I'm covered under my husband's policy. He works for a government agency. I'm having knee surgery next week, and BCBS told me I didn't need precertification, but they are "UNDER NO OBLIGATION TO PAY FOR THE SURGERY" and they won't tell me it's covered until AFTER the surgery when they "review" it to decide if it was necessary or not.

EXCUSE ME??????

And Obama and the fine ladies and gentlement in ELECTED (????) OFFICE are telling me I'm going to HAVE TO buy insurance? That I HAVE TO support this bullshit or I could go to jail? :nuke:

Are we all going to sit around until after we're all completely broke and destitute before we start raising hell about this?

What in the hell is a "representative democracy" anyway? 300 million people BEGGING the rich and powerful to do what any "moran" can see is the right thing to do anyway?

Why do we have to beg & plead for our government to protect us from the corporations that are ruining our lives and our country?

I just feel like going postal on their asses right now. And I know full good and well that my husband and I are WAY better off than probably 70% of the people who live in our community. People who are in a more hopeless position must be out of their wits with worry and grief.

This shit has to stop.

On edit: I forgot to put "moran" in quotes. :rant:

Good luck with the procedure and with the coverage but it sounds like they do it all by the "dart board" method.

So surgery is really new for me, and I'm absolutely astonished at what a mess I've encountered approaching this experience. And my surgeon is the guy who operates on the Carolina Hurricanes....evidently the best (at least the most popular) orthopedic surgeon in Raleigh.

and haven't had similar issues; one daughter had ACL surgery, covered. U.S. govt bc/bs. Do you have 'preferred providers?'

Public "option" available to 5% of the people being FORCED to purchase insurance, the "option" to be FORCED to purchase insurance from a so-called "public plan" administered by the same companies instead.

Which half the party is now clamoring for would be a fig leaf administered by the exact same companies competing against themselves in a classic Clinton-era scheme.

Like hiring the cigarette cos to run anti-smoking ads.

Like the Telecom Bill requiring the new nationwide monopolies created to set up subsidiaries to provide the appearance of competition in certain markets.

Like Welfare and Public Housing setting up "boutique" programs for the "hard cases" while slashing funds for everyone else and passing laws requiring them to rely on the private sector if they are not one of the 5%.

When did these "enlightened, educated, upper middle class" supposedly liberal types who stand to benefit from this bill, stop learning Econ? Oh, I forgot, we're talking about people in the Democratic Party who were ALWAYS conservative on economic issues, masked by their support for government spending.

people don't get this. Sure, insurers won't be able to deny coverage. Good for them; they'll get those premium payments. However, the crux of it is in denial of claims.


Denial of claims!

Denial of claims!

Coverage means your claim will be paid. If they don't pay the claim, then you are NOT covered.

Unfortunately, that is not insurance company logic.

what a racket

MEGA MEGA BIG BUCKS plus any LEGAL FEES for failure to show good faith.

(But read your policy first. Make sure that the surgery you need is not specifically excluded. Then read it again to see if there is any ambiguous language about what they can and cannot deny.)

If they still refuse to precertify and pay the costs of the surgery, consult a lawyer.

The doctor's office has plenty of experience with this. Unfortunately, it's been going on for many, many years.

They are telling you that they will be reviewing your file to find any concievable pre-existing condition, detail you failed to mention in your medical disclosure on your application, or anything else they can think of.

The reason they state it this way is so they can honestly say when asked by government auditors or your lawyer that they DID NOT deny your treatment. They are just researving the right to deny paying for it.

If it was up to me I would line every insurance company major investor, administrator, CEO, or high level manager in the country and shoot them all. As far as I can tell they are the scum of the planet and we would be better off without them.

I hope you appreciate I've stopped making political donations and I'm now giving that money to:

http://www.freeclinics.us/

Because not only do I think they do great work, I honestly hope their work will SHAME our country into doing the right thing...

We're certainly all going to need them soon.

He could call BCBS and get the matter straightened out. I am not kidding. A friend of mine worked at BCBS and he took the calls from Helms office and his instructions were that if Jesse called his constituent got paid or covered.

Maybe you should try Kay's office. Can't hurt.

That's why he was re-elected so many times. Nobody since him has done much of anything for anyone except themselves. Kay is useless.

Yeah.... you go right ahead and keep on believing that!

rep David Price got one of my co-workers off of the no-fly list.

A sad, and painful truth it is.

I am making that part of my sig line later today.

Really great notion.

and my real worry is how to pay for the minimal care I've gotten, not about how to kowtow to some fucking bureaucrat in a cubicle whose job description is to deny coverage to as many people as possible to fatten the company's bottom line.

I've missed that much stress, anyway.

Did you get that little snot's name? It seems he needs a call from your doctor to get that surgery pre approved.

And yes, they ARE under an obligation to pay for any necessary surgery and no one in his or her right mind would ever have a knee replacement unless there were really no alternative but a wheelchair.

I'm sorry those assholes are putting you though this. People facing surgery don't need to face the uncertainty of getting it paid for because some shit on the phone hasn't read the terms of your policy.

There has to be a special place in hell for these people, even though I don't believe in heaven or hell.

Tell him that unless you are assured that your insurance will pay for it ahead of time that the surgery is OFF.

Yeah, I said it...have had multiple, major surgeries and unless it's an emergency situation you can have a few days to play dat hardball game.

Another idea is to get your husband to contact HR in his company and get them to raise holy hell with the insurance provider (we did that once before when BC/BS was in a stand-off with a certain pediatric orthopedic surgeon in Jacksonville and the insurance company finally flinched).

promise me they would cover it until they reviewed it after it was all over with. They said they were under "no obligation to pay for it, pending a review AFTER the surgery" when the bills are submitted, but that "pre-certification" was not required.

