Eons: View message "Medical Bills and Insurance Companies " in Cancer Patients and Survivors Group

Message 91 of 354

Medical Bills and Insurance Companies

Honey Bee's message reminds me of my own situation as many of my bills of refusal to pay went unopened by me as at the time I was too sick to open them and deal with there refusal's to pay. Frankly, at the time I thought I was going to die anyhow so what difference did it make. Then I improved a little and would call the insurance company and inquire why they didn't pay the bill and was always given some excuse like "If you didn't file a protest for the denial in 120 days we don't pay. This led me to the collection agencies who again I was to sick to deal with. Finally one of them tried to sue me and I still was to sick to deal with it and even though I've always been a self supporting unit I got my sisters involved in taking over my affairs. I have 4 lovely sisters , each a success in there own way. I am reminded of my older sister ,Maria, who is a VP at NORD which is the National organization for Rare Diseases and spends half her time in Washington dealing with people in the seats of power and drug company executives. Her expression is that there is a special place in hell for these insurance company executives. One good rule of thumb in life is "Don't mess with the Pasternack sisters as a group as they are formidable". They took over the situation and if I had to describe their strategy it was first to let me sister Nicole, the Jazz singer make the initial inquiries. Nicole is the sweetest person on earth and would charm her way until she found out who Mr. big was at the insurance company and achieved many a bill getting finally paid by the insurance company. If not then my other sister Martha who is an advertising exec in NYC and she would call them and tell them where the dog died and would threaten them with going to the States Insurance Board or failing that would take u the matter with the attorney general. Then my sister Maria would hit them by name dropping Senate committee's she was part of and drop names of Drug company exec's she dealt with and knows the head of Social Security in person. Then there is Annette who is best described as June Cleaver with an ax hidden behind her back. By the time they got through with the insurance company they were only to glad to pay the bills, some of them 2 years old that they had previously refused to pay just to get rid of them. I have just had an experience that went under their radar though. When I first started to feed through a g tube 2 years ago I asked the insurance company if my nutrient that I needed was provided for and was told no. I have had to pay for it ever since. Then I needed a replacement for a part of my feeding tube and called the Gastrology doctor to get a new one. His nurse asked who my health company was and gave her my insurance companies name and she said "No I mean the people who supply your supplies" I said I didn't know what she meant and she asked me who provided my nutrient and I said " I buy it myself online" She called the Insurance company as she was sure they were responsible for my supplies and was told no also. This led me to try and find the part I needed for my tube with prescription in hand and none of the local drug stores could provide it or if they could they didn't have an arrangement with my Insurance company. I called them and asked who I had to go to to get the part that they had a relationship with and was given the number of a subsidiary of the Insurance company that dealt in such things. The girl at this company sent me the part the next day and she asked me also who was my medical needs supplier for my nutrient. I told her I had been buying it online myself and she went "No, no. no, that is covered under your policy. All you have to do is fax me a prescription for the nutrient from your doctor and we will provide it for you and ship it monthly" In other words the insurance company has lied to both me and the gastro nurse. I have been paying for this stuff for two years needlessly. Now I get it delivered to my door for free. The insurance company's excuse for their lie when I called them was I never sent them a prescription for the nutrient and when i said I was told it wasn't covered they meant without a doctors prescription. I said I both the gastro nurse and myself were just told "No" when we inquired not "No , not without a doctors prescription" They just said those were the rules and it was some how my fault I didn't know better. I am jst happy that I don't have a $350 dollar a month to pay anymore but the sisters are outraged. Were talking about over 8 grand I spent needlessly because of the insurance company's lies. They are in full attack mode to get my money back. I told them I was too busy for a fight and at this point couldn't afford a long legal battle. They said not to worry they would do the attack mode. I don't envy the insurance company by the time they girls get through with them. It should prove interesting, but I am just glad to have a major expense off my back. Not good enough for my sisters who are just plain outraged at their perfidiousness.
These bills come in when we are at our weakest and the insurance companies know this and create these loopholes to avoid paying what they are contracted to do. If you don't have a team of horses like my sisters, seek advice from agencies that know the insurance scams.
Mike

posted by blorno

(((( Mike )))) I am so glad you've got the famiy you do. I bet your sisters prevail on this one, too.

My small pile of bills from my bout of cancer (I really do have good insurance through the NEA) humbles me when I think of what others go through.

My post has a good conclusion. I'll post it there. In the meantime, I'm rooting for your sisters! You let them help with this and keep on with the important business of living your life.

Second chances don't last forever (as I remind myself), so we have a moral obligation to live a full life, don't we?

posted by Honeybee123
4 months ago

Mike,

I sure hate it that you are having to contend with all of this. I am currently a Construction Project Manager by trade. Fortunately, I have been able to use many of those skills in managing my own healthcare.

