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health insurance coverage

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fishlessman
fishlessman Posts: 32,767
in Off Topic
any one finding the new trend where your ins gets denied first go around. so far an ultrasound on my leg was denied, then the medication for dvt, waiting to see what happens with todays blood work. brothers second ankle replacement in the fall was denied after being covered, first replacement june of 2020 just got denied with an 88k bill and threats of a lien. girl taking my bloodwork says most are denied first second and third go arounds. are they shooting for a covid bailout, probably
fukahwee maine

you can lead a fish to water but you can not make him drink it
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  • nolaegghead
    nolaegghead Posts: 42,102
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    Some insurance providers deny just about everything the first time.  I'm sure they find some technicality (but maybe not).  It's really not a great way to live having to deal with this for-profit middleman just to get our healthcare taken care of.
    ______________________________________________
    I love lamp..
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  • JohnInCarolina
    JohnInCarolina Posts: 30,977
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    I don't think it's a new trend.  
    "I've made a note never to piss you two off." - Stike
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  • fishlessman
    fishlessman Posts: 32,767
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    JohnInCarolina said:
    I don't think it's a new trend.  

    seems more intense now. whens the last time you got a three way call going on with the insurance and the pharmacist, whens the last time insurance paid your claim and 12 months later put a lien on your house to get it back.  an uptick i guess is i pay full health for everyone that works here on a company policy and am not allowed to get involved with their policy regarding anything, they are all on their own with the privacy laws even with regards to denial. wouldnt want to be an insurance broker right now, after you lose the health ins because of denial, suing the broker is easy
    fukahwee maine

    you can lead a fish to water but you can not make him drink it
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  • JohnInCarolina
    JohnInCarolina Posts: 30,977
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    fishlessman said:
    JohnInCarolina said:
    I don't think it's a new trend.  

    seems more intense now. whens the last time you got a three way call going on with the insurance and the pharmacist, whens the last time insurance paid your claim and 12 months later put a lien on your house to get it back.  an uptick i guess is i pay full health for everyone that works here on a company policy and am not allowed to get involved with their policy regarding anything, they are all on their own with the privacy laws even with regards to denial. wouldnt want to be an insurance broker right now, after you lose the health ins because of denial, suing the broker is easy
    I'm just going to go out on a limb here, Fish, and suggest that the health insurance I have through my employer is of a slightly different caliber than what you're looking at.  So my experience is likely to be fairly different from yours, no matter what.  

    Nevertheless, we had to fight an insurance denial just last month.  And we had one that was similar about 8 years ago.  It took forever to resolve.  Most people just give up, which is what I think the insurance companies are counting on.  
    "I've made a note never to piss you two off." - Stike
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  • fishlessman
    fishlessman Posts: 32,767
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    JohnInCarolina said:
    fishlessman said:
    JohnInCarolina said:
    I don't think it's a new trend.  

    seems more intense now. whens the last time you got a three way call going on with the insurance and the pharmacist, whens the last time insurance paid your claim and 12 months later put a lien on your house to get it back.  an uptick i guess is i pay full health for everyone that works here on a company policy and am not allowed to get involved with their policy regarding anything, they are all on their own with the privacy laws even with regards to denial. wouldnt want to be an insurance broker right now, after you lose the health ins because of denial, suing the broker is easy
    I'm just going to go out on a limb here, Fish, and suggest that the health insurance I have through my employer is of a slightly different caliber than what you're looking at.  So my experience is likely to be fairly different from yours, no matter what.  

    Nevertheless, we had to fight an insurance denial just last month.  And we had one that was similar about 8 years ago.  It took forever to resolve.  Most people just give up, which is what I think the insurance companies are counting on.  

    mostly get screwed being a 10 man shop, costs, coverages, and whatnot. big companies, universitys, etc come with alot of pull. brothers getting screwed now, two ankle replacements, second one denied, denying the first one a year later so that the second one getting denied looks more plausible.

    what pisses you off is looking at your financial statement and insurance is more than wages

    anyways, getting blood work at the diagnostic center today about these denials and they said it happens way more frequently and it needs to be pushed thru before its covered, can take several times submitting the paperwork.
    fukahwee maine

    you can lead a fish to water but you can not make him drink it
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  • HeavyG
    HeavyG Posts: 10,350
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    fishlessman said:
    JohnInCarolina said:
    fishlessman said:
    JohnInCarolina said:
    I don't think it's a new trend.  

    seems more intense now. whens the last time you got a three way call going on with the insurance and the pharmacist, whens the last time insurance paid your claim and 12 months later put a lien on your house to get it back.  an uptick i guess is i pay full health for everyone that works here on a company policy and am not allowed to get involved with their policy regarding anything, they are all on their own with the privacy laws even with regards to denial. wouldnt want to be an insurance broker right now, after you lose the health ins because of denial, suing the broker is easy
    I'm just going to go out on a limb here, Fish, and suggest that the health insurance I have through my employer is of a slightly different caliber than what you're looking at.  So my experience is likely to be fairly different from yours, no matter what.  

    Nevertheless, we had to fight an insurance denial just last month.  And we had one that was similar about 8 years ago.  It took forever to resolve.  Most people just give up, which is what I think the insurance companies are counting on.  

    mostly get screwed being a 10 man shop, costs, coverages, and whatnot. big companies, universitys, etc come with alot of pull. brothers getting screwed now, two ankle replacements, second one denied, denying the first one a year later so that the second one getting denied looks more plausible.

    what pisses you off is looking at your financial statement and insurance is more than wages

    anyways, getting blood work at the diagnostic center today about these denials and they said it happens way more frequently and it needs to be pushed thru before its covered, can take several times submitting the paperwork.

    So... are you ready for a single payer health care system in the US yet?
    “Reality is that which, when you stop believing in it, doesn't go away.” ― Philip K. Diçk




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  • fishlessman
    fishlessman Posts: 32,767
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    HeavyG said:
    fishlessman said:
    JohnInCarolina said:
    fishlessman said:
    JohnInCarolina said:
    I don't think it's a new trend.  

    seems more intense now. whens the last time you got a three way call going on with the insurance and the pharmacist, whens the last time insurance paid your claim and 12 months later put a lien on your house to get it back.  an uptick i guess is i pay full health for everyone that works here on a company policy and am not allowed to get involved with their policy regarding anything, they are all on their own with the privacy laws even with regards to denial. wouldnt want to be an insurance broker right now, after you lose the health ins because of denial, suing the broker is easy
    I'm just going to go out on a limb here, Fish, and suggest that the health insurance I have through my employer is of a slightly different caliber than what you're looking at.  So my experience is likely to be fairly different from yours, no matter what.  

    Nevertheless, we had to fight an insurance denial just last month.  And we had one that was similar about 8 years ago.  It took forever to resolve.  Most people just give up, which is what I think the insurance companies are counting on.  

    mostly get screwed being a 10 man shop, costs, coverages, and whatnot. big companies, universitys, etc come with alot of pull. brothers getting screwed now, two ankle replacements, second one denied, denying the first one a year later so that the second one getting denied looks more plausible.

    what pisses you off is looking at your financial statement and insurance is more than wages

    anyways, getting blood work at the diagnostic center today about these denials and they said it happens way more frequently and it needs to be pushed thru before its covered, can take several times submitting the paperwork.

    So... are you ready for a single payer health care system in the US yet?

    no, its not like we could go to canada for health care if we really need it.  but then again im not looking forward to next years prices nor paying all the extra into unemployment, its going to get crazy.
    fukahwee maine

    you can lead a fish to water but you can not make him drink it
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