In other words....they just wanted me to know that my insurance coverage doesn't PROMISE me a damned thing.

who get to decide if it was necessary....but they also don't tell you until it's over.

Do they have us where they want us, or what? We pay them an annuity every month (a huge annuity, by most standards), and they can willy-nilly decide if they'll uphold their end of the bargain.

And our legislators ALLOW them to get away with this. Up til now, the "conservative"/capitalist view is that I don't HAVE to buy insurance at all, so why should the congress step in and interfere with a contract between two parties?

Things are so screwed up in our health care industry that the system really needs to collapse before they collapse the whole country.

Did you hear that Congress-they are coming after your health care benefits too!

Yes it does!

And we need to clean out DC ASAP because the current occupants will NOT stop this shit.

(Very sorry that you have to put up with this nonsense)

and to have to face this, too, is ....well, it is SO unnecessary.

If you need knee surgery, and your Dr says you need the surgery, it will be covered.

Hope that helps.

which is what made me so furious. They made sure I knew that they were the ones with the power .... not the doctor, not the hospital, and CERTAINLY not me! And as I continued to ask questions about it (and I didn't get snarky or sarcastic about it, which I'm usually prone to do after a while), she made it more and more clear that their review is what decides...nothing else decides. She was the "precertification" person; Customer service told me the same thing.

What they could have said to you instead is that knee surgery is a covered service, subject to the terms of the policy.

"elective" procedure that they wouldn't pay for. As long as your doctor told you to get it done and gave you a referral or some doctor at least told you to get it done, they'll pay for it.

I couldn't get any real answers to my questions before we had to make the decision. Like how much will I have to pay out of pocket for my very, very, very expensive treatment that I must have to remain on this earth.

None of the companies would give me that answer before we had to choose. We wound up just going with the company who had the best cap on annual out of pocket expenses, even though we were terrified we'd hit the cap in the first month.

ANY procedure these days is pretty expensive, it seems. It's like pinning the tail on the donkey .... nobody's sure you're going to get coverage or not until it's all over.

procedures. I can't imagine they're really concerned about your pain and suffering so that certainly isn't in their equation.

Another popular trick is to make people 'uncomfortable' with getting psych services. They use nurses with scripts that push the 'stigma' button. It's a sick industry that is not focused on health care.

(I have no ins.) She told me it was such a rip-off that, I was better off not having it.
:shrug:

you BUY insurance.

It's certainly not a "health care" bill....it's an insurance company support bill.

Insurance through my wifes employment at local hospital. Insurance co. never settled until I was receiving threats from the hospital, surgeon, and anesthesiologist. Months went by. At least once a week I would get a call from some agent of the insurance company that would typically start a conversation by asking me when the "accident" occurred. Repeatedly I would explain the injury, time and life style related, and they would act as if this was the first time they heard it. They were repeatedly trying to entrap me into some indication of an accident that would then be some other insurance companies responsibility. Finally, after so many of these calls I lost track, I confronted the caller and asked pointedly if they were following a set of instructions designed to deny me coverage. The caller, just someone with the job to do, broke down and admitted to me what they were paid to do with enough remorse I feel sorry for anyone who is so employed. I then called the office at the hospital where my wife works and told them of the situation, as well as all the parties waiting for dispersement of funds. They were all furious at the situation, calls, I am sure were made, and I never received another call.
You must take an active approach to these people and let them know that you know what they are up to.

It could have ruined your credit....and these days, they'll deny credit for no reason whatsoever, it seems. I'm glad you got to the bottom of it!

Especially if they get the idea, in a non-threatening way, that they may become personally involved in "legal difficulties". Keep track of calls, who you talked to, extension#'s, etc.. I have had some success with the phrases "acting in bad faith" and "fair dealing".
Depending on the person I'm dealing with, sympathy with them for being "set up" by their employers can be useful - as in randr''s example.

Don't you realize what you're doing to your insurance company? It's going to cost them a lot of money! I know it's all fun and games to go to the hospital, but you need to be more considerate of Blue Cross.




/sarcasm

How could I be so ..... selfish????

...needs a good cleaning?

Jewelry cleaner is expensive!

Can't slow down the "service" economy the republicans are so proud of!

corporate junkets, a small fleet of jets, new high rise office buildings with corner offices, and country club memberships among other things. How insensitive of you. You most assuredly are a terrorist practicing class warfare and totally ungrateful that you even have an 800 insurance number to call.

Sounds illegal to me. Get them to try and rectify the situation.

This is nothing new and it certainly won't be the first time the DOI will have heard about it. Standard practice (for 20 years or more) is that no insurer will guarantee payment of a bill they haven't even seen yet and that wording is required by the various states to reinforce that fact so that they don't have to play referee if someone tries to assert that they were guaranteed payment of a claim that has yet to be presented. This way, the insurance company has a recording of the fact that they told the patient/hospital/doctor outright no such guarantee was given. Doesn't mean that there won't be grounds to challenge a denial if that happens, just to avoid an argument about what was and wasn't promised before the fact.

Ask the insurance department in any hospital or doctor's office if they don't hear that statement each and every time they call to certify that the patient does, in fact, have insurance coverage. I promise you, they'll say that they do.

Then we need NO MANDATE whatsoever. Being forced to support an industry that has willingly and systematically killed thousands of Americans, and put even more out on the streets, is the biggest domestic crime against humanity this country has faced since the internment of the Japanese-Americans during WWII. I think this is bigger.

Welcome to the desert of the REAL.

and then at a later date, when it;s impossible to live with and surgery gets scheduled again, they will refer to the cancellation and deem it "elective" and unnecessary..

but it makes perfect sense doesn't it?

need to feel some pain....

Ask them to check with BCBS to see if it's covered. Raise almighty hell with them and give them the name of the woman you spoke with.

at this point if they won't pay would it even matter if you had it or not? Just wondering

It's really painful, and the doctor said it's going to keep getting worse unless I get it fixed.

