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Re: [IP] scary insurance companies

In a message dated 5/11/99 6:20:15 PM Central Daylight Time, 
email @ redacted writes:

<< I'm not sharing this to complain.  I just think it illustrates that one 
 NEVER stop with what the insurance company tells you the first time.  I have 
 incorrect information and dealt with erroneously unpaid claims too many 
times to
 trust that the people on the phone know what they're talking about.  I'm 
sure I'll
 get blasted by the insurance people on the list, but it has been my 
experience that
 one must push and push in order to get the basic insurance rights one pays 
for.  It
 makes me absolutely crazy to think of all the claims that must have gone 
 when they should have been paid, not to mention the health care compromises 
 have undoubtedly made! >>


I couldn't agree with you more, and I'm one of those insurance people <grin>.

When I first went on the pump, we were administering our own plan and the 
claims folks were just downstairs.  I personally took my doctor's medical 
necessity letter to the department manager and was given approval on the spot 
(11 years ago).  Instead of rejecting a claim, they would call and ask me for 
clearification first.  BCBS now administers our health plan and I am at the 
mercy of an often times uneducated claims processors who frequently makes 
typos and can have god-like complexes.  

I've had claims for boxes of syringes turned down because it was keyed as 1 
syringe rather than a box of 24.  I once had a woman tell me that my infusion 
sets were no longer covered because I had been on the pump long enough that I 
should be "fixed" by now and should go back to shots.    

You are so right Jen, you should never settle for a no answer.  Ask to speak 
to their supervisor.  If refused, call back and ask to speak to the claims 
manager.  If no one will discuss things, immediately send a letter to your 
state's insurance department and copy the insurance company's legal 
department.  You WILL get a response.  


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