Wellpoint- "Our system is Broken"

[wilt the stilt]

I was on the phone on Friday with wellpoint and this is what happened over the last year. I filed multiple out of network claims with one claim form. They applied it to two different policy numbers. It took me faxing the claims 4 times to finally get it paid. It took over 6 months. Then my daughter went over the $2,000 out of pocket maximum. I caught them trying to charge me for procedures that was in excess of $2,000. When I caught them the poor customer service person was actually adding it up manually.

A couple of months ago my daughter went to the eye Doctor. They coded me as the patient and applied it to my deductible. They said that the Doctor filled the paperwork out wrong. I got the paperwork from my doctor and it was done right. I faxed it right in and I followed up two weeks ago they told me it was in process. I called on Friday to see where the payment was and they had no record of me sending in the paperwork( I of course have the fax confirmation). I had been communicating with a supervisor and she refused to email me back(ignoring). Finally, i said what is wrong with you and why are you ignoring me. She responded and on the phone she said to me "Our system is broken"

This is on top of me buying insurance for 7 years and paying outrageous sums and when I had to get my daughter's jaw rebuilt after surgery i couldn't even claim it because it would have made the entire procedure "cosmetic"

She would have ended up without a jaw if I didn't rebuild it. That was 10,000 out of pocket.

No supervisor is ever available. They told me that they went home. My response was that it pretty amazing that they let you open up and lock up the facility.

This is the most pathetic system ever(U.S. healthcare)

[dkf]

1. Beats me how the Republicans think you can do a cost analysis on health care plans

When you can't take into account stuff like this.

[PA Democrat]

2. Yeah, I'd say a system where profits trump actual health care is broken...

and immoral, and criminal.

If you purchase the plan on your own, have you tried filing a complaint with the state's insurance commission or whatever body is supposed to regulate the crooks? Sadly, too often the regulating agency is headed by an insurance industry insider, but it is worth a try.

Also, I'd look for a sympathetic reporter to do a story and let the insurance company know that they will be getting a phone call for an interview.

Best of luck to you and your daughter.:hug:

[Vinnie From Indy]

3. I bet their executive compensation procedures run flawlessly

Angela Braley and the other top execs never have a snafu with their paychecks you can be sure!

[Kurovski]

4. Sorry that this has happened.

K&R

[unblock]

5. there are many areas of the economy when INefficiency is highly profitable

anyone who insists that the free market always has an incentive to be as efficient as possible is speaking to their own simplistic religious belief about free-marketism rather than the reality of what actually happens.

generally, companies have an incentive to be efficient in collecting but inefficient in paying. why pay today when you can pay tomorrow? why not wear the other guy down? why not allow yourself the chance that the other guy will give up negotiating and claim less? why not give yourself the chance that the other guy will die or otherwise abandon the claim entirely?

all of this sucks, but it's the reality of the way it works. one of the many ways our economy is broken.

[CrispyQ]

6. The guys my husband works with all say that the US has the "best health care in the world."

They argue that rich people from other countries come to the US for healthcare. My husband says, "Exactly. We have the best health care in the world for rich people. What about you? What if something really bad happened to you? I have the same insurance you have & I can tell you, no. Unless you have a rich uncle we don't know about, you can't get the same care they get" Then they are silent.

Dealing with insurance companies can make you go postal. Good luck & the best to you & your family.

PS - Rebuilding a jaw, after surgery, is cosmetic & not covered - that's just cruel.

on edit: spelling!

[SharonAnn]

8. Actually, many international rich people go toother countries. There are

great medical facilities for the rich in Germany, in Israel, in Chile, and I'm sure there are ones in other places, too. I'm just familiar with specialty medical care in those countries.

Sometimes the best worldwide facility for the rich is in the United States, sometimes it's not.

We're being very chauvinistic to think that we're the only ones who have great medical care for the rich.

[area51]

7. We need freedom from the insurance cartels.

We need single-payer health care.

"We will never have real reform until people's health stops being treated as a financial opportunity for corporations."

"Employer-based health insurance has always been a bad idea. Your life should not depend on who you work for." -- T. McKeon

"Any proposal that sticks with our current dependence on for-profit private insurers ... will not be sustainable. And the new law will not get us to universal coverage ...." -- T.R. Reid, The Healing of America

"Despite the present hyperbole by its supporters, this latest effort will end up as just another failed reform effort littering the landscape of the last century." --John Geyman, M.D., Hijacked! The Road to Single Payer in the Aftermath of Stolen Health Care Reform

[Vinca]

9. I'm in the federal pre-existing condition pool and recently I got the strangest questionnaire

in the mail. I had been to the doctor to get antibiotics after having been bitten by a deer tick. I've been treated for Lyme Disease in the past and know my ticks and figured I'd hop right on it and not wait for the bullseye rash. So I got this 2 page questionnaire from the company that administers the new pool asking questions about where the "injury" happened, did I have workman's comp, did I plan to sue anyone, was a claim filed with my homeowner's insurance, yada, yada, yada. This was for a $40 fee. I sent it back in with a note telling them how totally puzzled I was by it all and they finally paid a whopping $10 of the bill. Life would be so much simpler with a Canadian-style system.

[Shagbark Hickory]

10. They broke it. n/t

[CoffeeCat]

12. They wrote the healthcare bill...

...so if they've got some complaints, they need to direct it to their powerful
lobbying effort that wrote it.

[PETRUS]

11. recommend

The US health care system is a classic example of market failure. Any serious economist - i.e. not ideology-driven, evidence-ignoring types or shills for the 1% - can see this and explain why.

[marked50]

13. Talk about broken

Not that this issue has any of the magnitude of wilt's but I have to share.
I have a HSA/High deductible with an insurance carrier and one of the things they say in their materials about paid coverage is that Glaucoma testing is paid for (up to $400 per year for routine stuff). The wife and I had our eye checkups and I told the Doc to break out the glaucoma- he did the best he could with the coding but didn't have a specific for that. We submitted and it was refused. I contact the insurance folks and went round and round. Review claims, etc. Spent maybe three or four hours over many weeks with them in multiple phone calls and multiple levels. Now we are not talking lots of $ here but it was the principal of the thing. Turns out that they don't have a glaucoma code in their system, hence, the doc's don't have it, hence, no one can make a claim just for that. No way that they can make the claim to pay for the test. Really pissed me off. But I made sure that the time they spent on this was at least costing them as much as the reimbursement would have been. So much for efficiency of the system.

[kenny blankenship]

14. But but but without insurance companies we wouldn't have an efficient & rational market for health

We might end up with the most expensive system in the world!

[eppur_se_muova]

15. An understatement. nt