I wish you the best of care and a speedy recovery.

Needles, knives and all. Not my thing at all. Is your knee ok? Was it awful?

I retired from the NC school system (Raleigh). First, I have had surgery on both knees...when I was much younger. I had no problems until I got older and developed arthiritus (sp) in both knees. Secondly, in the '90's, when Jim Hunt had to balance the budget, he did so by freezing teachers' salaries. The "health insurance" became so expensive, I had to drop my wife from coverage. Third, I solved my health insurance problems by moving to Prince Edward Island, Canada. Good Luck to you; I hope you prevail with BCBS.

I remember when Jim Hunt froze the teachers' salaries....ouch. Lucky you moving to Canada!

Torn cartilage is not something that is always operated on. It can dangle there for decades and after the swelling is gone the knee works about as usual. Depends on location and severity. Maybe you should get a second opinion on it - 2 recs for surgery may sway the insurer. Or you may find out you can avoid the surgery altogether.

a couple of weeks ago & it's not getting better, and this time I really can't walk.

I just got back from the doctor's office for my pre-op consult, and saw my MRI results(which Blue Cross DOES NOT PAY FOR under our policy..go figure) on the doctor's computer. My knee is more of a mess than he thought it was....I was pretty sure it was more of a mess than he thought it was.

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after my girlfriend got foot surgery and was prescribed a wheelchair. Insurance would not commit to whether they would pay for it.

I rarely go off on company representatives, but boy was that rep glad for the end of that call.

Very frustrating!

There was a clinic here that wanted to do the testing.
The last time around they had referred me to another facility
because they knew THEY weren't covered to do it...

This time they said that MAYBE they were covered to do it,
that I'd have to find out for myself by calling my out-of-state
insurance carrier and getting the OK.

After 2 FRUSTRATING hours with the insurance people, I STILL
didn't know.

I told the clinic that I would just go back to the old place,
and the clerk got really snotty with me.
She couldn't understand why it would matter to me whether I
paid $600 for tests or a $30.00 co-pay. Pissed me off.

:crazy:

They are not messing with me as much as they are with you--but they
are ticking me off.

I am so sorry this is happening. It is maddening! I can't believe that it
has come to this. We have insurance, but the insurance company flat out tells
you that it won't tell if you they'll pay--and that they're under no obligation
to pay. What? That is so absurd.

I knew this would happen. After the health-insurance legislation failure--these companies
now know that they're untouchable. They own our government and they know it. So, they
can abuse us any way they want. I'm sorry to not be an uplifting voice, but this is
only going to get worse, because HCR is dead and they know they can do whatever they
want.

I'm so sorry!

My situation is that I owe $1,000 for a CPAP machine. I purchased it in Sept. I had
to pay a $500 co-pay. I was just informed that this co-pay starts over in Jan. So...I have
to pay another $500! I am paying $1,000 for a machine, that I would have paid only $500
for if I had purchased it in Jan. It's ridiculous. I've argued with them, that this
is unfair--but so far I'm not getting anywhere with them. Can't say I'm shocked...

Best of luck to all of us.

Which is one more issue!! BCBS doesn't pay for any type of medical "hardware" under our policy. After the sleep study, they told me a CPAP machine would cost me $1,300. I told them my ins. co. wouldn't pay for it, and that I don't HAVE $1,300. So they said they'd sell me a "rebuilt" machine for $300 to $600. I told them to give me the $300 one.

The truth is, if it wasn't for insurance companies, we'd all probably be paying so much less for our health care industry.

You're so right about the insurance companies now KNOWING they're untouchable. Congress has so publicly screwed the pooch on this.

they would pay the rental AFTER the yearly deductible, but wouldn't just pay to purchase the muscle stimulator which had been ordered for me via PT. I ended up buying one NEW from the company who provided it for less than half that year's deductible. Now I can use it whenever. Supplies are fairly inexpensive and don't need to be replaced that often.

Same with our nebulizers, BCBS didn't want to pay for us to buy three of them for the family (there are 5 of us with serious asthma). We needed to keep one at two different schools and one at home. We finally got a script from the doctor(s) and bought them new. BCBS sucks!!

I'll end up paying $1,000 for a machine that probably cost about $1,000!

What a total con game they've got going on! They charge me $1,000--and pad the bill and
make it look as if I'm paying $1,000 for a $2,500 machine---that they probably paid $200 for!!!

Grrrr............

the machine, the price dropped dramatically. The whole industry is one big con game, and all of us are the suckers.

some time ago. Supreme Court Justices and representatives should have to wear the logos of their bribing corporations on their clothing when they are working.

And corporations have no feelings, no morals. They are sociopaths, and they own us.

n/t

people for not buying medical insurance. If you are unable, please go crawl back under that rock you came from.

Don't they tell you people when your memes wear out so you can toss new ones around??

If you don't pay the fine you go to jail.
What, you think they just ask pretty please over and over until you pay it?

Edited to add: Actually it's more likely they'll just fine you for not paying the fine, with interest. It's rare they put low end tax dodgers (Which is what you'll be) in jail. They just fine you. Because the solution to people that can't afford something is to trap them in an ever increasing network of fines they can't pay. At least until they owe enough to put them in jail over.

That was the senate's HC version. You know, the one that sucked so badly everyone hated it? Yeah. That one.

Go ahead, move those goalposts one more time.

Seriously?

OK, what do you think taxes are? What do you think happens when you don't pay them?

If you choose to be a citizen of America (We're free to leave at any time) then you agree to fund the systems that our (increasingly un-)representative government has enacted into law. Taxes are your 'membership fee'.

