Had shoulder surgery. Insurance company denied the claim afterwards.

Had shoulder surgery. Insurance company denied the claim afterwards.

They are trained to say no as the first response. Keep after them.

Well that's not how insurance works. They would not have checked you into the hospital without telling you that you were pre authorized. That's the point of the insurance auth worker that makes you sign a bunch of paper work...

I read this on a "what's a shady thing your company does" here that said exactly thi

goddammit they got to him first

Are you ok?

Was in a car wreck 2 years ago. I now had shoulder surgeru that is unrelated. Personal Insurance company says it might be related to the auto wreck and is trying to not pay the claim.

I went to a doctor's office that said they would accept my insurance through blue shield. I went in for my check up and a month or so later I get a bill at my home saying that I owe some 300 dollars for said check up. Normally it is just a 20 dollar copay ends up being 15 times more expensive. They may say you are good to go, but people make errors.


The problem is that you're being nice.

Be curt, but professional. "I need to speak with your manager." Don't ask, tell. Take notes with names, dates, times. Tell the person you are taking notes (ask how to spell their name), for reference. Ask for a call reference number. Get email addresses, because this can give you the "code" for their email system, and you can search executive level names online, and "carpet bomb" the highest people in the company, once you figure out how their email names are set up, until you get a resolution.

Make people responsible, because they won't accept it willingly.

EDIT: Now that I'm not on mobile, here's a helpful how-to: https://consumerist.com/2007/05/11/how-to-launch-an-executive-email-carpet-bomb/

That can easily be worked out. I'm assuming you have medical records supporting the shoulder condition existed prior to the accident? Contact the insurance & ask what evidence they need & the hospital/doctors office will help get the necessary records over.

Lol the US health market is more expensive (per capita and by GDP) than any other developed nation. I'm a conservative and even I know that the current US system is bullshit. Maybe the Libtards have a point?

Maintaining a healthy and productive population is the other half of a good economy. Good jobs and healthy people make a productive country.

I love America. I love your people, your altruism, your culture and your creativeness. I love your history and your ability to constantly innovate. But what the fuck, guys? What the fuck?

That sucks. Unfortunately, the people who work in doctors' offices are a really bad source of information when it comes to insurance, and they deliver their bad information with a great deal of confidence. Your insurance company is the only good source of information about what will be covered.

Maybe the US should have some sort of tax/insurance taken from your wage weekly. Then this could pay for this treatment in advance. Everyone one in your nation could do this. Call it...i dunno ...national Insurance.

It's great idea. Just don't overspend. Don't let people use it who haven't paid into this insurance and don't fuck it up.

Sincerely Great Britain

but then the hospitals do extra shit that wasn't authorized extra and you get stuck with the $50 to $50,000 bill. Mine got the auth for my CT but not for the bloodwork they told me i had to do before it so I got stuck with the bill that will go unpaid. This means for i dont know how many years if I ever need my blood drawn and sent to labcorp (the only other one i know of is quest and usually your insurance only covers one or the other) it wil not be tested and get discarded by labcorp and they will let my doctor know that.

Take their families hostage, it's common practice these days.

Nah. You're creating a paper trail, and most execs aren't aware of the day-to-day operations of their company. Dump shit on an exec's desk, and they'll want it cleaned up...or "shit rolls downhill".

To: Claims Manager "Why is this person fucking bothering me, clear this up ASAP."

The paper trail is something your state reps/senators would appreciate, as would a journalist.

EDIT: The intent is to amplify, and escalate. There is always someone higher up in the food chain, and survival in Corporate America is as much about passing off responsibility and ducking, than anything else.

I went to a doctor as a new patient and did a checkup as well as blood test. All of this was covered under my craptastic preventative plan but I got a bill for the lab. Took a half year before they fixed it and I heard so many different reasons.

this is exactly why if we're going to continue with the current system in America we need to have education in school to prepare us for how to understand insurance plan language.

In your case, the information was correct, but you had no idea the covered amount would first apply to your deductible. Then again, I'm pretty sure if people were educated in this manner there would be unilateral support for single payer because everyone would realize you always have to choose between debt and health. Very rarely can you have both at the same time and only if you're extremely diligent about price checking.


Actually on top of this the insurance company themselves should be requesting records to make claim determinations like this.

Also insurance and billing in a medical setting can become an absurdly complicated thing.

Source: I'm the one they ask and I've worked the admin side of healthcare for about 8 years.

Try again, if not you can sue or you can negotiate with the hospital directly to owe less money.

he must have been talking about candlejack at some poi

they bank on most people just paying any bill they receive. seniors are especially vulnerable to this. its really fucked up. essentially they are scamming our grandparents because they dont know better.

