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#312891 - 02/04/05 08:59 PM Health Insurance **Rant Warning**
Princess Leia Offline
Diamond Poster
Joined: Jun 2004
Posts: 1,975
Alderaan
2 months ago my daughter (11 months at the time) had an allergic reaction after eating French Toast and started to choke and turn blue. The nurse line (wisely) advised us to call 911.

Blue Cross covered 80% of the ambulance ride, doctor bill, ER bill and meds according to our insurance plan like I expected. They paid out over $2,000 for this one incident.

At her 1 year visit, the doctor did an allergy test called RAST Testing on egg-whites, egg-yolks, and milk. They drew 1 vial of blood and viola - she's allergic to egg-whites.

I got an Explanation of Benefits statement yesterday with 3 $32 Lab/X-Ray procedures that states "These Charges ARE NOT (bolded & capitalized) covered. The services and/or supplies are excluded."

I called BCBS today and was told RAST testing is specifically excluded from my plan. I asked, "So you would have paid for another ambulance/ER incident if I fed it to her again not knowing what she was allergic to?" She said yes.

It's not a lot of $$ out of pocket, but shouldn't that be considered preventative?? This ranks up there with the insurance company that didn't cover birth control pills once-upon-a-time but would cover 100% of my pregnancy/birth expenses.

No wonder why health care's in that handbasket in Devil Girls signature line

**Rant over**
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#312892 - 02/04/05 09:41 PM Re: Health Insurance **Rant Warning**
deppfan Offline
Power Poster
Joined: Dec 2000
Posts: 5,184
All over the map.
I'm with you sister. When my husband was employed, his health insurance covered his insulin, but not syringes. Since that is the only way for him to take his insulin, it makes no sense. He has taken 2 shots a day for the last 37 years, and pills are not an option. Stupid stuff!
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#312893 - 02/04/05 10:37 PM Re: Health Insurance **Rant Warning**
obx nut Offline
Gold Star
obx nut
Joined: Oct 2003
Posts: 304
Midwest
The year before last my insurance covered my son's ADD medicine, but NOT the doctor visit for the diagnosis. When I called the insurance company they told me that it was the was my employer wanted it. Sure enough, it was written in the benefits guide that way.....
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#312894 - 02/04/05 10:41 PM Re: Health Insurance **Rant Warning**
Queen Mum Offline
Power Poster
Queen Mum
Joined: Mar 2001
Posts: 3,920
OK
I'm with you. They wouldn't pay for BC pills used as Hormone Replacement Therapy to keep from having surgery. But...if I would have the surgey they would pay for the prescription! So they would rather pay out thousands plus the $30 a month rather than just the $30. Doesn't sound logical to me!

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#312895 - 02/04/05 10:49 PM Re: Health Insurance **Rant Warning**
corkygirl Offline
Power Poster
Joined: Sep 2004
Posts: 4,241
middle of the country
My oldest son's insurance company will pay for the medicine he needs to control his bipolar condition but limits the number of visits to the Dr and pay 30% of that bill. He can't get the meds without the Dr and they don't pay enough for the Dr. Guess they like the BIG hospital bills instead!!!!
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#312896 - 02/04/05 11:54 PM Re: Health Insurance **Rant Warning**
CRAatBOK Offline

Power Poster
Joined: Mar 2004
Posts: 6,172
Further South than I wanna be.
Quote:

Doesn't sound logical to me!




Well there is your problem Boomermom, you are trying to use logic with health insurance. That is like using logic and compliance regulations. It can't be done, or at least shouldn't be if you want to keep your sanity.
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#312897 - 02/05/05 02:32 PM Re: Health Insurance **Rant Warning**
Greg Offline
Platinum Poster
Joined: May 2004
Posts: 833
Michigan
I hear ya! BC will pay for my cholesterol meds, they paid every penny to have an angiogram to see if my arteries are clog, but they won't pay for the blood test to check my cholesterol! They pay all but $10 of the Dr. visit if I'm sick, but if I need my meds checked, that comes out of my pocket. So, I always have a sore throat when I go in to get my meds checked. . . you think they'd notice that I get a scratchy throat about every three months!
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#312898 - 02/05/05 07:56 PM Re: Health Insurance **Rant Warning**
Busy Bee, CRCM Offline
Diamond Poster
Joined: Feb 2004
Posts: 1,089
PacificNW
My insurance plan will cover any expenses incurred for someone to quit smoking, but won't cover someone's weight loss treatments. That's really messed up in my mind.

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#312899 - 02/07/05 04:00 PM Re: Health Insurance **Rant Warning**
Anonymous
Unregistered

I think insurance companies are "legal thieves."

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#312900 - 02/07/05 05:40 PM Re: Health Insurance **Rant Warning**
thomasj Offline
Power Poster
Joined: Mar 2001
Posts: 5,063
Pennsylvania
I just heard of a young lady locally who was a junior in college and found out she had cancer. Her parents health insurance covered her since she was a full time student; but when she became too ill to continue in school she was dropped from the health insurance company.
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#312901 - 02/07/05 05:57 PM Re: Health Insurance **Rant Warning**
Bones Offline
Power Poster
Bones
Joined: Nov 2003
Posts: 3,020
Land of Enchantment
It is really awful having to deal with insurance companies. During the last few months of my pregnancy I had to go for fetal monitoring twice a week because my baby was breach. EVERY SINGLE claim submitted for this was not paid and I had to call EVERY SINGLE time to straighten them out. They said it was not ordered by my PCP ... well my OB/GYN was my PCP and of course it was ordered by her. They always ended up paying the claim, but it happened every time.