If health insurance becomes mandatory or some other system of government-funded coverage is created, then we citizens will fund it. Whether you want to call it a fee or a tax, it makes no difference. You have to pay.

You may not want to pay for roads or clean water or safe food, but it's been decided that we all must pay for these things.

We have a sitting Dem President with majorities in both the House and the Senate. There is no acceptable reason why Dems cannot deliver meaningful healthcare reform. The President clearly lacks a principled commitment to delivering such reform. He is however quite interested in the appearance of having made an effort to do so. Fuck him.

I haven't seen a doctor for any reason in nearly 15 years. I don't have the luxury of waiting another couple of decades for the issue to be revisited. I fully expect to live a life that is unnecessarily diminished and shortened by my lack of access to healthcare. And I know that life is far to short for me to settle for voting for candidates that do not serve to advance or protect my needs and interests. Especially the very basic needs that sustain life.

If Obama has a progressive Dem opponent in the primaries than the challenger will get my vote. And likely a third party progressive candidate in the general election.

And, no, a Dem that does not serve to advance or protect my needs and interests is not an improvement over a puke who does likewise. Both are utterly useless to me.

While I have referrenced Obama here in this post let me be clear and say that I have similar feelings about many incumbents in both parties.

The entire election process is so FUBAR that who we vote for doesn't even matter anymore. The corporations just got permission from the Supremes to buy the legislators without reservation, shame or impunity, and the corporations already owned the voting machines. Now we're going to have this MANDATE to buy crap from the insurance companies.

I hope you are able to get medicare before you get too sick to appreciate it. That is, if we still have medicare after the next 2 "elections" where the republicans start getting back in the majority.

I'm a throwaway - and many years away from being old enough to qualify for Medicare. And I am not unique. There are millions more like me.

Yeah, I'm hoping this clusterfuck proposed insurance reform legislation with the mandate goes down in flames.

I understand it is your surgeon's responsibility to obtain authorization. BCBS asked for a lot of BS information and did not approve my surgery until a few days before my surgery. If your surgery is necessary, it most likely will be approved. Don't give up. I think they create this agravation hoping that people will give up and opt to suffer. They are truly evil.

They should be outlawed instead of mandated.

nm

One of the things that the legislation provides for is a uniform (and extensive) package of required benefit coverage that ALL insurers would have to provide. They wouldn't be able to arbitrarily not cover needed procedures, as they are now able to.

It appears that there are not going to be proper price controls on the insurance we're all going to be forced to buy. An extensive and uniform package of benefits would be really nice. But you and I both know the insurance companies are raising their rates by huge percentages right now, and they are the ones writing the legislation, if the truth was told.

The ins. co's may be giving an inch in any legislation that gets passed, but they're taking a mile.

My idea of "comprehensive" is NOT paying 40% of costs up front. That is useless garbage that actively interferes with your ability to pay ongoing expenses.

Just kidding! :sarcasm:

I'm very sorry and I completely agree. I'm sick of busting my ass and giving hard=earned scarce dollars to these back stabbing politicians, just to get called a "retard" or "lunatic left" by them.
I hate them all with a white hot passion. I actively fight against this crap to get our party back. If not possible, to get some opposition to corporatism.

I was pre approved and AFTER the bill was sent my insurance refused to pay. I fought it hard, but they sent me to collections so I had to pay or I would never be able to rent a house - no living indoors!?!?

"On February 17 spoke with Joe Blow at 10:15 am. He said.... I said.... " yada yada yada

Everything should go in that file.

There's some good advice in this thread. Best of luck to you in dealing with the people who work for these bastards, and swift healing.

Hekate

I've been writing everything down as you suggested.

ERS (Employees Retirement System) says it is in the hole and will need to either raise premiums, raise deductibles and co-payments or some combination. Now, the state pays the premiums of employees but not coverage of dependents. But now they are talking about making the employee pay. This would, in effect, be a pay cut and, no matter what you want to believe, state employee pay (especially in the fucking hellhole that is Texas state government) is pretty bad. I have had some cost of living increases in the last five years but not enough to actually keep up with the actual cost of living, which goes up faster all the time.

If we had single payer health care this would not be an issue.

But I am leaving this hellhole of a state as soon as I possible can, hopefully for the much greener pastures of Oregon.

Unemployment is super high here!

No, I wouldn't move without a job already lined up.

I wish you great success. I'll be out looking as soon as I can walk again! They say the economy is picking up in some sectors, so I hope we can find jobs.

stupid Americans for putting up with this bullshit.

I'm so sorry you are having to deal with this, loudsue. I hope it all works out okay, and I hope your pain and recovery are minimized.

I know, my entire family has used medical in developing countries and it is superior in every way. And you don't have to act as a hostile witness in a court case while you're sick.

and he said that I should have minimal recovery time...which is great news, because I need to find a job!

Americans are certainly being screwed by our lawmakers these days. The rest of the world is still under the impression that we actually elected these fools. They haven't yet learned who owns the voting machines and the media.

why we are all sitting around cheering for individual mandates to buy a private product is beyond me.

I appreciate that.

The mandate thing gets all over me. I really can't even stand the idea. I'm afraid that's where I might go postal.

Kicked and recommended.

My wife had knee surgery that she did certify as covered, and afterward the insurer tried to break out certain parts of the surgery as outside the plan. It's all outrageous.

One breathing treatment sitting alone with a nebulizer, one minute for a quick x-ray, two minutes with a PA (not even a doctor).

Total bill: over $2,000

Insurance will pay 3/4.

Insurance is a problem, but I just realized we really need to get costs down. My insurance just paid $1,500 for very little actual work done on me. That doesn't do well for premiums on the other end, and probably for people getting denied for surgeries in order to keep the company's profits up.

don't raise hell because they are 'completely broke and destitute'. Broken spirits, feeling like you can't get any lower, maybe very ill and too busy trying just to stay alive. :mad:

What a awful country this has become.