Yet another tally in the column of 'really simple situations single payer would've handled better'

Dude, please don't talk about candlejack on this si

I can't get a tooth fixed that is starting to rot in my mouth because it's been broken for seven years. It'll cost me 1500 just to have it removed and a root canal, then another $1000 for a replacement. I don't have insurance because I'm unemployed now, and the ACA would cost me $300 a month.

Insurance company denied my emergency appendectomy because it wasn't pre approved....

Conversation with agent went like this

me: I'm calling to see why my appendectomy was denied? agent: It was not pre approved. We require approval for surgeries m: You do realize it was an emergency appendectomy and was in no way elective? a: Sorry sir, but you should have gotten approval ahead of time m: I was curled over in a hospital unable to do anything. When the scan came back they rushed me into the emergency room as it was moments away from exploding - resulting in a good chance of killing me a: I'm sorry sir, we will look into this

About two more calls and it finally got resolved.

One of my coworkers got free dental work for her son at the dental school in Augusta, now part of Augusta University. There is a wait list but it's relatively close to you.

We'd still have the choice of private insurance. I don't know how that always gets lost in the discussion.

Because when he says "free" healthcare or education, a lot of people actually think it means free.

The opposed right wingers assume that healthcare actually costs what we charge for it, and have a "Fuck you, I'm not paying for other people's shit!" attitude. They also ignore the fact that if we had free post-secondary education, doctors wouldn't start off with huge amounts of debt, for the same reason. These people also tend to be older now and have nothing better to do than vote and believe bullshit about how Australians have to wait 10 years for elective surgery.

Supporting left wingers too easily dismiss the actual logistics needed to back it up, the regulations that need to be enacted to make it work, and they don't like to get out and vote for people that could make it happen.

Aside from the corruption that goes on, like gerrymandering, the sad truth is that there are just a lot of people who choose not to give a fuck about other people, even if they are in a shithole place themselves. It's worth mentioning that there were enough people who didn't know that Obamacare was just a nickname for the ACA, and were extremely uninformed on the topic.

Welcome to America, where party comes before country and fellow man, and you need to know exactly nothing about a topic to debate it.

No one in this hospital is going anywhere until my son gets a heart transplant.

I tried an nothing helped (including "sorry to go over your head, but can I speak to someone higher up" and "I feel this is very unfair, is there anything that can be done"). Nada.

What's candleja

Too many Americans hate the idea of anyone getting anything for "free" even if it would benefit them and society as a whole. They don't think government can do anything right and they've convinced themselves that everything was great before Obamacare came along and ruined everything

What you need is proper national health care... depressing to see all this over there. Being sick is the biggest sin over I. The US.

Yes, altruism and culture. American arts, particularly since the beginning of the 20th century, is unparalleled in terms of music and cinema.

The constant outflow of relief money and labor to help with the world's problems has never been even closely matched by any other country in the existence of humanity. Despite what you may think, Americans are for the most part good, generous people, and we do give a shit about other people.

Move somewhere else.

In Sweden insurance is not involved other than pay for traveling costs and your family in case of death.

Other then that it is paid by the government. all you pay is about 100$ at most a month for administrative fees.

Tell me again how Bernie Sanders is a stupid Socialist? he whould be the first step to fix all this shit, but noo, US want an orange moneky

I'm in the US. Made a dermatologist appointment yesterday, earliest I could be seen is October. Made a gastro appointment too, September was the soonest. Went to the ER last month, 4 hours in waiting room.

The whole "we can go bankrupt, but we have faster wait times!" comment is basically bullshit.

we're never going to have an affordable healthcare system for everyone so long as the industry is for profit. that's the main problem.

Don't you worry about that. :)

Dude, insurance companies do this stuff all the time. Seeing all these people question this situation is kind of sad, it's just a reality of health care in the US.

Actually the insurance company often misquotes the office staff. While offices will give you an estimate based on what your insurance company tells them it cannot be guaranteed as the insurance company will not even guarantee their quote. You should always call your insurance company directly before any costly procedure and verify yourself, offices get quotes so that you won't have any big surprises but unfortunately they get bad information sometimes. And no, doctors don't do this to make money, they would much rather be paid by insurance as it is unlikely the patient will pay the bill if it is any significant amount of money.

Uh....yeah. Let me just jump in my private jet.

