My heart goes out to anyone who has had to battle any medical insurance company. I never dreamed that I would be faced with that battle. It's unreal the lengths that these people will go to in order to not have to pay. The irony of it all is that the testing we had done that they don't want to cover had the potential of saving them millions in the long-run.
We FINALLY got myself, my husband, and my daughter's testing covered. We're almost done with my oldest as well. However, there are still two more that they refuse to pay on the basis that they deem the testing, "not medically necessary" or "does not meet criteria for coverage".... it's crazy! All of us (except for my daughter) went and had the blood work drawn on the same day and had the same test done on the blood. For some reason they just want to pick and choose who and what part of the testing will be covered. It doesn't make sense.
I have spent so many hours on the phone on hold and talking to people that my ears are ringing. I have talked to my insurance company and the hospital. I have received many versions of their story and it's never the same. Of course, the latest "story" is that my hospital has not given my insurance company enough information and then the hospital is saying that they are denying it in spite of the information. The last time I spoke with them I was told that they cannot call one another to straighten this out. That was the last straw for me! MY last words to the hospital were, "if that's the case, you leave me no other choice." I hung up and called my dear husband who (as many of you know) is a lawyer. :)
I know that with a lawyer's letterhead it will be taken more seriously. So far I have been very sweet and patient on the phone. Perhaps now they will realize that we mean business. We are going to make our demands known and if they don't do what they are supposed to do then they will be in essence not fulfilling their end of the contract. We pay on time, never late... and we haven't needed much coverage since we are all very healthy. Now that it's time for the insurance to do their part, they have the obligation to do so. It's not our fault if things are messed up with the paperwork. That is THEIR job to straighten out, not mine.
Four out of six isn't bad, huh? I am proud of myself for not giving up. I want all of you to know that there is hope with insurance companies. The main thing to remember is to call them as soon as you realize there is a problem. NEVER assume that the hospital, doctor's office, or ESPECIALLY the insurance company will take care of things. It's up to you. I know that's unfair, but it's true. Sometimes it's just a clerical error and that can be resolved fairly easily. Make sure to keep all your "Claim Reports" and especially your bills. I will let you all know when I am six for six! Hopefully that will happen very soon. Wish me luck!!
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Insurance companies know that
all you can get them for is
"breach of contract" when they
refuse to pay. Most people
do not have a lawyer to help
them. That's just wrong!!
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