It's disgusting and inexcusable.

K&R

workers' compensation is mandatory and HEAVILY regulated. They don't pay, you get a hearing pronto and an impartial judge decides.

Ever hear about car insurance horror stories like you hear about health insurance horror stories? Wonder why? It's mandatory so it too is heavily regulated. I've worked in both industries. Even worked for an insurance company in workers comp. Different animal.

Once health insurance becomes mandatory, it will happen there too.

--there will never be the political will to do so.

civil rights? do you have anything to back up what you say?

you do know, I'm sure, that social security, as originally passed, only covered rich white people? (in practice) And that the first civil rights act had NO teeth (which is how LBJ got it passed, "hey, there are no means to enforce it, the bill is meaningless, so vote for it) That workers comp is the same, now with heavy regulation as to what must be paid and the rates insurance companies can charge.

Maybe your way is better though. To not pay any attention to history. Or the current political climate. Maybe you know something I don't know and it really will be better and different when the GOP gets back in control so the best thing to do is attack dems now and bloody them so bad the lose.

I hope you understand why I don't believe you.

SS did NOT start as a legal requirement to invest in the stockmarket or get fined by the IRS.

There is absolutely nothing stopping Congress from imposing actual regulation on insurance companies right now, other than being corporate whores. How do you expct that to change?

it forced people to pay into the system, it was a legal requirement, if they didn't (self employed) they got fined by the IRS. What's the diff? Not only is it still mandatory, all the money I put in is now gone because the feds used it to balance the budget.

I know you republicans (nee progressives?) are upset about this but I don't see your point and god knows I've been trying for some time. Seems you are just pissed off you didn't get all you wanted or have bought into that loser Dean's bullshit.

But instead of making baby steps you'd rather blow it all up.

Doesn't seem productive to me.

--and being forced to become customers of useless shitstains who kill and bankrupt for profit, with no meaningful controls on their antisocial business model.

This isn't a baby step to anything--it's a giant step backwards and a total economic disaster. Deficit spending is only useful to the public if it is invested in productive sectors of the economy, which the health insurance industry is not.

I knew you could!

Here's how it goes. You don't want to be forced to purchase insurance. If you get a job, your boss has to pay for the insurance not you.

Ergo, if you don't want to buy insurance, get a job.

--and being hijacked by profiteers. Moving the profit taking one step back to your boss doesn't help at all.

if there's any money left after that they pay for health care.

There will be no regress until these people are out of business or burnt to the ground

The insurance company isn't taking your money just so they can turn around and provide service for you when you need it. Those premiums are meant to increase their profits - not your health!

:sarcasm:

:sarcasm:

And shouldn't throw stones.



It's awfully nice, and in a convenient location. I have often wondered how big the pitchfork-wielding mob would have to be to get them to give a shit about the people of North Carolina.

Show up with about 1000 seriously pissed off folks at 11 AM so that everyone is there. Surround the place. Block off the roads to keep the cops (I.E. hired corporate enforcers) out and then go to town. Let the secretaries/clerks/low level functionaries go and then hold a little long pig BBQ on the front lawn.

Run powerful deguassers over all of their computer equipment. Infect their network with every virus the hackers in your mob can think of. Burn the building to the ground.

Find out where all the high level execs and majority stockholds live. Rinse and repeat.

The plan is run for the exclusive benefit of the executives, who are very well compensated, especially considered it's a "non-profit."

They are few in number, live here in the Triangle, but feel no shame.

once the doc has approved it the office then sends to Carefirst for preauth. Make sure you have the right info. we called them 3 times and got 3 different explanations.

Can you postpone? Call them DAILY and make them nuts. Call the insurance commissioner, call the media if you don't get an answer from them.

and they are just as bad. they know that nothing is going to be done and that they have also bought all the politicians.We will be forced to buy this crap and with no price controls.Raise a stink and they might cover you.That is all I can suggest.It helps that your doctor is well known.That counts for a lot with them. Bless you.I hate those bastards and I hate the folks who are letting them get away with this.

Representative democracy is hanging by a thread.

They STILL have not regulated the derivative markets that have ruined us. Imagine that.

We are living under corporate rule right now. Time to fight back.

There are magic words to use in an appeal.

Usual & Customary are a couple.

2nd Opinion is a good thing.

If you do not get the payment you want appeal to the insurance company and copy everything to your state insurance department (division or whatever they call it there). Do not under any circumstances give up. You can appeal forever, no matter what they say.

I had a problem with my insurance years ago and he helped me get them to pay for a program that my ex wife sent her daughter to and they were going to leave me with a $200K bill.

PM me if I can be of any help to you, I will certainly try.

There are no criminal penalties involved. In fact, the government is explicitly forbidden to subject anyone to criminal penalties or liens for either not having insurance or not paying the 2% tax for not having insurance. This, of course, is driving the insurance industry nuts. Congress has essentially created a mandate with no enforcement mechanism. Literally, the worst it can possibly do is slightly damage your credit score.

and when the first, less invasive, procedure did not work for my wife, they did not pay. They did pay for the second, more invasive procedure which worked to solve the problem.

The practicioner did make adjustments to the bill, however, I ended up having to pay $6,000 for the procedure that did not work and co-pays on the one that did. So I ended up paying about $8,000 out of pocket when my insurance had a "maximum $2000 annual out of pocket" theoretical limit. What they do not make clear is that the $2000 is only for costs that they cover, things they refuse to cover don't count. Fortunately, I had the money.

The next year, I switched to the lowest premium coverage they offered, and started to bank the savings.

Call all the media and host it on the steps of the hospital as you hobble in for your surgery, as a walking (sort of )example of why we need a public option. Better yet, research where your local insurance president lives and hold the press conference in front of his mansion.

