I'm sorry, but your earache is a pre-existing condition.

Last December I went to Eloy, AZ to go skydiving between Christmas and New Year's. Two days after Christmas I got an earache that wouldn't go away so I left earlier than I wanted to and returned to San Diego. Basically, my left ear wouldn't 'clear.'

I tried Benedryl, Sudafed, Tylenol Cold & Sinus to try to get my ear to clear but nothing worked.

On January 17th I finally went to my doctor and he told me I had a eustation tube dysfunction. He gave me an anti-biotic and it cleared up after a week.

My insurance company is now refusing to pay the $45.15 bill for the doctor visit because they claim it was a pre-existing condition, even though I hadn't been to the doctor in 14 months prior to this.

I am tired of having to pay close to $200 a month for insurance only for the insurance company to deny paying the bill when it comes due.

So I'll be wasting another 3 or 4 hours today fucking around with this goddamn insurance company because there's not way in hell that I'll be paying for this doctor's visit.

/rant

You have to go to the doctor when you're healthy. Because anything you have before you get there is preexisting. The only thing they'll cover is stuff you pick up while you're at the doctor's office.

:-P

Insurance company policymakers should be hunted for sport.

The last visit I had previous to this one was for a regular blood test to check my cholesterol levels and blood sugars.

Because the previous year's blood test showed slightly elevated cholesterol levels, but not high enough to be treated, the insurance company refused to pay for the blood tests. My test results did show that my cholesterol levels dropped back into the healthy range by a combination of diet & exercise.

It took me close to 9 months of fighting with the insurance company before they finally paid the bill.

Between this type of crap, and trying to translate taxes, we're wasting an amazing amount of time.

What a wonderful idea.

Their enablers as well--wet and naked, through a mosquito-ridden terrain, with giant rubber band shooters and slingshots and sharp rocks.

can sometimes win.

of course, it is a preexisting condition.:sarcasm:

These companies want only profit. You are not supposed to get sick and make them pay the bills. That hurts their bottom line!

Bastards.

It's funny, but even as a kid I've never had ear problems.

And this company is incredibly myopic. This will cost them way more than $45.15 in wasted time and productivity for the worker(s) that I'm going to involve in getting them to pay this bill.

everything is a preexisting condition. You pay only 200 a month for insurance? Ours is over 900.00 per month and will go up at retirement.

And that $200 a month is just for me, it's partially work-subsidized (and they're not paying much) and has a $2500 deductible for anything major.

We pay almost $800 per month for Blue Cross Blue Shield family coverage. We have an HMO option at the University we work at, but opted for the BC/BS to avoid hassles. We are lucky in that we can afford it, but we aren't rich so it does take a chunk out of the paycheck.

A few weeks ago my wife started lactating. Not being pregnant, there is really only one explanation for this which is a pituitary tumor. My wife is a physician and diagnosed herself then went to her physician and they both agreed that this was the obvious cause. The next step is to have an MRI to locate a tumor and see what the size is, but first a routine blood hormone level was run. The level was lower than they would have thought, but the presence of lactation indicated an MRI.

Blue Cross denied coverage for the MRI because the hormone levels weren't high enough yet. So, in essence, she must wait for the tumor to get bigger in order to get an increased hormone level so she can get an MRI to verify a tumor exists.

Priceless.

Needless to say, I'll be canceling my very expensive health insurance for the HMO plan which, we found out, would have paid for the MRI without question.

I hate insurance companies.

That is incredibly horrifying.

I pray that your wife makes a full recovery.

I'm sure she will. The pituitary condition is more common than one would imagine and the procedure is less risky than most operations near the brain.

I'm sorry to hear about your insurance nightmare.

We need single payer insurance in this country now more than ever. The insurance companies are getting worse and worse.

I had chronic ear infections for many years and I thought the bacteria had built condominiums in my eustation tubes and used bottles and bottles of Otic solution.

They were recurrent for a long time and really painful.

I used to take the high speed express elevator in the IDS tower in Minneapolis just to alleviate the pressure.

