Health Insurance, getting worse or is it me?

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Specializes in vascular, med surg, home health , rehab,.

Hi all.

Have spent a lot of hours on my past 2 days off on hold to insurance companies, am so frustrated need to vent! I am arguing with my last job insurance as to the "medical necessity" of my last pap from January. Yes, hands up, it did it for fun! My docs office faxed it twice, now I have letters threatening collection agencies. Talking to these people is like talking to androids..."we will review the information and in 10-15 days blah blah. Now my new insurance....an HMO. I have to wait until January for a dental appointment, late December for a mammogram. It seems I always have to fight tooth and nail with these people for covered services. Reminds me of that John Grisham novel, The Rainmaker....they hassle you enough you give up and pay yourself, they save money. And then this week at work. I have a young man brought in the ER unconscious with a blood glucose level of 600+. Admitted to med surg at 2am. At 4pm I have a discharge order. The man's CBG is still 300, on a sliding scale. His dc orders are for glucotrol XL 10mg. Teach diabetes. He saw the CDE for a few minutes, she scheduled an appt to see him the next day with his wife (maybe he would have actually slept,l felt better, been able to take in the info). He was upset about the discharge, I called to see if we could delay it and was told "do you know how much it costs to keep a patient in the hospital? " "whats his insurance?" (an HMO not bad coverage), and "I don't see whats so overwhelming about sticking your finger and few times a day, send him home". I was shocked; what are they doctors or accountants. I felt we let this man down. Have noticed this attitude more and more lately. Is it me?

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

It's not you. Getting live humans on the phone is one task. Once you do, getting them ACT like HUMANS is yet another. It's beyond frustrating.

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I find it best to put my complaints in writing, being very careful to state my case clearly and to state my expectations. I then send it by registered mail so I have a receipt. After a few days I begin the phone calls, but sometimes that is not necessary. Seems they will respond to mail better, although it is slower. Unless the provider has a contract with the insurance company, and maybe not even then, you are responsible for your bill. Insurance is there to help you pay for your bill, not for the provider to collect their fee. I hope you get your problem resolved soon so there will be one less stressor in your life.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

also make sure you get NAMES of people you talk to .....ask for correct spelling so they KNOW you are recording them...

often THIS helps a lot.

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Hi all.

Have spent a lot of hours on my past 2 days off on hold to insurance companies, am so frustrated need to vent! I am arguing with my last job insurance as to the "medical necessity" of my last pap from January. Yes, hands up, it did it for fun! My docs office faxed it twice, now I have letters threatening collection agencies. Talking to these people is like talking to androids..."we will review the information and in 10-15 days blah blah. Now my new insurance....an HMO. I have to wait until January for a dental appointment, late December for a mammogram. It seems I always have to fight tooth and nail with these people for covered services. Reminds me of that John Grisham novel, The Rainmaker....they hassle you enough you give up and pay yourself, they save money. And then this week at work. I have a young man brought in the ER unconscious with a blood glucose level of 600+. Admitted to med surg at 2am. At 4pm I have a discharge order. The man's CBG is still 300, on a sliding scale. His dc orders are for glucotrol XL 10mg. Teach diabetes. He saw the CDE for a few minutes, she scheduled an appt to see him the next day with his wife (maybe he would have actually slept,l felt better, been able to take in the info). He was upset about the discharge, I called to see if we could delay it and was told "do you know how much it costs to keep a patient in the hospital? " "whats his insurance?" (an HMO not bad coverage), and "I don't see whats so overwhelming about sticking your finger and few times a day, send him home". I was shocked; what are they doctors or accountants. I felt we let this man down. Have noticed this attitude more and more lately. Is it me?

I am afraid that Health Insurance Companies are going to get worse. Its sad that many insurance companies give you such a difficult time when it comes to paying the bill. It aggravates me that working in the HealthCare Industry you see so many abuse the system by coming into the ER with their gold cards (Medical Card), costing the taxpayers a tremendous amount of money for ridiculous things( few examples would be bringing child in with a fever to get a dose of tylenol because they do not want to spend their ciggerette money on OTC meds. That cost us taxpayers about 500 bucks for that dose of tylenol. The patients that come in by squad repetedly for toothaches, abdominal pain due to constipation, and toothaches using the Gold Card annoy me too. They do not have to worry about deductibles or paying their hospital bills, we do that for them.

I have also found that people that work in the Medical Field seem to be the unhealthiest people, because we have deductibles and co-pays to meet when getting our own healthcare. So, we think twice about even going to get ourself taken care of.

I do not have problems with people that truly need medical cards, and I think some people really do need them. Its the ones that abuse the system, and are just as able to work like I am is the ones I have a problem.

Sorry your insurance company is giving you a hard time, I know the feeling. But I am sad to say, it is not going to change...

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