You can find out who the CEO is at www.hoovers.com. Then do a google search for their name and city, and see if you can get the home address. Worked for me once before; I called and shamed a CEO into covering an MRI for my daughter that had been denied twice on review.

I supposed mentioning that I was an investigative reporter and had found some dandy info about prior lawsuits against the company in other states may have had something to do with the callback I got 5 minutes later assuring me her test could be done. It showed two broken bones in her foot, and the poor kid had been hobbling around in pain for 2 months before we could get this done!

A little fear of public shaming is the best way to get them to behave, until we get a public option.

Several years ago my sister in law (a runner) was having lots of knee pain. The insurance company refused to pay for an MRI so they could accurately diagnose the problem. This crap has to stop.

Don't take a verbal.... make them send a letter to you.

It's very strange that a knee surgery is not covered under a government BCBS. Are you federal or state? Federal BCBS should pick up on this. Get your letter and also complain to the state insurance board.

It took me 5 long phone calls and a lot of dancing about to straighten out one claim with BCBS and a major medical center. Could not get a straight answer out of people as to who was responsible for payment before I made an appointment with a specialist. Finally, I got some waffle words in writing. Talk about dealing with a bureaucracy and they say govt health care is more bureaucratic!

K and r

This is the letter I sent to them. Funny thing, 3 days after I sent it, the doctor called and asked if I was ready for surgery the next Thursday. I had marked the letter CC to my attorney and the State Insurance Commission. I finally had the surgery done in April of 2000.

TO: NYLCare


In late summer of 1999 I began experiencing difficulties in moving my left arm, including pain and numbness. I saw my Primary Care Physician, Dr. X, on Oct. 12.
He referred me to Dr. Y and after the referral was approved, made an appointment for Nov.1. Dr. Y took X-rays of my shoulder and neck and determined that there was nothing wrong with my shoulder but that there appeared to be bone spurs on my cervical vertebrae. It then took 2 ½ weeks to get the next referral approved. By then it was the Thanksgiving weekend. The week after Thanksgiving Dr. Z was on vacation. I then saw Dr. Z on Dec.8. He wanted some more X-rays and an MRI done. The approval for these tests came within 48 hours. I saw him again on Dec.15 with the test results. Dr. Z then wanted an BMG run on my arm.
Nothing was accomplished over the Christmas Holidays. After the New Year, I tried to get word on the approval. I finally got the approval when I went to Dr. Z’s office in person on Jan.18. I then had the tests done on Jan. 21 by Dr. A. I went back to Dr. Z on Jan.25 and he determined that part of my problem was due to my diabetes but that I also had a pinched nerve in my arm. Once again I am waiting on a referral approval.
I went on medical leave from my place of employment on Dec.15 for two months, hoping to have everything cleared up now. I have two weeks left on that and nothing to show for it.
I AM IN CONSTANT PAIN, I AM UNABLE TO PERFORM SIMPLE BASIC TASKS. MY WIFE HAS TO BRUSH MY HAIR AND TIE IT BACK, PUT MY SOCKS ON FOR ME BUT I AM NOT GOING TO ASK HER TO WIPE MY REAR END FOR ME. AS FAR AS I CAN TELL, THIS CONSTANT NEEDING A REFERRAL APPROVED EVERY TIME MY DOCTOR WANTS TO DO SOMETHING IS DESIGNED THROUGH DELIBERATE DELAY AND OBFUSCATION TO DISCOURAGE A PATIENT FROM GETTING MEDICAL TREATMENT.
I AM STRESSED, ANGRY AND FRUSTRATED AND SERIOUSLY CONSIDERING CONSULTING MY ATTORNEY TO SEE IF THIS CAN SOMEHOW BE SPEEDED UP.

My husband is having arthroscopic knee surgery. I was super angry too. I realize they have their "script" and I feel confident that the surgery will be covered, but it takes every ounce of kindness in my being to not lash out at the poor sucker who has to work for the insurance company. I consider it a spiritual practice.

I was so angry already my monthly rate is increased to just under $1000 month for 3 of us and this is with a $5700 deductible. The premium started at $297 in 2004. The increase is nearly $700 in 6 years and they raised the deductible. So our health care costs this year will be over $20,000 since there is also a condition that has an exemption rider. I feel lucky that we can afford this but get so concerned for the average family.

So when I get calls and emails from the Dems or Organizing for America my response is "Stop Calling Me". That they even have the nerve to call the bs they are proposing reform is insulting at best.
And I am sick of that line "Would you be better off if John McCain were President?" The Dems better stop taking us for granted bc if they were to listen to us they would know that they are losing our support and not just in MA.

Good luck with your surgery. I do feel confident that my husband's will be covered and I hope yours will be too. I wonder if they use that spiel in hopes that someone will decide not to do the surgery for fear of having to pay out of pocket. That just occurred to me

tell them all to cancel their insurance. If everyone (that is left with insurance) would drop these assholes. They would go belly up and we might actually get our representatives to pass real reform. Just my opinion.

with the provider of the surgery. Those terms can hold the provider responsible whether the procedure is deemed medical necessary or not by the insurer as long as the patient did not sign a very specific waiver stating that he understood BCBS might not pay.

It happened to me with an expensive scan. BCBS of NC told the provider I didn't need precert. I signed the generic paperwork the day of the procedure. A month later I got the EOB with denial due to medical necessity. After a few months of back and forth the provider had to eat the charges because they were in violation of their agreement with BCBS.

Good luck!

All insurance companies want you DEAD.

I'm a Calif. state retiree on the PERS health plan. They raised my rates 22 percent in January, so now I'm being scalped 30 percent of my retirement check on monthly premiums! This is a group plan, for crying out loud!

Where's the revolution? I'm ready to join up!

