OT: Has anyone seen Sicko?

[skymax2000]

I don't want to debate whether you like or don't like Michael Moore but I can relate to some of the insurance victims in this movie. I was denied health insurance a couple years ago because the insurance company didn't want to take on someone with anerexia, even though I'm not anerexic, never been told or treated by a doctor for anerexia, and I love to eat. The insurance company inferred it because I was skinny for my height with low blood pressure and a history of depression. Anyways, so to get health insurance, I had to lie about why I was declined before by excluding this info on my application. Now I'm afraid if I get too expensive, they are going to look for a way to deny me and uncover the previous decline. Sigh...

[ChitChatNine]

My thyroid surgery is in appeal for 2nd night stay but according to my rights under my HMO anything performed by an in-network provider w/o the provider getting a pre-cert if necessary is eaten by the provider and/or appealed by the provider with zero $ responsibility for me, the patient.

I learned this all too well with my thyroid surgery as the hosp. wanted me to stay a 2nd night but the insurance wouldn't give a pre-cert beyond the 1 night's stay so they are appealing and will appeal all the way up to the state level but I am not involved, nor am I resp. for any owed money other than my co-pay which I paid.

I had SEVERE VERTIGO, with nasuea and SEVERE migraine headache and couldn't use the toilet to get up out of bed w/o falling bcz of the dizziness.  It was so bad I couldn't tolerate my glasses and I felt this way for over 36hrs after surgery ...... I used the bathroom with 2 people assisting me 36hrs after surgery ..up until that point I was on the bedpan and they expected me to go home???? The HMO said calcium and bloodwork was fine as well as eating and not throwing up .. what about using the bathroom on my own?  They didn't offer a home nurse or ambulence to get me home as I would have puked before I reached the front doors I was so sick.  

Another issue was a few mos later I passed a truckload of kidney stones and the Dr. sent me off-hours for a CT Scan ..I asked 3 people if I had all the right paperwork and was told yes ... and then 2 weeks later got a bill for $4,300 only to find out the hosp. radiology never got a pre-cert and it was declined ..... After mos. of battling it out the hosp. finally gave in to the terms of the HMO contract once I used the LAWYER WORD and sent me a zero balance bill .. THEY GOOFED and had to eat the loss.  I was so upset on that one for weeks wondering if I was responsible or not ... geez... BTW, it showed a pesky 1mm stone stuck was causing all my problems and finally it passed and I feel good now.  I did pass a 4mm stone 12 days post op and now just have a 2mm left and it is painless as of this writing.

INSURANCE WOES ............................yikes!

C~

[SuzieQTT]

Unfortunately...I have worked for several insurance companies and so has my husband...he works for one of the insurance companies named in this movie "Sicko".  coughHumanacough (we now have a $5000 deductible, pathetic!).  We are so glad that I no longer work in this business and he can't wait for his job to end in about 7 months.  I haven't seen this movie yet but I did watch him on the Larry King Live show...and the one disagreement I have with him is that I loved my HMO.  I think a lot of HMO's get a bad wrap because of the name alone but as long as I had that plan I never got turned down for anything.  I only had to be referred to a specialist by my PCP and it worked for me, though I can see how it wouldn't work for some people.

The main thing is ...know your plan inside and out, all appeal rights and learn the numbers for your states Department of Insurance (Each state can have different appeal process and rights).  In most cases you can appeal any denial unless it is specifically stated in your Coordination of Benefits plan/book.  Insurance companies back off when you get loud and threaten them with the DOI.

[imedicmommy]

I've noticed that since we used up all our deductible this year (first time ever) they are sending letters that all procedures are getting a second review. So far the ins hasn't denied us anything but boy are they watching closely!

[ChitChatNine]

UGH ....... insurance woes ........ always have to be one step ahead it seems on it all .... and never say yes to any procedure w/o calling ins. and dotting i's and crossing all the t's!  OR they can deny you 1-2-3 and you are left to pay for it.

They declined the scan my Endo ordered for the existing nodule on the other side of my thyroid even though I had two small areas of cancer on the other side ??? GO FIGURE ??? We decided not to fight it "for now"  but she said maybe if she appealed we would win but save it for the bigger stuff.........a political game and snafoo I think ...

C~