It also helps with job portability and velocity of workers. If they don't have to worry about losing their health insurance they're much more likely to change jobs of they don't like their. Losing healthcare is huge factor for a lot of people when looking to change jobs

You can call the hospital or whatever's billing office and have them freeze the charges while you sort it out with insurance. Had this happen to me. And apparently my was because someone ticked a box saying I was a female... The charges were for going to a specialist for a testicle problem! Like the fuck? Lol

You should call your insurance company and ask to speak to the HIPPA compliance officer. Then ask them for the credentials of every person who had access and made decisions about your claim denial. Most of the people making those decisions don't have legal authority to access your medical records and insurance companies would rather pay a claim than reveal non-compliance with HIPPA laws.

Insurance company told me verbally that I would be covered for 3 MRIs a doctor suggested I get. Since I was covered, why not?

What she didn't say was I was covered for 50% because I hadn't got my deductible yet. This was in November. $2700 dollars later.

I have a freedom of choice story for national health care.

I have a torn meniscus in my knee. It's not too bad, but it keeps me from hiking and other activities. Its my choice whether I want to have it fixed. I go to my family doctor to have a referral - I had originally chosen my family doctor and they were given the opportunity to choose if they wanted me as a patient. My family doctor asked if I wanted to see local orthopaedic surgeon or research my own - I chose to research my own and provided a list of five highly regarded surgeons to see who was available and up for the case. I was chosen by a great surgeon and I drove to another city to see them - my choice. They investigated the nature of my injury and offered me multiple solutions; some non-surgical and some surgical - I chose what we were going to do based on their information and recommendations. Now we're finding a time (in the next two weeks) to perform the surgery - I want to go on a road trip and will be driving, so I'm going to ask that we book something a little late in the summer.

I live in Canada. I have given and will give the hospitals and doctors involved $0.00.

What freedom of choice am I missing?

Americans favor freedom of choice over anything. Idealism wins over pragmatism in America.

The longer you wait, the more it's gonna cost you.

Removal is better than sepsis you can deal with a missing tooth but having a rotten tooth is wayyyyyyy worse

I work with insurance and all I can say is don't ever forget to get a reference number for the call.

A work mate had knee surgery.

He didn't have to pay for it.

After he used up his 2 weeks of sick pay the government payed his wage for the rest of his weeks off(I think he was 50$ worse off)

And now he is back at work doing his work like the accident never happend, plus a little complaining about how expensive parking at the hospital.

Australia Mate

And that is the favourite circle jerk by those who rail against a civilized health care system. Is Canada's system perfect? Of course not. Would we trade it for anything remotely resembling the disaster that exists in the US? Hell no!!! If the situation is serious, you get dealt with quickly. If the situation is not life threatening, then there will be some period where you will have to wait. This is just the reality of having a system that isn't motivated by unrestrained greed and complete disregard for people's lives.

Here in Canada, I don't live in constant fear of getting sick and being financially wiped out. I don't have to make medical decisions based on whether I can afford to go the doctor. If I'm sick, I go to the doctor. If she thinks it's something serious, I get any necessary tests almost immediately. If it's something maybe serious, then I might go in a week or two. If it's something non-life threatening, then there's going to be some wait.

Lastly, stop just pointing to Canada's perceived issues and take a look at some other countries (source on which Canada shows up 16th nicely enough). Single payer/government run health care systems work, it's just that simple.

shouldn't matter in the US. ACA prevents insurance companies from denying claims based on pre-existing conditions. that's why they're trying to force everyone to either have insurance or pay some penalty. theoretically, this should prevent people from just dropping their health insurance and signing up only when they have a medical condition.

with one comment you out yourself as a moron.

Good thing congress is going to help us not have any, so we cant be confused.

There are a lot of intelligent, educated, well read liberals. I find being a staunch conservative is nearly always due to one of two causes. A person is either wealthy and determined to avoid paying their fare share of taxes, or they are ignorant and uneducated.

Sadly it is often rural Americans that fit into this second category, and are bound and determined to elect politicians that will enact policy that will damage them disproportionately.

Rural Americans have a higher per capita use of food stamps as well as a higher rate of food stam...

Rural patients and hospitals will be damaged disproportionately to urban ones with the new medica...

There are plenty of other examples. So ask your self. Are you in the first group, and you don't care who dies, starves, is exposed to dangerous emissions, because you want to do whatever it takes to be as wealthy as possible in comparison to the majority of Americans? Or are you in the second group, and eating up every lie the first group feeds you.


Sup Denzel

I realize that. I'm dirt poor and was supporting three people before I lost my job. I have no cash, no insurance, and live in Abbeville, SC. Look at it on a map.