They also make it impossible for seniors to obtain insurance. My mom is retired. She is a couple of years shy of being able to obtain medicaid. She has had the hardest time obtaining insurance that doesn't cost an arm and a leg. The only insurance she can afford has sky high deductibles, which doesn't help her any. It is just awful.
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#312902 - 02/07/05 07:01 PM Re: Health Insurance **Rant Warning**
BamaLaw Offline
Member
BamaLaw
Joined: Apr 2004
Posts: 98
My favorite story is from a few years back. I was having major facial surgery in an effort to alleviate a sleep apnea problem. The surgery involved having both upper and lower jaws--both sides--broken, pulled forward, plates inserted, and bunches of screws inserted to hold everything together until it heeled.

Of course, it had taken the doctor almost a year to get the insurance company to agree to pay for the procedure. Once they did, apparently all the necessary pre-certs had been obtained. All was a go. I had the surgery. Had a couple of complications, was in the hospital a couple of extra days and in SICU a couple of extra days, as well.

Anyway, insurance paid for every aspect of the bill: ER use, Surgeons, Hospital Room, Meds, ICU charge, etc. (totaling nearly $200,000); however, they wouldn't pay for the anesthesiologist--about $3000. When I called, they said I had not had pre-certification! I said, "You've got to be kidding! The pre-cert for the surgery itself is not sufficient for the anesthesia!" What did they expect? Was I to undergo this procedure without anesthesia? That had to be one of the most stupid encounters I've ever had with an insurance company! Eventually, they did pay, but arguing with them while my mouth was still wired shut was not very easy!

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#312903 - 02/07/05 07:27 PM Re: Health Insurance **Rant Warning**
hmdagal Offline
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hmdagal
Joined: Dec 2002
Posts: 3,816
Many years ago my mom had an incident where her heart was beating so fast it wasn't actually pumping any blood. She collapsed on the floor. It was a good thing it happened while she was at work in a hospital. One of her duties had been training in CPR and her co-workers found her pretty quickly and started CPR. The emergency staff also arrived almost immediately and continued shocking her long after they normally would stop. She recovered and had a defribrilator implanted to prevent any other incidents.

Her insurance initially refused to pay for any of it. They claimed it should be covered under workman's comp because it happened while she was working. After going through the whole process of getting rejected by workman's comp, they finally paid.

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#312904 - 02/07/05 07:37 PM Re: Health Insurance **Rant Warning**
HMS Pippii Offline
Diamond Poster
HMS Pippii
Joined: Apr 2003
Posts: 1,636
snorkeling in warm, clear wate...
My daughter was dropped from our policy when she started grad school -- she was a full-time grad student, under the age limit -- but because grad school is full time at 9 hours instead of 12, our insurance company said she wasn't full time - her school won't allow grad students to take more than 9 hours because they don't think they have time to deal with research, reading, and writing papers if they take more -- so we got caught between the university and our insurance. She ended up on student insurance through the university, but that only covers her during the semester --- so, when did she have a major allergic reaction to a new medication, pass out and end up in the ER? Not during the semester....

And now we're losing the good coverage and essentially being forced into a high deductible plan with a health savings account -- we have a "choice" but the difference in premiums and coverage takes the "regular" policy down to the level of the high deductible/HSA --- this is the first time I've seen employees this upset about changes in our insurance -- and oh yeah, they limit mental health visits to 20 a year, so better not have a problem in that area that can't be solved in 20 visits....

</RANT>
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#312905 - 02/07/05 09:00 PM Re: Health Insurance **Rant Warning**
Anonymous
Unregistered

How about this... One time my father was having severe chest pain, so bad that the nitro pills he had were not alleviating anything and we (my mother and I) could not get him to the car ourselves to drive him to the ER. So we called an ambulance and he was taken to the ER, stayed over night, they did some tests, blah blah blah...I don't remember what the verdict was after that (I think that's when it was determined he needed a stent) but I remember when my mother got the Explanation of Benefits from the insurance company.

Nothing was covered because it was all deemed by the insurance company as "not being medically necessary."

HELLO?!?!?! The man's having severe chest pain, dizzy, can't breathe and the whole damn thing, ambulance and ER visit wasn't medically necessary??!?! What crackerjax box did this insurance company (BlueCross/BlueShield at the time) get it's license to do busines from?!?

Anyway, after my mother raised hell and the doctors raised hell, the insurance company paid. But, man I am so jaded about health insurance and have been since college (I'm 28). I went through what a lot of you have posted about where your college aged child is covered as long as they're full time or until whatever age (21? I can't recall), but when I went from full time to part time I took out my own single coverage health insurance. I had to do this THREE times in the last year and a half of my schooling, because the companies would drop me like dirty shirt. I remember one letter explaining it to me so gracefully "It is no longer profitable for us to offer single coverage insurance."

Well. Excuuuuusseeee me! I'm sorry my pitiful existence as a part time college student is an excrutiating cost of doing business to you. Thanks for nothing!

And now, my parents who are 64 have had their insurance (through my father's retirement) changed twice in the last three years. My father has Medicare as well. I just hate the whole thing. I hate Social Security, I hate Medicare and if I have to go through this same crapola when I hit retirement age, I'm just gonna drive myself off a cliff. Gawd.

Okay...end rant. I feel better now. LOL

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