I finally got permanent relief by using Mullein oil topically (available at health food stores) and a singular 20 minute acupuncture treatment.

It worked for me and you may want to consider the doing the same.

Hope you feel better very soon.

HMO's are total scam artists. BTW

... it's "eustachian tube".

Yours truly,
The Spelling Police

Stories like the ones you all are telling here are why I no longer work there. I just couldn't take it anymore. Sadly, when I saw "Sicko," it really didn't tell me anything new.

Yes, insurance company policymakers should be hunted for sport. They are the lowest form of life.

you have a body that it susciptible to illness. Likewise with injury.

Until we outlaw "pre-exising condition" exceptions in health insurance, we will all suffer from nonsense like this.

So I guess all of humanity is not covered.
Yep, I'm about right!
Sigh.

Hope you get this resolved.

I am a health care provider, small business, do my own medical billing. Not an absolute expert, but it is what I do and have done for many yrs.

Question first, can you tell us which ins company it is?

Ideas: Some ins co's routinely deny many bills on the first time through. Resubmit it, or have doctor's office resubmit it, with chart notes saying not pre-existing. This is a game they play, if they can get you so frustrated you pay, they don't have to and make more money and, after all, that is what they are in business for. Making money. Keep it civil (hard to do), keep repeating, work your way up the ladder. It is a pain because it is wasting your time and your money. Oh yes, good to do it all by mail.

If it comes down to it, see if your state has an Insurance Commisioner (we do in WA) as they often act as advocates between ins so and people.

I had a co who denied my prenatal visits (think one of the BC/BS ones) 20 yrs ago as they never received any of my bills. I ended up having to mail them in "receipt requested" for them to get them. Odd, eh?

Now I'm dealing with what should have been billed as a routine office visit got put in the system as an ER visit.

Best of luck and yes, it is frustrating. Their time is worth money and yours isn't. Hope your ear feels better too.

That's how it works. They will deny a claim even though it may look entirely legitimate because there's money in it for them. A lot of claimants will accept this as the final word so it works out pretty good for the people at the Ins Co usually.

Too bad there's no way to find out, as far as I know.

...you're expected to do one of three things: stay healthy, get sick and go bankrupt, or die. People who go with options "A" or "C" are "good," according to insurance company actuaries, because they're not costing the company any money.

Those in the "B" group are "bad" because they'll cost the system way more than they're worth and some poor for-profit entity is going to get stuck with the bill. So the industry does what it can to quietly move them from the "B" group to the "C" group. Amazing how effective denial of coverage can be when applied as a lethal weapon.

Thing is, we're not really talking about medical insurance; it's protection money paid to an organized crime syndicate to keep medical providers from stealing your house, cars, bank accounts and anything else that isn't fused to the earth's core in case something serious (i.e., expensive and maybe requiring hospitalization) happens to you.

The US is unique in the world in its child-like belief in corporate good citizenship and the intrinsic benevolence of a medical system based solely on profits. This is not only naive, it can't happen under US law and SEC regulations that demand a publicly owned, for-profit corporation base its entire business model on achieving one single objective: maximizing shareholder equity.

Anything that bumps the stock price is good, and anything that lowers it is bad. So paying claims is bad because it sucks money from the bottom line, while not paying claims is great because it saves money that contributes to corporate profitability, which ultimately helps raise the price of the stock, keeps the investors happy and keeps the SEC off the CFO's back for another quarter.

In short, it's literally impossible for a US for-profit publicly held medical insurer to live up to its opposing obligations to both its subscribers and shareholders at the same time. And, as noted above, if somebody has to get screwed, by law it's going to be the peasants.

Sounds like a case study in dysfunctional systems with a built-in set of unresolvable problems to me. You'd think it would never be allowed to get off the ground in a country whose leaders have even a shred of common sense. Unfortunately, we're talking about America here and we routinely choose leaders -- or have them chosen for us -- who are senseless, often stupid, generally uncaring, sometimes completely insane; and in the present case, all of the above.