Corporations own the media. Our voices won't be heard. I'm afraid it will take more than talk.

With a 5k yearly deductible. It will be cheaper for me to go to Costa Rica for operations like the one that you are having than to have it done through my 'insurance.'

Fucked up, isnt it? Meanwhile NOTHING is being done to stop it. Insurance companies just outright steal money since Bush.

I've been following BCBSNC for a couple of years now re: profound difficulties in finding a place to get a screening colonoscopy. I had BCBSNC for 10 years, every year w/ the premium creeping up until it hit $1000/ month for a three member healthy family and that was THAT. All that info has been documented at my blog on this matter: http://madamedefarge2scutinizingbcbsnc.blogspot.com/

BCBSNC is 'overseen' by a 'committee' on the NC State Legislature. You guessed it: BCBSNC runs the state legislature. They are the largest private insurer in NC. See the blog for details.

I called Senator Hagan's office this am, specifically her aide Michelle Adams, and left this message: "Hi, this is Dr. Hammond. My healthy 3 member family cannot afford $1000/ month insurance premiums. I am asking that the Democratic senator get on board w/ the other Democratic senators until the public option is offered. I will be calling back EVERY DAY until I hear something positive about this from your office."

Here is Hagan's number: Call Michelle Adams: 202 224 6342

And welcome to DU!! :hi:

I will call Hagan's office/Michelle Adams and do the same. I knew (because it is obvious) that BCBSNC was well represented in the legislature, but I had no idea it was actually overseen by a legislative committee. Does that stink or what?

It is much cheaper never to pay out. Don't you understand?

Somebody has to pay for those big bonuses and lobbyists.

North Carolina's Blue Cross Blue Shield Trying to Kill Key Plank of Obama Plan

By Ceci Connolly
May 18, 2009

http://voices.washingtonpost.com/health-care-reform/2009/05/by_ceci_connolly_one_week.html

One week after the nation's health insurance lobby pledged to President Obama to do what it can to constrain rising health costs, Blue Cross Blue Shield of North Carolina is putting the finishing touches on a public message campaign aimed at killing a key plank in Obama's reform platform.

As part of what it calls an "informational website," the company has hired an outside PR company to make a series of videos sounding the alarm about a government-sponsored health insurance option, known as the public plan. Obama has consistently maintained that a government-run plan, absent high-paid executives and the need for profits, could be a more affordable option for Americans who have trouble purchasing private insurance. The industry argues that creating a public insurance program will undermine the marketplace and eventually lead to a single-payer style system.

In three 30-second videos, the insurer paints a picture of a future system in which patients wait months for appointments and can't choose their own doctors, according to storyboards of the videos obtained by the Washington Post.

One video titled "Waiting" shows a receptionist fielding a request from a patient enrolled in the new program.

"The government plan. Okay hold on...let me see what's available," the woman says into the telephone. On the screen, with the caller on hold, the receptionist rearranges items on her desk, looks at a wide- open calendar and then fibs: "It looks like the first time we can fit you in is in two-and-a-half months."

Another spot in the series, being developed by Capstrat media in Raleigh, shows a woman and child wandering down a darkened hospital doorway "as if they're starting to realize that they've lost their way," according to sketches of the video. "We can do a lot better than a government-run health care system," the narrator concludes.

Blue Cross Blue Shield spokesman Lew Borman said the videos are still in the draft stage. On the question of creating a public option to compete with private insurers, he said: "We believe an unchecked government-run plan would lower payment to doctors and hospitals, forcing them to attempt to charge private insurers more and thus further eliminate private insurers' ability to compete against the government."

On its Web site, Capstrat touts its "agility in turning complex issues into simple, powerful and persuasive stories." Company president Karen Albritton declined to comment.

Blue Cross Blue Shield of North Carolina has 3.7 million members and processed more than $10.7 billion in medical claims last year. Get a first look at the video storyboards here http://www.washingtonpost.com/wp-srv/politics/health-care/BCBSNC_HealthplanVideo.pdf .

..........

Check out the comments section!

And even with the "new" bill it won't go into effect until 2013!!

:banghead:

And find a friendly columnist. They just LOVE doing stories like this!

If that doesn't work, tell your insurer you're filing a complaint with your state insurance commission and you want to make sure you're clear on their reasoning. Most insurers will do whatever they can to make you happy when you threaten them with this.

with THE BANK for the the 5th time in less than a week!

I'm so :grr: I could :nuke: too.

This is knee surgery, right? Not a face lift! Why and HOW can one have unnecessary KNEE surgery? Is it cosmetic knee surgery? :eyes:

I'm getting a visual of one good-looking knee, and one 60-year-old saggy one. :rofl:

At least you will likely get covered.

I had an auto accident 3 years ago that left me with a spinal injury. I am partially paralysed and in constant pain. I've lost my job. I may lose my job. I think about eating a gun everyday.

And the reason why is that the surgery I needed was denied. I have a lawyer, but because 3 years have gone by, even if I get a settlement or win a judgement, I will still be paralysed and in pain for the rest of my life.

I'm fucked. And the only reason I am fucked is because I live in the Retarded States of America. Had I been in Canada this would not even be an issue.

Any country that allows this kind of thing to happen to its citizens in the name of "capitalism" and "profits" is a country that is mentally ill.

I hope you decide against eating a gun...in the strongest way I hope that. I hope there comes to you a more satisfying solution...somehow...soon.

Heck, they wouldn't cover me when I developed post-partum ecclampsia and had to be readmitted to the hospital following a seizure.

Why? Because I had not gotten preapproval for a hospitalization 48 hours in advance.

Oh, and they didn't cover most of the care for my newborn because he didn't have a social security number. When we got his SSN, then it was "past the appeals date".

And we have "good" insurance.

Single payer is what we need.