What /u/urmomwearsarmyboots said: Their model is to automatically reject your claim, which shifts the burden of dispute onto you! Lucky for you:

Disputing a claim rejection is easy!

All you have to do is enter Dante's Inferno by dialing their customer service number. Then just sit back and suffer your way through all 9 hells of customer service rep transfers. In my experience, it usually takes about 5 hours and multiple calls before BCBS will pay up.

But on the real, I've found the following practices to be helpful:

Take notes of everything . Date, time, number you called . Name of rep you are speaking with, including all of the names of reps you are transferred to . Call ID/ticket #, which is generated for every call into BCBS customer service . What each rep tells you

Be direct with your requests and questions

Do not hesitate to ask to speak with a supervisor Don't waste your time. If a rep cannot answer your questions, or says they can't fix your billing/authorize your request, thank them for their help and ask to be transferred to a supervisor. If the supervisor says the same thing, ask to speak their supervisor or the person who has the power to solve your problem. You may run into a wall and just have to start all over until you are connected to a person who will help you.

Unfortunately, sometimes you're just effed.

I've even gone to the regional BCBS office, seeking a human. The reception area was 4 big security guys, metal detectors, and turnstiles blocking the entrance to their impenetrable fucking compound (which I was not expecting). I'm a very non-threatening, pretty young lady, so I was immediately escorted to the elevator by a very polite security guard. It's scary to know that that situation could have been quite different.

And if you live in a the great state of Georgia, like myself, the Insurance Commissioner is useless.

*edit- speling

Become a Canadian. You're a citizen ... you're insured. Be Happy. Be Canadian.

If you're suggesting that being seen in a timely fashion isn't possible in Canada you're talking out your ass. Whether in emerg or seeing your specialist, you're triaged in Canada, so if you're dying you're front of the line. If you're not then you'll be seen appropriately.

My wife received her cancer diagnosis on a Thursday...scans began that weekend, met with the oncologists by Monday...chemo started on Wednesday.

Along the process we met with various docs, including the interventional radiologist who is an American practicing in Canada and he said he takes the Canadian system over yours any day...both professionally and with regards to patients.

After a 3 week stay in hospital for my wife, 8 rounds of chemo, home visits by the nurse for two months, surgery, another surgery, 25 rounds of radiation, and reconstruction, wanna know what our bill looks like? Not a one. Fucking zilch. The only thing we've been out of pocket was for certain laxatives that weren't covered.

You have some of the best teaching/research medicine in the world...that only the rich have easy access to. The rest of the world has comparable health care that ALL have access to.

Get Cancer in the US and report back...let me know if you can just choose which cancer hospital you can go to without asking your insurance company first.

Dental isn't necessarily included with Medicaid


Just get rid of medical insurance and have the entire US population taxed $1 for every $100 they earn that pays for the health system.

As an example in the UK I was paid this month; Total Gross Pay £1113.50 PAYE Tax £44.60 National Insurance £57.84 My employer also paid, Employer NI £66.52

This covers me for my full medical health. If i need an MRI/CT Scan or even blood work. It's all of no cost to me at all. If i need any drugs the prescription is something like £12.50 per item? (I have an exemption card so pay nothing for my prescriptions)

The problem with this is the people don't want to pay that money in to the NHS (US version) and allow it to cover other people. Someone i've spoken to said "Why should i have to pay for someone that can't be bothered to get a job or is a junkie" Unsure if the majority of the US is also like this or just him... Anyway the insurance companies and medical companies will lobby against this. The pharmaceutical companies won't be able to push the prices up anymore as the new NHS.US would just source its medical stuff from other places.

I find it really sad and even horrifying that we have to go to these lengths just to get healthcare that they promised they'd give us.

Preauthorization. An expensive but important lesson.

The sad part is if we saw how much they were charging for a heart transplant back when that movie was made (2002) it would probably seem like a bargain now.

Grats on your feminine penis

What can you do with emails? The higher ups will just say "sorry, that policy, there's nothing I can do about it" and hang up on you if you persist.

Hopefully Trump fixes this.

You're funny!

Thanks for not hating us

Conservatives have this issue where they don't want someone get get something they don't "deserve". (By someone, they mean black people). This is how the Republicans can get a bunch of people on Obamacare and Medicaid to vote for the candidates that are going to get rid of those things, becuase they think that only those who don't deserve it will have it taken away, and good God-fearing white people such as themselves who have earned the right to to these things will continue to have it.

Hmmm paying a lawyer or paying the bill? Just saying somebody can sue is not a viable response, that shit takes money too! I'm assuming he doesn't have money for the bill so where is he going to get money for a lawyer?