Who makes health care choices now?

[JBear]

After reading SeattleGirls post, I thought I would share my interaction with an insurance company and the inane choices that they wanted me to make...

First, I have company paid insurance. I actually had a choice between several plans and I chose the one that I thought would be most appropriate for me. It was probably the lowest cost of the plans for my employer too - an HMO style plan with set co-pays and no deductable.

While on vacation I was injured. I was in fact on a ski mountain about 1.5 hours away from the nearest city. The snow patrol's assessment of my injuries told me that I probably had some broken bones (like the pain didn't tell me that). The ambulance arrives and the techs give me 2 options - 1) take the 1.5 hour ride in to the city down an icy mountain road or 2) have them take me to the orthopedic clinic 2 minutes away (no charge since they had to go that way anyway).

Long story short, I went to the clinic where they saw me immediately, discovered my separated shoulder and 2 cracked ribs, patched me up with sling and meds for a fairly reasonable price. I filed this with the insurance company who denied coverage because I was "out of network."

I appealed the decision based on the fact that this was an emergency and I did not think it required pre-clearance. Additionally it cost less to do everything than the ride to the city alone! DENIED. The clinic was not an approved emergency medical facility. At this point the insurance company has spent more fighting my claim than I paid the clinic.

Why does it make sense to keep this kind of system?? These people are NUTS!

:bounce:

[hobbit709]

1. Friend of mine had her claim denied

because even though she went to an ER on their list for her broken arm, the orthopedic surgeon on duty at the time was not in their network. It was only after she threatened legal action that they grudgingly paid.

[Ilsa]

2. My husband's doctored dumped him. He can't get in to see him

because he hasn't been sick in six years, other than a cold. He is old enough now that he needs more frequent checkups, but it looks like he is going to need to change doctors.

[HopeHoops]

3. Death panels

It is called "pre-approval".