Here in south-central New Mexico (where you just happen to be a Godmother!), we are praying for excellent results and a quick recovery. I am just so sorry that the insurance bastards have to give you a moment of grief, wondering if they will actually pay for the surgery. I had no idea they could do that...just leave you hanging about whether or not your ins will cover your surgery. I can't imagine going into the OR with that hanging over me. Sorry.

I just got back from my pre-op consultation with my doctor in Raleigh, and he had just seen the results of the MRI which I had taken yesterday. My knee is more screwed up than he originally thought (which I kind of knew), but he said the surgery should be great, and I should be able to walk CAREFULLY without crutches by the 3rd day. Which is good news, because I've GOT to find some work!!


Big hug. :hug:

works for an insurance company. This would NOT happen in a single payer system.

There are 16 Senators in Congress that have signed a letter to Sen. Reid to put the public option up for a reconciliation vote. Check out the list in today's blog at Prune Juice Media, http://www.prunejuicemedia.com/?p=876.

I'm very sorry to hear about your situation. Trust me, my family and I have been jerked around by the insurance companies ourselves.

The overall thing that leaves me so confused is WHY IN THE WORLD do these people NOT support a public option?? I don't get it. How many more people have to die or go without coverage before this changes? It's as if the people don't exist. A public option is the right thing to do, it will lower costs, and insure the uninsured. It makes absolutely no sense.

We have to keep pushing Congress to do what's (obviously) right!

1. Have them read back the original call notes where they told you knee surgery pre-certification wasn't necessary.

if they don't have those call notes, as them to read back the notes from that phone call, all of them, out loud. This is important.

2. The pre-certification is the part where they determine that the surgery is covered, or not

3. They are under obligation to pay for the surgery unless a pre-surgery certification examination determines that the surgery is not required

This is BCBS jacking you around. Ask them what they are willing to do to precertify you, and if they're not willing to do that then tell them you'll sue them for racketeering (charging you for a service they don't provide) and ask for information relevant to filing a lawsuit against them.

Also, ask to speak to their supervisor. And their supervisor. Don't lose your cool, not even once.

Oh and before I forget: if you have a pocket recorder, put your phone on speakerphone and record the entire phone call. If it still doesn't work out ON THE CALL, finish by saying woopsie, I forgot, I was supposed to inform you that I was recording the phone conversation, but better late than never. You do have my contact information right? I'll let you know which news outlets I'm releasing the recording to if you would like to have your corporate communications people reach out to me.

Good information there.

Also, in North Carolina, if you are a party in the phone call, you can record it and don't even have to notify anybody that you are recording it. Which is the way it should be everywhere, in my opinion.

Had a breast cyst drained and fluid tested in the lab for cancer cells. No cancer found. BCBS NC refused to pay the lab- testing wasn't necessary because no cancer found!!!! How the hell would we have known that without the testing??!

Write Sarah Palin and ask her to explain how insurance companies are not the real 'death panels'! These groups and politicians that are against the public option are all paid off by the insurance companies.

1) Get this stipulation in writing from BC of NC.

2) Get your orthopedic office to put in writing those two diagnostic codes...

3) Then, go to your local consumer news-person who likes a good story and give it to them, papers in hand.

4) Inform your state insurance commissioner with an e-mail and reference to the story and video link.

5) Send it to Olberman, links, and all.

Good luck in noise making, meanwhile, they'll probably cover it IN PARTICULAR, cause you'll have a follow up story, if they don't!

for anything. It is only if they "want" to pay for it.

"Why is it that a handful of thugs and plunderers can commit unthinkable atrocities (and in the case of the GM executives, for scores of years) and when it’s time for their gravy train to crash under the weight of their gluttony and overwhelming stupidity, the force of the full federal government has no difficulty coming to their aid within days if not hours? Yet at the same time, the joke we call the American medical system, including the drug and insurance companies, are murdering tens of thousands of people a year and stealing from the corpses and victims they cripple, and this country’s leaders don’t see this as important as bailing out a few of their vile, rich cronies. Yet, the political “representatives” (thieves, liars, and self-serving scumbags is far more accurate) have endless time to sit around for year after year and debate the state of the “terrible health care problem”. It’s clear they see no crisis as long as the dead people don’t get in the way of their corporate profits rolling in."

http://joemygod.blogspot.com/2010/02/suicide-mission-pilot-crashes-plane.html

It truly is dispicable that this is happening in America.

It has to STOP!

Have top of the line insurance until they actually have to use it for some major procedure.

Welcome to the New World of the Bought Out Corporate Elite, and the Wonderful "Reform" Legislation that they are paid to bring to us...

This reform effort is so successful that coming soon, to a federal government that matters to you, Corporate "Reform" of Social Security.

That is the lay of the land today. The ones with the money either make the rules, or they use that money to influence others who have the power to make the rules.

What Republicans don't get is that we already have 'death panels' created by private healthcare insurance companies, and their decisions as to who will be covered for what procedures already doom way too many people to their early deaths.

And it's not just the insurance companies....it's ANY corporation of any size: car companies, health care, utilities, phone, cable/satellite, Best Buy fer crin' out loud, mortgage/banking, it's everywhere. Corporations OWN the lawmakers in this country....federal, state & local, and it has to stop.

Go to www.ncleg.net to find your representatives, write them a letter and follow up with a call.

Ask them to investigate BCBS about this in addition to other issue.

Also, NC Insurance Commissioner Wayne Goodman is a true advocate for citizens,
he's worth contacting too.

Lawmakers question Blue Cross calls, mailers :: WRAL.com Nov 24, 2009 ... RALEIGH, N.C. — Twenty North Carolina lawmakers are questioning political advocacy by Blue Cross and Blue Shield of North Carolina. ...
www.wral.com/news/state/story/6488466

That's totally insane.:(