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taffylinden

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 #1 

Who hasn't felt like throwing something heavy when dealing with health insurance companies? I am always very nice, but I've had to go around and around with them too often. Here's the latest:

My surgeon's office submitted the pre-cert paperwork on 7/5 for the surgery I' scheduled for this Wednesday. Never heard back, so finally I called Blue Cross/Blue Shield. And guess what? They said they lost the paperwork, and we'd have to start over. They also said it takes 7-10 days to get approval. I politely pointed out that since I had done my part promptly, and the surgeon's office had done their part on time, but BC/BS screwed up, maybe it was theirs to make right. They said they'd rush it.

I have not heard anything, so I'll be heading for Salt Lake on a nonrefundable ticket and praying like crazy. 

What's your funniest or most frustrating tale of woe with health insurance?

Cakelady

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 #2 
When savannah had to have knee surgery in the 5th grade the pediatric orthopedic surgeon the only one in my area he said wait till,it breaks then we will repair it. She jumped up ran out of the examine room out the office door and all the way to our truck. I had to fight with blue cross/blue shields and get administrators involved before she was allowed surgery at Lucille Packard children's hospital





Been saying my prayers for you







Note: Please excuse any misspelled works or grammar errors. I have CNS lupus and brain lesions and use a program to help me type

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Jen47mac

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 #3 
Taffylinden wow. Good for holding their feet to the fire but still. Not the most comfortable any to start the trip. Good luck.

Cakelady I can't imagine having to navigate for your child watching them suffer along the way.

So far I've been lucky but I'm always on guard.

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Jenny
taffylinden

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 #4 
Thanks, Jen. I'm trying to stay optimistic. 

Cakelady, there is no excuse for what happened to your daughter. None.

My actual worst story is what happened to my son at age 4. We were visiting my parents in CA when he developed croup. It triggered his asthma, and his respiratory system started shutting down. My mom rushed us to the closest ER, Scripps, in La Jolla. I acted very calm so my son wouldn't be upset, but he was desperate to tell me something. He could only get out one syllable per breath: "Tell the doctors not to let me die." 

Long story short, Scripps got him breathing better but thought he had epligottitis. (Inflammation of the epiglottis, the valve that keeps food from going into your lungs. It can kill kids in 45 minutes.) They had no peds dept., so they sent for the pediatric trauma team at San Diego Children's Hospital. They rushed him to the ICU, and, of course, he made it. 

And then the billing started. Children's couldn't release info until it heard from the Trauma Team, who was waiting on the paperwork from Scripps. Scripps apparently only let the most stoned employees work in their office. Every time I called, a dreamy voice would say the computers were down. And HERE'S THE CRAZY PART: Scripps sent my bill to a collection agency, and I had to pay Scripps $50! Insurance covered it at 100%, but of course, I never got the $50 from Scripps. 
Cakelady

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You know savannah got burned when she was making soup one night in the microwave. The dog got under her feet. The last thing I wanted to do on a Sunday night was go to the ER but we went. They took us right back but said they did not have a bed so we sat in the middle of his room with people all around us. There was only one seat so savannah got that. The doctor said he could not look at all of her wounds because there was no where for her to change he spent less then 5 minutes with her. Then the nurse came and she said she could only put burn cream on some of her burns because the rest were covered by her clothes so she sent us home with it and more burn cream. They said they were first degree burns. We were in and out of ER in under 45 minutes

Well she did not sleep that night so I took her to her doctor who looked at all the burns. He was pis sed at the ER she has 2nd degree burns and some 3rd degree burns. He gave her better medicine.

When I got the bill with insurance it was $3000 when I called they said it's because she was burned and they had to take extra care which cost more. I told them what happened and that the doctor could not look at all of her burns because there was no room not to mention everyone could hear everything. Then I told them I took her to her doctor and his dx was different. She asked me to fax her what her doctor said and I had pictures. I then filed a complaint plus called our insurance and told them what happened. I had to tell this story like3 more times then they said the bill had been taken care of and not by my insurance company.

When you have a case like burns and it requires more time the ER doctor gets paid more. I was shocked and pis sed at the same time.

This is one reason I hate going to the ER

Note: Please excuse any misspelled works or grammar errors. I have CNS lupus and brain lesions and use a program to help me type

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Cakelady

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 #6 
Jenny when it comes to kids you do what you have to do. My son has autism and mild retardation. My husband left me when we found out his dx. I did meet a wonderful man who accepted my son for who he is. But I have been fighting for him since he was 1 years old. I have had to fight to get him Into the right classes I have also had to fight the state regarding his dx. But they came around and made the school teach my son. At one point his teacher said he doesn't need to learn to write his name I was floored at this time it was just me and my son. Thankfully I had my dad who went to every meeting with me.

