic detail until they agreed to process the claim
