[sugahorse1]

Gee, my medical aid officially sucks!!!

So, when I started my new job, I was told I'd have to join the work medical aid. I had to disclose any medical conditions, and at the time told them I was dx'd Major Depressive Episode and had been hospitalised.

So they wrote back to me to tell me that I would be excluded for any depression related claims for 1 year (Expires end August 2010)

SO my T has been claiming from medical aid, with the code for bipolar - my new dx.

They paid my first visit with her, and after she put the next 2 claims in, they now tell her they won't pay for those, and want a refund for the first, as my exclusion now covers depression and ALL MOOD DISORDERS. Hello!!!

So I have a bill there of R1800 (+-$250), I saw a new pdoc, paid cash and planned to claim from medical aid, which will prob also bounce (Another +-$250)
and my old pdoc has 2 claims waiting to be paid of about $150!

Where do they expect me to find that at short-notice?
How can they write me a letter telling me about depression being excluded and now include Mood Disorders!?!?
I'm not sure if I have a leg to stand on, to tackle them...!
I pay over $100 / month contribution, and my work the same... (Together about $250/month) and now they won't pay?!?!?
Financially this is a bit of blow, as it was NOT what I was expecting.

I'm soooooooo angry right now!

[Trippin2.0]

HEY, THEY'RE NOT ALLOWED TO DO THAT!!! BIPOLAR IS A PMB (prescribed Minimum Benefit) IN OUR COUNTRY, THEY HAVE TO PAY FOR IT!!!

Can't believe the chances these people take. IT"S THE LAW! http://www.profmed.co.za/content/sch...mb/default.asp

You should report them, I mean seriously...

[sugahorse1]

My doctor has put the correct ICD10 code in too !!
The stupid consumer protection act only comes into play in October.
I'm actually seething...!

[Trippin2.0]

They suck, seriously they suck. I'm still waiting for my bill...I'll be cussing soon too...

I don't know how they expect a person to pay these bills...

[sugahorse1]

Just threw my toys out the cot.
When you have a hypomanic person at the other end of the telephone, can you doubt the diagnosis!??! I mean, really!

No they say thay are meeting the claim, there is a reference regarding Prescribed Minimum Benefits next to the claim, and no-one knows about the phonecall to my T telling them that the claim would not be met.

[owllover99]

I really feel for you sug and you 2 Trippin. I'm in the USA and work for the Federal Government and even their choices of insurance are going down the tubes. But not like that yet. We shall see. And insurance can't see that you really need these things. That really sucks. Oh, watch what med you take for whatever you have bipolar or not. I just found out part of my jaw is dying because of my osteoporiosis med and there's nothing that can be done about it. The oral surgeon gave me antibiotics and something to swish in my mouth twice a day. So be careful.

[sugahorse1]

They are useless.
but now apparently they will pay, cos someone woke up to the fact that bipolar falls under prescribed minimum benefits...!!!
Arg, I have a T visit 2moro, now don't know if I'm paying cash, if I should cancel..!?!?

[Trippin2.0]

Don't cancel, they've seen the light, so you go, and make them pay under the PMB law...

[sugahorse1]

But my poor T now doubts me - well, I'm sure of it anyway. It's like paying with a credit card, and having it decline. VERY embarrassing!!
Just sent medical aid a nasty mail. This is not a Mickey-mouse medical aid; it's Medscheme!

[Trippin2.0]

I also have medscheme, and they also give me the run around the mill Luckily my pdoc knows his stuff, so I don't pay unless I absolutely HAVE TO... like my hospital stay. They say they only cover state, and 60% of Private...so I'm waiting for my bill...

They really suck, they had me stressing so much last week...

Hope it works out for you suga, really I do!

[sugahorse1]

Yup, this week I'm the one stressing - I know how it worried you last week. My plan advertises that they cover private stays...!
I feel like such an idiot, don't even know what to tell T. She e-mailed me what they had said, sent me banking details to settle the account and asked if I still wanted to come in to see her tomorrow.
I really don't think I can face something like that.

[Trippin2.0]

Well take some time to think about it calmly...

Then decide whether you can or can't handle it...

[sugahorse1]

AND IF I CAN'T HANDLE IT????
Then I should be going to see my T, who I now have to pay for alone, and that stresses me even more!!!!!!
*&@^$*(&(^*&!!!!!!!!!!

And they thought a T bill was the biggest of their worries. Have they ever heard of TRIGGER!!???

Well, they will be sent a hospital bill to settle next if they keep triggering me and sending me over the top!!

ARG!

[Trippin2.0]

Maybe a hospital bill's exactly what they need to see the severity of the situation! But I am by no means cheering you to hospital! Hang in there,you're a tough one!

[sugahorse1]

Still haven't gotten to the bottom. I cannot find any proof that they are refusing to pay. I've seen T 3 times, once she's been paid, the second is ready for payment and the third is still awaiting processing.
T said she'd forward me some correspondence from the medical aid.

[Trippin2.0]

I get notifications from medscheme. Anytime pdoc claims or authorizes a new script, I get an sms and an email with the details. Maybe you should try and get the same? It's a great way of staying on top of the probable pending bills...If anything's incorrect on one of my statements, I can query it, because I have it in writing...

[sugahorse1]

I get my claim acknowledgements e-mailed (Not sure why no sms's?). and on them, they have acknowledged T's claims, and it says ready to pay. (First and second one already paid, third one ready to pay). ??? I just don't know?!?

[Trippin2.0]

Don't stress yourself out over something you have zero control over, I KNOW easier said than done, but TRY. Next time you speak to one of their consultants, have them add sms notifications to your profile. YOu should be getting a new statement that states T, Paid... I also hate the in between ones, that state "we acknowledge your claim of" etc... but the payment authorization usually follows shortly.

Take a few deep breaths, and cross that bridge when you get there

[sugahorse1]

*(^(%^@$#&&* - It is totally spinning me out now. It's actually just too much for me to handle. and I still don't know about seeing T this PM. Think I should cancel.
But gosh, I feel so embarrassed. How could they do this to me? Make me look like an idiot. Plus - HELLO - note that the ICD code is a mental issue - maybe not a good idea to make the situation any more stressful for the client, else there may just be more bills to settle.
Flip - I've pretty much gone a week without a benzo, and now I cannot think straight and the anxiety is coming back - GREAT!

[sugahorse1]

Arg - going to run away from the office now.
Think I've sorted the insurance, T seems to think so too (Great relief if at least most of the outstanding claims are met!!)
I need some sunshine and fresh air. Now the systems at work are refusing to work, my network keeps disconnecting, bf just phoned to say he has a 6PM meeting, which could well become a dinner with a prospective business partner. So I'm home alone again.

ENOUGH ALL RIGHT!!! Can life not just hand it out in small doses?!?!

[Trippin2.0]

thinking of you...

[Shakti]

This is just terrible.

I HATE insurance companies. Health Care should be a RIGHT for EVERY human on earth.

Ridiculous.

I hope this is sorted with the insurance, though. Do something nice for yourself now. Try to decompress a bit.

[sugahorse1]

Shakti - now work has decided to take a stab at me (Other thread)
It's like it just NEVER stops.
Short of me running into the HR office or my manager's office and admitting to my dx. I don't think I want that tho