Understanding that I am fortunate to have good insurance and a wife who is a Chief Nurse who is able to connect me to great healthcare, I can only imagine how difficult it must be for those without "connections."

But as a Project Manager I take the view that there is no one in the world more interested in my health as me. I view my health care institutions and insurance company as my "sub- contractors" who will work for me when I motivate them. I have spent the past 3 weeks trying to get a pre authorization for my PET/CT scan in the morning. Eventually it all works out. But I am convinced that had I not taken the offensive and kept pressing the issue then I would not have gotten my pre authorization in time for the test tomorrow. As it was, I called my Oncologist's office and my insurance company on the average of 3 times a day until things got done. I don't like having to be a pain, but if it is going to happen ... I have to take charge of it.

I remember that an insurance company doesn't make its money paying my claims. Therefore, I have to be the one to keep after them to take care of me in a timely manner. Left to their own devices, they will just let me go... After all, their motivation is to not spend money.

Bill

posted by ltcolh
4 months ago

In this case the insurance company outright lied to both me and my nurse. I also spent over 6 months getting them to pay for a procedure that the doctor had gotten pre-certification beforehand. I was just busy going from my bed to the toilet during chemo and radiation and truly was at their mercy or lack of it. I'm glad you don't have any insurance problems, but if your insurer performed like mine did all the planning in the world would have frustrated you to no end. Thanks for the input.
Mike

posted by blorno
4 months ago

Mike,

I can appreciate your frustration regarding the feeding supplies. Cancer patients are unique in that they deal with many service providers such as the hospital, medical oncologist, radiation oncologist in some cases, GI specialist just to name a few. All of them have their own billing practices. They also make you guarantee payment regardless of what the insurance company does. This puts them in the drivers seat as they are guaranteed payment regardless of what the insurance company does. At the same time the insurance company has no incentive to make the payment process easier. We did a project for an insurance company several years ago and the internal motto was "lose, lie deny. You don't make money paying claims." I hope your sisters eviscerate the insurance companies execs. Errors of ommision are the same as direct lies.

We have had several problems regarding payment of claims. Fortunately my wife is good at the administrative side of things and was able to keep on top of the companies and the service providers who always seemed willing to send a threatening letter as opposed to calling to see how things could be worked out. Our experience was that neither the insurance companies or the service providers wanted to go out of their way to make the payment process easier. For the service providers they would just sent out the nasty collection letters. For the insurance companies it is easier for them to just deny the claim. At one point my wife had to threaten the insurance company that I would have nothing to eat and would starve if they didn't move on the feeding supplies claim. (An exageration on her part but it worked.)

Where I am going with this is that I think all cancer patients right at the outset need to establish an advocate for their interests and not just the financial side. No one else is going to look out for them. That may sound harsh but that has been my direct experience so far and it is what I have observed from other peoples situations. I am not saying they are bad people (though I do agree that there is a special place in hell for insurance company executives) but the focus is on treating the diagnosis and not the patient. I am finding this out now as I move to recovery from the treatment.

Tom.

posted by oneilt
4 months ago

Mike,

I fully understand that your insurance company lied to you. I suppose that is where my experience in running Construction Subs has helped me. I go into every encounter understanding that some people will shade the truth, stretch the truth and that to get prompt action, I have to ask the right question in the right way. Hence the response you got that the nutrient had to be with a prescription.

Sad but true, we have to "work" the issue hard and research not only what we want but how to ask for it....

Bill

posted by ltcolh
4 months ago

Personally, I'm convinced that all insurance companies hire 18 yo GED's with no life experience. I've gone so far as to ask who the MD/DDS who made the decision is. Frequently it is not - it's that 18 yr. old again. Then I inform them that it is illegal to practice without a license and would they like to reconsider their previous decision. It works. I've also written to the state legislature with good results. I've yet to call upon the muckraking press but I'm all for what works.

posted by traildoc
4 months ago

traildoc,

That was what got us involved with doing a project for an insurance company 7-8 years ago. They had secretaries denying pre authorization for drugs and procedures and they were taking 30 days to do it. The law in NYS was that denials could only be issued by a pharmacy doctor and had to be turned around in 48 hours. They actually fought the ruling and only when the state threatened to go after the directors individually did they change their procedures. Talk about a rush programming job!

Recently there was that decision in California where one of the major insurance companies were canceling policies years after they were issued based on technicalities if the insured started filing claims. They were OK with collection premiums on the policies as long as they were making claims. In the trial it turned out that they actually ha quotas for their employees to cancel these type of policies and bonus's were tied to how many the denied.

Its unfortunate but people need to realize that they shouldn't trust the company that they have contracted with to make life easier when ill. You really need to have an adversarial view of the insurance company. The sad thing is that this all happens when you are your most vulnerable.

Tom.

posted by oneilt
4 months ago