Medical insurance has nothing whatsoever to do with health care except in the twisted minds of Chicago School libertarian fanatics and free market pitchmen. Break that nonsensical, artificial link, dump the idea of for-profit medicine entirely, replace it with a single-payer, universal-access system and spread the risk over the entire population in the form of a modest, progressive tax.

In other words, take a hint from the rest of the modern world where people pay far less per capita for their health care, never see a doctor or hospital bill and enjoy far better outcomes than in the US -- lower infant mortality rates, longer average disease-free life spans, a focus on preventative rather than reactive care, fewer stress-related illnesses and deaths per capita, and on and on and on.

And here's the final insult: We suck at keeping people healthy although we spend far more money pretending to try than any other country in the world. Here's some info I got from doing a sort on the World Health Organization database and, lookie there, the US spends more money as a percentage of GDP than any other country in Europe or the Americas.

Which is bad enough, since most of these other countries manage to spend far less and still provide universal access to health care for all. But then you look at this chart and discover that the US ranks 37th in the world in overall effectiveness of its health care system -- right ahead of that medical nirvana, Slovenia.

Finally, here's an article I wrote in January on single-payer that might interest you if you haven't had enough of my writing style yet.


wp

"Thing is, we're not really talking about medical insurance; it's protection money paid to an organized crime syndicate to keep medical providers from stealing your house, cars, bank accounts and anything else that isn't fused to the earth's core in case something serious (i.e., expensive and maybe requiring hospitalization) happens to you. "

That's what a Rethug acquaintance of mine bleated when I ranted to her about how evil and disgusting American health insurance companies have become. "Look at Canada," she said. "People have to get on waiting lists for care."

I told her about an old friend of mine who found a small black spot on her face. She went to see a doctor, who told her it was nothing. She tried to get a second opinion, and it took weeks to get approval to do that. The second doctor sent her to a specialist, and again there was a long wait for approval and for an appointment. The specialist sent her to a different specialist. And so on.

By the time my friend was able to get scheduled for an operation to remove the malignant melanoma, it had claimed 1/3 of her entire face, including one eye.

THIS is what we get with CAPITALISTIC medicine.

It's failed us completely. Time to try single-payer.

I've been furious in the abstract about this so-called health care system for decades, but I've generally had good jobs with full benefits for a long time so my fury remained theoretical until I got my own personal education in the American way of medicine, watching helplessly as a friend was victimized by soulless parasites for whom the bottom line is the only thing that matters.

About 10 years ago, a friend of mine in Santa Cruz, Calif. started having cramps and sharp pains that became increasingly severe over the next couple of months. She was a part-time music teacher in the SC school system and local performing musician, so no benefits.

Her family doc was one of those old-school, pre-managed care saints who aren't in medicine for the money. He had a pretty good idea what was going on, but to be sure he set her up with a gastroenterologist friend who had the same ideas about the relationship between money and medicine. This high-dollar specialist saw her the same day for free and diagnosed her as probably having stage one colon cancer.

He was 95 percent certain, but needed her to have a couple of routine tests to confirm it -- some blood work, a urinalysis, stool sample. Of course, she would have had to pay for these out-of-pocket with money she didn't have, but this specialist snuck her into the lab at a local hospital, drew her blood himself, gave her a cup to pee into, gave her the stool sample kit to take with her, gave the blood and urine to a tech who also happened to be his daughter in law, and got the results in a day which, unfortunately, confirmed his preliminary diagnosis and which was then re-confirmed by the stool sample test results.

Which is when the American way of medical murder kicked in. Even though the specialist would have been fine continuing to treat her for nothing or close to it, she needed an MRI to get a fix on location, size, presence of secondary tumors, and so forth. This would have helped determine the course of treatment. However, the MRI would have cost more than $1,000 that she also didn't have.

And that was just the beginning. Depending on what the MRI showed, it was almost guaranteed that surgery to remove the cancerous mass would be required, followed by radiation and maybe chemo to keep the cancer from returning; things that are only possible in a hospital and cost a fortune. No insurance, no way to pay; no way to pay; no hospital; no hospital, no treatment. And no more social safety net, thanks to years of GOP "reforms."

