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My Rant Against My Insurance.


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#1 Ariel K.

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Posted 06 January 2012 - 02:23 AM

Okay ya'll. Sorry in advance if this seems like rambling. I need to vent.

First and foremost, my insurance is through my father. He is a full-time firefighter, has been for 20+ years. For those of you who don't know this, firefighting is not exactly a lucrative industry. You don't get into is for the paycheck. My dad has been saving people's lives for twenty years at his full-time department, as well as working two other jobs on top of it. He makes $16 an hour,and our insurance is OUTRAGEOUSLY priced. The entire department has gone without a pay raise for five years, yet the cost of insurance has increased 30% in the past two years.

I have had a slew of crappy health the past few years. First was a blown disc in my back for which I had to attend twice-weekly physical therapy sessions. I ultimately opted to have surgery to have the discs shaved down, because I was in so much physical pain (even after attempting the therapy, massage therapy, and cortisone shots) that I didn't know what to do anymore. Surgery was in January of 2011. I received a bill for $35,000 in the mail a few short weeks later. My insurance refused to pay a dime. A single &%(&ing dime. Commence a flurry of phone calls between the insurance company and I, the insurance company and my dad, and a LOT of swearing. (It's an inherited thing, I suppose :]) They finally decided to pay their portion in May. Five months later. After the hospital had already sent me to collections, despite me calling four times to explain the situation.

Enter Narcolepsy. I had my sleep study done in November. Granted, this isn't the first sleep study I have had done, I had another in December of 2010. The one I had most recently was prescribed by a sleep specialist, who strongly suspected Narcolepsy, but wanted to confirm his diagnosis. I was diagnosed in December, got my Nuvigil, and have been happily trying to figure out all this Narcolepsy business all alone (and with you all :])

I go downstairs today to find a bill from my insurance company for over $7,500. Because apparently I needed a pre-certification? Although I didn't need a pre-cert for my last test, and it was covered in full. (Same insurance, same company, everything.) Even though their rates increased dramatically? I asked my dad about it and he said that he hasn't received any information about benefits changing, and if they were, they should be increasing, not decreasing, due to the affordable care act.

I can't forget to mention the cute little note about how I can make convenient monthly payments of ONLY $351!! Well guess what, I work in fast food. I have other bills. I am paying for a college education. I have to pay $40 a month for the medication that allows me to work, which allows me to pay for the college education. I am on a tight budget, the economy sucks, I don't have $351 mothereffing extra dollars a month!!


So here is my question for all you beautiful people:


Do I fight this? Do I make them pay up? What experiences do you have with it?


I need advice please :)

#2 Mrs. Bento

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Posted 06 January 2012 - 03:36 PM

Okay ya'll. Sorry in advance if this seems like rambling. I need to vent.

First and foremost, my insurance is through my father. He is a full-time firefighter, has been for 20+ years. For those of you who don't know this, firefighting is not exactly a lucrative industry. You don't get into is for the paycheck. My dad has been saving people's lives for twenty years at his full-time department, as well as working two other jobs on top of it. He makes $16 an hour,and our insurance is OUTRAGEOUSLY priced. The entire department has gone without a pay raise for five years, yet the cost of insurance has increased 30% in the past two years.

I have had a slew of crappy health the past few years. First was a blown disc in my back for which I had to attend twice-weekly physical therapy sessions. I ultimately opted to have surgery to have the discs shaved down, because I was in so much physical pain (even after attempting the therapy, massage therapy, and cortisone shots) that I didn't know what to do anymore. Surgery was in January of 2011. I received a bill for $35,000 in the mail a few short weeks later. My insurance refused to pay a dime. A single &%(&ing dime. Commence a flurry of phone calls between the insurance company and I, the insurance company and my dad, and a LOT of swearing. (It's an inherited thing, I suppose :]) They finally decided to pay their portion in May. Five months later. After the hospital had already sent me to collections, despite me calling four times to explain the situation.

Enter Narcolepsy. I had my sleep study done in November. Granted, this isn't the first sleep study I have had done, I had another in December of 2010. The one I had most recently was prescribed by a sleep specialist, who strongly suspected Narcolepsy, but wanted to confirm his diagnosis. I was diagnosed in December, got my Nuvigil, and have been happily trying to figure out all this Narcolepsy business all alone (and with you all :])

I go downstairs today to find a bill from my insurance company for over $7,500. Because apparently I needed a pre-certification? Although I didn't need a pre-cert for my last test, and it was covered in full. (Same insurance, same company, everything.) Even though their rates increased dramatically? I asked my dad about it and he said that he hasn't received any information about benefits changing, and if they were, they should be increasing, not decreasing, due to the affordable care act.

