Next time your HEALTH INSURER DECLINES a claim or pays less than you think they should

[Eliot Rosewater]

have paid, CALL THEM and argue with them.

You have to trust me on this, here is how it works:

...Unless it is a straight forward, in network physician or facility for a straight forward procedure, it is likely they will either pay nothing or far less than what they should pay...

EXAMPLE - acupuncture - is covered by most plans as an out of network procedure and if your acupuncturist gives you the right codes to bill or they do the billing, you will have an argument to make to get some reimbursement but they will almost ALWAYS initially pay you nothing.

What you DO is call them and say why? Why did you pay nothing or so little and then ask them if there is an EXCEPTION they can make...For instance with mine i have had FOUR ONE TIME ONLY EXCEPTIONS done in the past 6 weeks for acupuncture.

Insurers are crooked and you have to force them to pay you.

I was thinking of going into business and doing this for people...

[cilla4progress]

1. So true.

I fight with them all the time, for proper coverage WHICH I HAVE PAID FOR. Typical money hungry corporations. I usually succeed.

DON'T BE THE LOW-HANGING FRUIT. My motto.

[Eliot Rosewater]

2. They rely on up to 75% of the public never calling them and giving up.

[cilla4progress]

9. 26 years ago when my daughter was born,

i fought for several years for a refund for the 2nd night of hospitalization. My water broke well before she was born, and they kept us both in the hospital an extra night. Insurance tried to avoid paying the 2nd night for one of us (can't recall who) - A NEWBORN MOTHER AND BABY!

After a few years, I got my $400 back! I think the law may have even changed.

I hate fucking for-profit healthcare. It is a sham and obscenity! Goes to the core of our original sin as a country....

[Demovictory9]

12. yep.

[redstatebluegirl]

3. I spent the majority of 3 months after my back surgery arguing with Aetna.

They had refused to pay almost 10 thousand dollars worth of claims. But I had records of all of my conversations with them prior to surgery. I had emails to back up things they said they didn't have to pay. Ultimately I still had almost 6000 out of pocket but it could have been much worse.

[Eliot Rosewater]

4. MADNESS that we allow this to go on for one more day!

Even if we cant get to UHC now, surely the laws could be made so denying claims simply CANT happen.

[redstatebluegirl]

5. I wish, I will need more surgery in the next few years.

I am hoping I have medicare by then.

[mcar]

6. True story (from 22 years ago)

My 2 children are 10 years apart. Got pregnant with son #2 at age 38 thanks to the miracle of modern science. Of course, it was considered a high risk pregnancy so at the appropriate time, I had amniocentesis. All was well.

My employer provided insurance denied the claim for the amnio, saying it wasn't medically necessary.

I wrote them a letter requesting a review, outlining my circumstances and basically mocking them for their denial - how could the amnio be anything but medical necessary?

The claim was covered. The Benefits Manager kept the letter on file until she retired a few years ago.

[Eliot Rosewater]

7. If they killed you that would have been the best outcome for them.

Not really, then they stop collecting premium, but like the traitor in the WH these insurers dont care about your life, at all.

[Hoyt]

8. For what it is worth, Medicare and Medicaid do not cover acupuncture.

Both Canada's and the UK's system have very limited coverage of acupuncture.

[doc03]

10. I had ocular melanoma 14 years ago. I have done a follow up MRI

every year for my liver and pancreas since but this year my Medicare advantage insurance denied it, they said that the Medicare protocol says every other year now. A person could get liver or pancreatic cancer and be dead in a few days but they say it is only necessary every other year. Also every year I have always had the PSA test and the doctor did the digital exam on the prostate. This year they denied the digital exam saying I can only get one test a year for prostate cancer. Either the digital or PSA not both. I assume this is part of the trillion dollars Trump took out of Medicare.

[lanlady]

11. Cigna is awful!

My asthma medication jumped from a $25/monthly co-pay to a $350/monthly co-pay for what is just a stupid plastic disc with some inhaler in it. Why? Because, Cigna explained, they moved the med to a "Tier 3," whatever the hell that means. And not just the particular med I take, Breo -- all of them in the same category, like Advair and Symbicort, are exorbitantly priced now. Cigna's advice? Find a coupon on the Internet. Well, fine, I did so - for a whopping $5 off at CVS. So I refused to accept the med.

Told my doctor, who was shocked. He said to call Cigna back and tell them that people like me will start dying from asthma if they can't afford their Advair and Breo.

I'm going to call them up tomorrow and try to argue with them. It's just ridiculous! Are they really so callous? How much of this can people take?

[ecstatic]

14. That's awful! I hope you can appeal. nt

[Eliot Rosewater]

15. Call your local newspaper...anything...good luck!

[UniteFightBack]

16. Very bad publicity if asthma folks die because they can't afford price gouged medication. nt

[ecstatic]

13. Interesting. I didn't know you could do that. nt

[WhiskeyGrinder]

17. I have had people in the industry tell me that every bill should be appealed. Every. Single. One.