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Adventures in Healthcare



September 07, 2010 – Comments (4)

For a long while, my girlfriend's employer provided both of us with heath insurance. She quit a few months ago to go back to school, so now we buy our own policies. No problem with that. We're fine with it.

But individual plans, as we're learning, are an insulting joke.

Our policies began in July. By pure coincidence, we needed medical care almost immediately. This wasn't pre-existing stuff; just random stuff that came up and needed attention.

Procedure 1: $500. Denied.

Procedure 2: $800. Denied.

Procedure 3: $1,800. Denied.

Boy, these guys are rough. But I singed the papers, and it says what's covered and what isn't. Apparently this stuff isn't. Fine.

Then, 9 days after our policies began, comes a letter notifying us that our premiums are to rise by 22%. "This is a reflection of the ongoing rise in the cost of healthcare" they tell us.

Maybe that's good news. Apparently the insurance company is paying for someone's medical care. Just not ours. 

4 Comments – Post Your Own

#1) On September 07, 2010 at 2:17 PM, vriguy (83.65) wrote:

Guess what: they probably denied the providers too.  You got some care, even though you were stuck with a bill.  The providers got your co-pay.  The insurance company paid nothing to anyone and is laughing all the way to the bank ...

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#2) On September 08, 2010 at 11:12 AM, Dow3000 (< 20) wrote:

True healthcare reform would have been soooo much did your plans cost?

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#3) On September 08, 2010 at 11:30 AM, miteycasey (29.80) wrote:

Refile the claim with the insurance company.

Look at it this way. Every claim they deny is money in their pocket. If you refile you are basically telling them "BS, your paying. Look at it again." They are most likely to pay something. This has been my experience with insurance companies.

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#4) On September 08, 2010 at 11:50 AM, zymok (25.71) wrote:

Somewhere in your policy there should be a description of an appeals process.  Find it and file.  It costs you very little - some time and a postage stamp - and may very well change their decision.  Make sure you have all your paperwork in order, including any required referral letters and diagnostic codes.  Also, check your policy carefully and make sure procedures are coded appropriately.  Sometimes closely related procedures can have drastically different coverages.  Your providers may be able to help you with this.

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