insurence companies SUCK

[AbbaRabbit]

Posted: 2/3/06 at 6:29pm

here's the deal: are no doctors in network that do what this doctor would be doing, so we met with the doctor, we liked her, decided she was a good match, and started the process of getting the paperwork to get aetna to cover our visit.
last week we were told that they would cover it... today they tell us they found a doctor in-network and won't pay for our doctor anymore. problem is, this doctor in-network does NOT do what we need...
we're still going to end up going to our doctor but it will cost us almost $2000 for the whole thing.
why can't insurence just cover all kinds of doctors?

[voztimbrada]

Posted: 2/3/06 at 6:51pm

I am sorry to hear about your plight. Unfortunatley, I am of the opinion that the entire insurance industry is one of the biggest scams on the face of the earth. All of 'em. Auto, Health, Property, etc. Basically, we have bought into a system of paying to be "insured" and "assured" that our damages and health will be covered when things go wrong. Then they come up with as many technicalties as possible so they can pay out as little as possible. The varioius insurance indusries generate endless millions of dollars every year. It's a crooked, disgusting industry, and I think it's unfortunate that by virtue of being American citizens, we have no choice but to get insurance. It's one of the suckiest parts of our system. I would advize fighting it tooth and nail. If you feel like you are bing wronged, check up on all the facts with all the doctors involved, then call them and mention taking this up with your lawyer. In my experience with auto insurance claims, I have found that they will offen challenge just about anything, whether it shoulod be covered or not, just to see if you will absorb the costs. A lot of people will just take their word for it and pay for it themsleves. But when you fight, and mention lawyers, their tune seems to cange really quickly a lot of the time. It's worth a try.

Updated On: 2/3/06 at 06:51 PM

[AbbaRabbit]

Posted: 2/3/06 at 7:02pm

we have been fighting it... this is probably the end of a fight that has lasted since mid-june.
i mean, by law can they do that? say they'll pay for it and then change their minds?

[Elphaba]

Posted: 2/3/06 at 7:10pm

I believe they can. I used to have Aetna until last year. You can go to any doctor, but if it's out of network, they pay less......yes it sucks.

[AbbaRabbit]

Posted: 2/3/06 at 7:16pm

that really sucks... things like that should be illeagle.

[CostumeMistress]

Posted: 2/3/06 at 7:32pm

Cheer up, you *have* insurance!

[Elphaba]

Posted: 2/3/06 at 7:38pm

excellent point!

I complained I had no shoes, until I met a man with no feet......

Posted: 2/3/06 at 7:41pm

I've seen your feet...you're not that better off

I KID!! I KID!!! I KID ElPHABA!

[Elphaba]

Posted: 2/3/06 at 7:54pm

why chita I have fabulous feet! lol

[voztimbrada]

Posted: 2/3/06 at 7:56pm

I've always disliked that "Cheer Up, look on the bright side" attitude towards suffering. It usually doesn't help. It only serves to agrivate. Suffering is suffering, and it is up to each person to deal with it and get through it how they need to. I find the comment "At least you have insurance" to be insulting, and I am sorry the originator of this thread had to read it. That's like telling somone who has cancer, "At least your not dead." The fact that one person has no insurance doesn't lessen the degree of suffering for the person that does. It's a bad situation whther they have insurance or not. Why can't we be sympathetic without telling AbbaRabbit they shouldn't be upset? Yes, there is always someone in a worse situation than your own, but it doens't mean that your situation doesn't still hurt. There's always a bright side, but it doesn't mean the darker side of things goes away. C'mon folks.
Updated On: 2/3/06 at 07:56 PM

[JerseyGirl2]

Posted: 2/3/06 at 8:14pm

Trust me Abba, it's something that so many families in your situation have to deal with. I hear it every week. There are certain doctors that do certain therapies and others that don't. The parents that get the services covered are the ones that end up fighting for every little thing they get.