Cruelest of all, no way to qualify for even the miserable pittance still available through state or local govt. assistance programs like MediCal unless she, her husband, both their families and every single relative the govt. snoops could possibly find were all so completely broke that even pooling all their pocket change, they still couldn't come up with a lousy buck for a cup of coffee.

So she tried to get individual coverage on the open market, but that's nearly impossible unless you're young, healthy and preferably rich, because the premiums are insane. And since she was neither young nor healthy -- with the added gotcha that now she had an expensive pre-existing condition -- it didn't matter how much money she did or didn't have, since she was now uninsurable at any price.

By the time she finally found a county government program that would cover most of her medical expenses, she had gone from stage one -- the point at which she first experienced pain -- to stage three. Stage one is no big deal these days; most people recover just fine with proper care. The higher the number, the more damage it's doing and the more difficult it is to get rid of. And the more painful, particularly when the meds are so expensive that she could only afford to take half the prescribed dose so they'd last twice as long.

So... thus far, the American way of medicine had refused to insure her, which meant she was denied access to hospitals, which made effective treatment impossible. The two docs who took their Hippocratic oaths seriously could only do so much until they ran up against the accountants and the cheesy remains of the so-called safety net, which though never even close to what's available to everyone in civilized countries, at least had provisions to help the non-rich deal with the lunacy of for-profit medicine.

But timing is everything and, even though the local program finally gave her access to quality care in a good hospital, stage three had become stage four. There is no stage five. So she died after another couple of months, leaving a husband and two kids, a bunch of friends and a few seriously pissed off activists who have made it their second job to bring this truly shitty system down once and for all.

It's gratifying to see -- at last -- that the American people are finally starting to understand how badly they've been conned, lied to, manipulated and in many cases bankrupted by this national tragedy and international joke. But you saw what happened to Kucinich, the only candidate talking about single-payer.

Mass media and the DLC essentially cut him out of the picture -- literally at times -- leaving the field to people who are talking about universal "coverage," which is a hell of a lot different than universal access. "Coverage" is just code for insurance, which means keeping the same parasitic sons of bitches in the game so they can continue to profit from misery and death. Such is the grand plan floated by Ms. Clinton, the altruist and the peoples' pal.

I think Obama's plan isn't much different, but I'm not completely sure. I sincerely hope not, but he's getting an awful lot of campaign money from the for-profit medical swine -- second only to Ms. Clinton so far, with the old uninsurable bastard himself and his pre-existing everything running a distant third.

Fortunately for him, the other two, every single member of congress, and higher-ups throughout the judiciary and the executive branches, taxpayers will provide care for them and their immediate families -- for life. And this is the plan they say we can't have because, I suppose, we're just not important enough.

Rat fuckers and thieves, the whole lot.


wp

And every other civilized country on this planet gets this. Would you please e-mail this to McCain, Clinton, and Obama? Oh, wait -- the last two at least have some idea of what you're saying.

"What we have now is predatory capitalism which makes of the American people a cash crop for the insurance companies"

of warren pease's post just upthread. Anyone who hasn't read it, please do.

that they had preapproved and paid more than a year prior. They did it by taking the money from other patients' accounts, forcing the provider to pass the bill along to us. That's as much as my freaking car is worth, and we were completely blindsided (Blue Cross didn't even bother to notify us).

I naturally appealed, and Blue Cross "approved" my appeal...by sliding the claims into a different category under which they could also deny them.

I'm sure that is illegal as heck, but I don't know what else I can do. My wife and I are both so burned out from dealing with insurance companies that I don't know if I can keep appealing this crap, which I'm sure is exactly what Blue Cross intended.

Fuck 'em. I will send my credit to hell before I will pay for the racket that I got caught up in, so yeah piss on them!

WP, I've always held your opinion and your writing style in great esteem.

Thank you for your contributions to my thread.

You will make several calls and get VERY irritated and finally they give-in.


That's the system.