I can't forget to mention the cute little note about how I can make convenient monthly payments of ONLY $351!! Well guess what, I work in fast food. I have other bills. I am paying for a college education. I have to pay $40 a month for the medication that allows me to work, which allows me to pay for the college education. I am on a tight budget, the economy sucks, I don't have $351 mothereffing extra dollars a month!!


So here is my question for all you beautiful people:


Do I fight this? Do I make them pay up? What experiences do you have with it?


I need advice please :)



Insurance Companies are no one's friends hun. You may vent all that you feel the need to do. I however, have no insurance advice for you. There are many of us here who do not have Insurance. You should try to figure out if it is worth the fight. But you already knew that and are probably waiting for me to tell you whether it is or not. The answer is it depends. I have had my own fighting with insurances and am currently represented by a lawyer for just that. I can't tell you if I'll be victorious because no one knows the ending to that story either. Just know that insurance companies have their own lawyers and they are not interested in your struggles one bit. If you think you have a case, try. No one will fault you for an honest try. Considering your track record on them paying the last denial, I would say give it a shot. I did not need pre-certification for my sleep studies but my husband did for his. We ended up having to pay out of pocket for that large bill. I think after a year they settled on a smaller sum but it was not pretty and I think they reported it on our credit. Best of luck.

Lisa
:

#3 AmandaR

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Posted 07 January 2012 - 11:03 AM

I say you fight it. They don't want to pay, ever. But you pay for the coverage and they should cover it. You call everyday if you have to and through some MF'ers at them. You keep a record of who you talk to and when and you keep calling, faxing, emailing, *BEEP*ing, and screaming until they pay for it. They will eventually pay it just to keep you from calling and *BEEP*ing out their employees everyday. I am a teacher and my father in law is a retired fireman - we get crap ass insurance that costs an arm and an leg and they want to weasel out of paying for anything. Don't let them.

When I started the job I have now, my family insurance monthly premium was $600/mo. We have since switched and I now pay $200/mo but the first $3k of ANY expense comes out of my pocket before they begin to cover anything and then it is only 80/20. I can tell I will be having problems similar to yours because I had to call to tell them that I never received my new insurance cards. Also, a friend said she is having problems with the new Rx system and couldn't get the meds she needed and has to wait until next week for our business office to fix it. This scares me bc if they f*ck with my Xryem shipment I am going to be one angry little girl.

#4 Kayra

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Posted 10 January 2012 - 06:53 PM

Insurance is a *BEEP* storm to deal with. From my experience all you can do is continue to call and harass them until they cover what they're supposed to. It took literally over three months just to get my medication approved by insurance. And that only happened from calls every couple days. Get doctors on your side that know how to deal with the insurance people, that helps too. I know mine have been really helpful.

#5 flutterbye_xo

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Posted 12 January 2012 - 02:24 PM

Go vote for Ron Paul. Lol. Obamacareless, I assure you, is not going to help. I work in a pharmacy, go to pharmacy school, and am a PWN so I hear all about insurance and am always on hold with some insurance company. The whole system must change. The American people must make this happen.

#6 Ariel K.

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Posted 12 January 2012 - 04:09 PM

Totally respect your opinion but I won't vote for Ron ;]

Thank you guys for your input. I guess I need to start making some phone calls.

#7 kyethra

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Posted 15 December 2012 - 10:11 AM

Totally respect your opinion but I won't vote for Ron ;]

Thank you guys for your input. I guess I need to start making some phone calls.


Additionally, look into financial assistance from your hospital for the portion of the bill left after insurance.

#8 SleepySiren

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Posted 21 December 2012 - 02:31 PM

I'm an insurance agent, property and casualty for the most part. I have always hated medical insurance for one simple reason, I don't recognize it as insurance at all but more as PRE-PAID Medical costs. Even if you have a catastrophic policy the premiums are ridiculously priced....

#9 3.8jake

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Posted 20 September 2013 - 06:49 PM

I always look up online what the script cost is to insurance before I try and fill it because if it's expensive there is very good chance there is some hoopla around it like xyrem... which is why I don't have it yet. Learn this the hard way with my second mslt.. dispite using in network all the way. they are claiming it's medically unnecessary.... which is bs by there own policy guidelines...