Worthless medical insurance - page 2

:angryfire At my last job I had a cancerous mole removed from my back. My claim was denied because they felt it wasn't necessary???? Anyway, after hours of combat and unending paperwork I finally... Read More

  1. by   Loving Life
    Priority Health in Michigan has been fairly good except for mental health, but they are improving. I had a corneal transplant and never saw a statement. I have no clue how much it cost! Of course co-pays go up like everything else.
  2. by   Blackcat99
    Thanks all for your helpful messages. I live in eastern Washington. Yes I had HMO insurance many many years ago and it was wonderful. No forms to fill out! :hatparty: It was great! I think I'll check out the jobs here and see if I can find one that has HMO insurance.

    Wow! A corneal transplant and you never even saw a statement? How lucky can you get? :hatparty:
  3. by   lisaloulou
    You can always make a consumer complaint to your state's insurance commission.
  4. by   Havin' A Party!
    Have always had great insurance through employers (non-nursing industries). Coverage now (at hospital) isn't as good.

    Consumer Reports recently did a story on getting individual policies. Their conclusion: no good / affordable source presently exists.
  5. by   kea6783
    The only thing that comes to mind is the military. My brother's a marine and we can take his daughter to the Dr. for anything.

    Any military hospitals nearby??
  6. by   Stephanie in FL
    Quote from Blackcat99
    Thanks Mindy and Suzanne. At my next nursing job I'm not going to get any medical insurance. The worst part of my ordeal was not the cancer surgery. What drove me totally crazy and stressed out was fighting the insurance company.!!! What's the sense of paying for insurance when you have to fight so hard to actually use it? :angryfire :angryfire

    Yes, fighting with insurance companies is frustrating. I've had medical insurance where the company refused to pay for a mammogram (even though I had a family history of breast cancer) and a routine GYN exam. But please do not refuse all medical insurance. I was glad that I had medical insurance last September when I was diagnosed with advanced ovarian cancer. I've had 2 CT scans, a hysterectomy, port-a-cath placement, 8 cycles of chemo, 6 injections of Aranesp (very espensive med to increase red blood cells), many MD office visits, many lab draws, and steroids and other drugs before each chemo to prevent an allergic reaction. If I had to pay out of pocket for all of that, I'd be bankrupt.

    Stephanie RN
  7. by   RN92
    I have dealt with insurance companies in the past...the wheel with the loudest squeak gets the oil. Everyone thinks that insurances have all of these rules that they follow - the truth is, they change the rules whenever its in their best interest. If they tell you no the first ten times, you just keep bugging them until they change their mind. It also helps if you mention reporting them to the state insurance commissioner (they hate this because it means they will be investigated.)
  8. by   IMustBeCrazy
    The squeaky wheel theory is so true.

    I have been through many insurances due to family employment changes, and I wised up in a hurry. My latest ordeal was a family member's yearly physical that came back as uncovered because it allegedly was a 'school physical'. After many calls and one pointed conversation with the supervisor on duty at the insurance call center, we got it changed. I will be careful of what I say during a physical in the future, however. It seems every little thing you share becomes part of the exception of why something isn't covered.

    I never take no for an answer, I just keep calling, faxing and writing the insurance commissioner until it gets dealt with. Of course, most people don't do that and they count on 'wearing you down'. As for me, I say 'screw that'--I pay a hefty premium and I want my coverage!
  9. by   IMustBeCrazy
    Which also reminds me...

    Lots of people don't realize that any portion of a deductible that is paid to Insurance Company #1 prior to an insurance switch in the same calendar year can be applied to Insurance Company #2. Another detail I learned in the years of dealing with insurance companies. Make sure you call up Company #1 and ask for a "Certificate of Creditable Coverage", which you also need as proof of coverage in many cases when proving prior continuous insurance coverage. However, be sure that Company #1 documents exactly how much deductible has been paid during that calendar year.

    Then, you are able to have that applied to the deductible for Company #2. It's part of HIPAA and I knew and loved that provision years before they started enforcing all the privacy provisions.

    Hope this is helpful!
  10. by   catcolalex
    I worked for the university of utah hospital and it offered great insurance, no deductable, 90-100% coverage on most everything for a very reasonable price, 130$ a month for myself, my wife and two kids, including dental.
  11. by   CHATSDALE
    the insurance coverage at nh is too high so many of co workers esp cna and support staff go to state charity hosp which drives up taxes but they have to provide care for children and themselves....i can share with stephanie of fla because i have been in a similiar dx but thank heaven i am still eligible for tx with my ex husband military coverage....lumpectomy, lymph gland excision, radiation tx i have gotten bills totally over $100,000 no way i could have taken care of that....
  12. by   Blackcat99
    Thanks everyone for your very informative information about medical insurance. I am going to have to memorize all of it so I can survive these insurance companies.
  13. by   vwgirl
    Quote from ang75
    What part of the country are you looking for?

    I had a great INS co while in denver. Here, it is another story. I dislocated my knee 1 yr ago and had to go to the OR for open reduction. I had sheared off part of my patella and my ins co just sent me a letter stating they finally sent payment to the doc and hosp. A whole yr!!!
    It took my insurance company THREE years to pay a claim. I wish I was making this up....Now, they have this new thing with my mail order RX plan where my doctor has to call the company with my medical history, some freakin' board of boneheads has to "review" my case and then they determine if I am eligible for coverage of my prescriptions, or if my doctor has to prescribe something else!