[SleepsWithButterFlies]

Ok does anyone here have any medical insurance savvy? I am getting the run around with mine..It seems they say just about everything is not covered OR to use another addy to all my docs...so they do and they do it again....I have a National Wrap .. I pay big bucks for my insurance monthly and NEED insurance but this is crap..I have called speak with very nice people they say have them rebill too....new addy..I do that and they rebill and it happens all over again...I just got a HUGE stack of BS denials and resends in the mail..who can I report a medical insurance company to? Thanks

[(JD)]

thinking... have you tried telling THEM ( a supervisor) that you are going to contact the federal trade commission (FTC) or the Insurance Commissioner unless they get this straightened out? I'm sorry, it seems to be SOP.

[SleepsWithButterFlies]

What is SOP???

No but thank you I didnt know who to threaten them with..This is all dumb if you saw the forms...my ear doc has not been paid from JUNE of last year...I am so mad and upset cause its just a huge run around. They paid one doc...same doc HAD to see me two months later on follow up to surgery ...they said no ....but it was the same code and charge...grrrr....would I really contact those agencies and how do I? THANKS

[gardenergirl]

Yeah, that really stinks. I think some companies go out of their way to make it hard to get paid on a claim in hopes that you won't keep following up, and then they won't have to pay.

Keep at it, and do mention that you want to file a complaint.

gg

[(JD)]

SOP = standard operating procedure DENY and DELAY. It's SOP for then to make doctors wait 6 months for payments... which means if it's a forever process (as is my physical therapy) the PT will NEVER collect the first 6 months... until I die!

[SleepsWithButterFlies]

GG AND SKY thank you this just sucks...I mean we are not talking small stupid fee and procedures and I KNOW I am covered for it...what a hellish red tape deal..I had one girl she was way nice give me her ext she sounded like Rosie Perez lol soo sweet and she said I have to get nasty...but man I cannot do that..its not me to like yell at workers on the phone and all...she had them conference call to her ...things are still not fixed I see by these new forms....sigh

[gardenergirl]

Is there an ombudsman or some other type of patient advocate who can intervene for you?

gg

[SleepsWithButterFlies]

what is ombudsman??

I have NEVER HAD issue like this I honestly have no clue as to who to go for help.....its a mess...Would I ASK the insurance company for that ombudsman???

Thanks

[(JD)]

I don't think you have to get nasty in your speech, but you do have to be firm, informed and CONSTANT.. "squeeky wheel" gets the grease.. the workers need to WANT to help you either to get you out of their hair so they can continue to do nothing, or because they like you and want to help you.. good luck with that!

[January]

Insurance Companies are terrified of State Insurance Commisioners. They can levy huge fines against them. Try that on them.

Good luck!

Hugs,

Jan

[gardenergirl]

An ombudsman is someone who makes sure that people's rights are respected. They have them for long-term care. There might be one for community mental health. There might be one in the insurance industry. I'm not sure where to direct you for this. Maybe in your insurance coverage book there's a section about resolving disputes, filing complaints and such?

gg

[dexter]

Just keep sticking with this until they sort it out.

Have you talked to your doctors about the problems with the insurance company? They may have more experience with what to do to deal with the paperwork properly, plus it is in their interest to GET PAID so they may work harder to sort it out than the insurance companies will.

Good luck... And try not to let it cause you undue stress. I know that is hard, but you are the one caught in the middle, not the one causing problems.

[SleepsWithButterFlies]

Thank you January, GG, Sky and Dexter.....I shall do that...I am sooo upset I would be a liar to act like I ain't...I have HUGE amounts owed and even small amounts....I just go in a circle with these people...I think some of you are right they wanna wear me out or something...I EVEN had to argue on WHAT kind of insurance I have ...thank God for that Rosie Perez sounding girl...she pulled my sign up sheet and said I was right my card is right,....the news I had a national wrap was NEWS to her and she was in the corp office ..what was cool about her is..she said call them and have them make this a conference call to me this is my ext...and if they say they will call me say NO YOU WANT TO BE IN A CONFERENCE call....she had the other office send me the CORRECT insurance card and guess what..its the same damn card...wait till I tell her that one..I PAY 700.00 a month for this crap....I will say what you all said..Dexter I am kinda tense and all....my arthritis is acting up its cloudy and foggy and drizzling...I am not good at hard ball but hell most of my income goes to medical then they give me the run around

Thanks all I will let you know what if anything goes on when I call ROSIE back on Monday..I really liked her she was kind

[(JD)]

OH! If you are being billed for charges you don't feel you have to pay, write them saying you are DISPUTING the charges. That puts them on notice, covers you legally for the time being.. and means that they can't turn you in to credit bureas for non payment and makes them prove and reevaluate the charges. TC

[SleepsWithButterFlies]

It's FIXED...well minus the card they are still working on getting the right card...so we can end this thread cause....IT BE FIXED

THANK YOU ALL

so we can end this thread

Nice try, thread killer wannabe.

Petunia

[gardenergirl]

Glad things are worked out. Allow me to kill the thread?

gg

[SleepsWithButterFlies]

LMAO PETUNIA AND GG....Umm I wont say who but someone PMed me last night and noted I was trying to kill some threads

[TheAngryPatient]

file a complaint with your state dept. of insurance - cc; the governor's office, the attorney general's office, the district attorney's office, the office of the inspector general, the consumer services department.

if possible - write a web letter. sometimes it can be more effective if they think it is going to be published on the www right along with scanned copies of the claims, their denial letters, etc. (redact personal info though)

if you are ok with it - send a copy to the newspaper - call the consumer hotline of your local tv news - send a copy of the complaint to all your state representatives.

the court of public opinion can be pretty effective. if word gets out - less people might buy their insurance.

tell everybody you know - spread the word. when we had an issue with a doctor - we even told the cashier at the grocery store and the waitress who served our lunch and the person in line in front of us. we might ask one simple question like 'have you ever heard of "dr. so and so"? when they say "no" we would reply "UNFORTUNATELY - we have". enough said.

"never underestimate the power of the consumer. " theangrypatient.com

[SleepsWithButterFlies]

WOW THANK YOU ...Great idea I am gonna print it all out tomorrow so I have it should this be a false peace with them