My son just turned 26 years old. He graduated from high school plus he passed the California exit exam. He holds 2 certificates one for floral design and one for merchandizing. He holds a job and can use public transportation. He can read and write his name and he prices flowers for his work. The teacher who thought he did not need to learn how to write his name no longer teaches special ed.


My daughter turned 20 in June she was dx with lupus at the age of 15. I had to do some fighting for her to.


Note: Please excuse any misspelled works or grammar errors. I have CNS lupus and brain lesions and use a program to help me type

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McKenna

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 #7 
The negligence of our health care system is shocking!  I'm sorry you have had issues.  We have had some too, but the latest thing I wanted to see if anyone else experienced is this:  I've been getting calls from a nurse in our insurance company asking if I want to talk to her regarding my health and if she can help with information or suggestions for treatment.  ????   I'm not telling them anything about my health!  I told her no thanks, but she's called at least 4 times in the past few months. 
wings65

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McKenna, I've received those calls, and I've refused to provide them with any information. I have doctors who have all the information they need on me and know exactly what state of health I'm in. I can't help but think that the gathering of any health-related information by my insurance company is suspicious and not in my best interest.
Cakelady

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Yep it's a new thing that a lot of insurance company's have. I got my first call in 2008 when I was undergoing heavy chemo for lupus. The nurse was very helpful. But then things changed about a year later. When the insurance company receives a bill from your doctor they have the codes on them for what you are being treated for. So they ask questions are you taking your medicine right , do you drink alcohol while on your medicine etc.

The first nurse was really nice and understanding and helpful the nurses since then have not and I have requested that they do not call anymore. It's almost like they want to catch you doing something you are not supposed to so they do not have to pay.






Note: Please excuse any misspelled works or grammar errors. I have CNS lupus and brain lesions and use a program to help me type

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Jen47mac

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 #10 
Cakelady - I had a second degree burn on my shin from steam table water. It was incredibly painful. I can only imagine the upset for you and the doctor to be treated so poorly. I'm not sure that hospital has anyone qualified working there. -you have had a good life with it all though haven't you? Sometimes it's easy to get down with the things life throws at us, and then we look back and see it's all ok.

McKenna, I don't think I'd be answering questions from a nurse calling, kind of like I won't let my insurance company track my car for lower rates. Intrusive and they are NOT looking out for my nest interests. Cakelady has some great points on that.

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taffylinden

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I used to get those calls. I don't think they're necessarily a bad thing. Most of them have been follow-ups from hospitals or clinics. Sure, they're doing it so they don't get sued if things go sour after I get home, but the nurses I've spoken with have all seemed like caring sorts. For a time, I got calls from nurses working for the insurance company, but that was when we had a wellness program. 

I wish insurance companies did more for wellness. Wouldn't it make sense to prevent serious health conditions? But a rep told me most people dodge wellness plans. ???! What I REALLY wish were improved were DENTAL PLANS. The amount mine pays is pitiful, and it doesn't really cover that much. Dentists and eye docs can detect serious diseases early on.

Cake, I can't believe how poorly you and your daughter were treated. I understand there not being a room available, but to dismiss her without even looking at her burns is inexcusable. I don't blame you for being furious. You have really been your son's advocate and a blessing to him.

Last night the vision in my left eye blurred. The flare has triggered inflammation. I have to get it to normal by Wednesday, or they won't operate even if insurance DOES decide to approve it. (I bump up steroid drops to every 2 hours per doc recommendation.) Fingers crossed!
McKenna

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Thanks for the replies.  I'm glad to see it wasn't just me getting the calls.  I have not discussed anything with them and have no intention of doing so.  Its so intrusive!  I know there is a bottom line somewhere for them and it definitely won't be in my best interest, but theirs.

meg

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 #13 
Good luck, Taffy.  I hope your surgery is on time and successful!

Mary

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Jen47mac

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 #14 
@taffy. Calls from the hospital, doctors office, urgent care etc. as follow up are one thing. Your health insurance company is a whole other thing...
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Cakelady

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 #15 
Taffy becareful how you answer. Because a lot of times those calls are recorded.







Note: Please excuse any misspelled works or grammar errors. I have CNS lupus and brain lesions and use a program to help me type

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The bond that links our true family is not one of blood, but one of respect and joy in each other's life
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