[AbbaRabbit]

Posted: 2/3/06 at 9:11pm

we have been fighting, for 7 months... my doctor is fighting for us too.
we would keeo fighting but it's getting to the point where we cant keep waiting.

and thank you voztimbrada. i also thought her coment was kinda rude but i didn't want to say anything.

[YouWantitWhen????]

Posted: 2/3/06 at 10:35pm

Abba, if you have it in writing that they would initially pay, complain to your state department of insurance.

If the person in-network does not have the speciality you need, you can also appeal.

I am not sure what state you are in, but there should be a website for the state department of insurance and a consumers affairs page.

I am not sure of the specifics of your coverage, and how it is set up, but get all of the paperwork together, and if you can show a paper trail of the promise to pay, and the fact that there is no one in-network that really provides the service you need, you should fight.

Look at the terms of the policy. It may say under what conditions they will pay for an out-of-network doctor.

[EadieWasALady]

Posted: 2/3/06 at 11:08pm

Hi sweetie. Might I please ask you to correct the spelling on main the subject line? i-n-s-u-r-A-n-c-e. Insurance is my business and it is annoying to see it mis-spelled. Thanks.

[AbbaRabbit]

Posted: 2/3/06 at 11:16pm

youwantitwhen, i will have to check to see if we have it in writing. i thinkg it was just said over the phone but i will have to check. i'll try to look for a website though thanks.
we have a folder an inch think of stuff we've collected over the past 7 months.

[YouWantitWhen????]

Posted: 2/3/06 at 11:18pm

A lot of times calls are recorded for customer service lines.

Call back the insurance company and see if there is a statement saying that calls may be recorded for cusomter service and/or training purposes.

Some states require the disclosure, other states just have "beep" on the call to signify the line is being recorded. If they recorded the call, ask for a copy or a transcript if needed.

[AbbaRabbit]

Posted: 2/3/06 at 11:20pm

ok thanks! that's good to know.
we got so close to getting it paid for too! all we were waiting for was an authorization number when this happened.

[gavrochegirl]

Posted: 2/4/06 at 12:58am

"I complained I had no shoes, until I met a man with no feet......"

And I said, "Hey, Footless Dude, guess you won't mind if I take your shoes."

[Elphaba]

Posted: 2/4/06 at 11:29am

votz, thank you for your opinion, but obviously you don't know me....and apparently Abba doesn't know me as well as I thought she did. She knows I would never say anything to hurt or upset her, as I have always considered her one of my favorites here.

Votz, I have two terminal conditions, one since 1991, one probably longer, although there is no way to tell. I have been through what Abba is going through and more.

When I was diagnosed and started having the insurance problems I reacted the same way. However age puts a different perspective on things, and while I would do exactly what she is doing and fight the system, I'd also realize that was all I could do, and that things could be worse, and be damn happy things are not.

And I realized I was so much better off having any insurance than my friends in the same boat as me with NO insurance. THAT was my point which was apparently lost somewhere.

Sometimes you have to realize in the middle of all the crap, that the glass is still half full, rather than half empty.

I have had several PM's from people in regards to this issue saying the same thing. In fact I didn't even know about your post and Abba's response until just now.

Abba......sweetie, you DO know me well enough that you can always PM me if something I post bothers you. I'd rather you do that so that we can discuss it rather than you be upset.

(by the way, more stamps are coming......forgot to PM that last night)

Updated On: 2/4/06 at 11:29 AM

[AbbaRabbit]

Posted: 2/4/06 at 11:35am

elphaba nothing you said bothered me. i wasn't talking about what you had said i was talking about what someone else had said. sorry if i made you think i was angry with you. i wasn't. i'm not angry with anyone.

[Elphaba]

Posted: 2/4/06 at 11:37am

ok sweetie, cept it was me who posted the foot/shoes comment....just wanted you to know I wasn't trying to be rude......(I reserve that joy of other posters, lol)

[AbbaRabbit]

Posted: 2/4/06 at 11:40am

i sent you a pm explainging everything