health insurance rant!!

[ut0pia]

First of all I should say I rarely ever use my health insurance, but I've always had it. Until recently I was on my parents' plan and now that I'm working I have my own plan, which started about 5 months ago.

Two days ago I went to the doctor because my tonsils were swollen, infected and had white puss coming out of them (It was really gross)..The doctor said I need to eventually get them removed. He didn't say it was urgent, but because of the discomfort it caused me I wanted to get it done right away. He said he will have someone from his office call me and schedule the surgery and also let me know how much will be covered by insurance. So, I get the call today, scheduled the appointment and when I asked to make sure my insurance will cover it, the girl said something like,  Oh, your insurance has a pre existing condition time limit of 12 months so since we can't prove that you don't have a pre existing condition, and you haven't had it for 12 months you have to sign a paper saying that if they don't cover it, you are responsible for paying for it...I got pretty frustrated because this is why I have insurance, if I wanted to pay it myself I would never have gotten insurance in the first place...She also said that they could waive this if I show them a letter from my previous insurance that I don't have a pre existing condition..

I was thinking wait a second, shouldn't they already have access to my medical records to be able to see my past history of doctor's visits, etc???

And, I haven't even had any illnesses in the past at all, let alone some kind of pre existing condition- I only go to the doctor to get my physical done...So, it would make sense that they would say this if I clearly did have a pre existing condition, but I don't...

I was SO FRUSTRATED!! It just sucks to have to hear that ...I felt like my health was being neglected, and it just stung a little. I am just so used to never having to worry about that kind of stuff.

I want to just call my insurance company and yell at them, and tell them that this is just wrong. What if I had something serious, what if I had cancer, would I end up having to pay for the whole bill myself because they can't prove that I don't have a pre existing condition???

And, I thought the whole point of the healthcare reform four years ago was to make it illegal for insurance companies to use the pre exisitng condition to get out of paying...Ugh Just needed to vent, I will probably call my insurance company tomorrow and try to deal with this...but it just sucks...

 

[speakhandsforme]

Unfortunately, even IF your tonsillitis was a pre-existing condition, the part of the healthcare reform act about that doesn't go into effect until 2014.

I'm sorry to hear you're having a rough time of it. Good luck.

 

[lizzie]

Might they waive your pre existing condition clause if you provide them with a letter of credible coverage?That would mean you'd have to get a letter from your parents insurance company stating when your coverage with them began and ended.That's how my insurance works anyway.Just a suggestion......

 

[MoochNNoodles]

That sounds like a runaround; cover thier butt, kind of statement to me.  I do think most doctors have a thing about payment if insurance denies it.  It covers their butts too.  When I was working in a medical office before DD was born, it would take a few weeks to get actual prior approval for some things.  Depending on what information was requested by the insurance company and then actually getting it through their chain of command.  I would also ask the doc's office why they can't prove it wasn't pre-existing if they have your records.  That is what is confusing to me the most.

That pre-existing stuff is one of the things that frustrates me most.  My MIL has Osteoporosis.  Back when she was still at the Osteopenia stage my FIL was laid off and basically they lost their insurance and had to buy it independently.  Well because the Osteopenia was pre-existing they wouldn't cover the treatments.  So they had to pay out of pocket.  Once it became officially Osteoporosis; they now cover it.  So yeah; her health took a back seat to their policy.  Not that it still wouldn't have progressed because she DID get all the treatments and what not.  It just cost her more than it should have had to.

 

[Willowy]

Insurance agencies are businesses. They aren't in it for charitable reasons---they're in it because it's profitable.

But do talk to your insurance people before you get too worked up. A receptionist at the doctor's office shouldn't be guessing at what they cover and what they don't. But I think it's fairly usual for the doctor to make you sign a thing saying you'll pay if the insurance doesn't. I'm pretty sure I had to sign one of those last time I went--and my insurance paid every penny.

 

[denice]

You should be able to get a letter from your previous insurance company showing coverage. I know everytime I have changed jobs I have automatically gotten that letter from my old company's plan. That letter was supposed to get around the pre-existing conditions clause in my new health plan.

 

[libby74]

Insurance can be a blessing, and it can also be a pain in the old whazoo.  It's the "pre-existing" condition clause that scares me more than anything.  When DH is no longer able to work (which will be because of his "pre-existing" conditions)  he will basically be uninsurable.

I hope you've called your insurance company by now to get this straightened out.  Good luck, honey.

 

[katachtig]

Check with your previous insurance company for a "certificate of coverage"  It should have been sent automatically when your coverage ended (maybe your parents have it?). Get this to your current insurance company ASAP.   Also check with your current insurance company on what they need to prove that it isn't a pre-existing condition. 

I ran into a problem with my husband's insurance company because I kept faxing the certificate of coverage and they didn't record it.  They did send me forms that we could have previous doctors fill out proving that the condition was not pre-existing.

Insurance should not be so difficult, but I've learned that it requires the patience of Job. 

 

[misty8723]

I don't have any advice, but I would like to add to the rant that our new insurance at work is a health savings plan, which means you spend your own money for your health care AND the deductible is $5,000.  So what that means is that not only do I have to pay premiums to the insurance company, I have to pay the first $5,000 of my care myself.  They claim you get a disounted rate, but my last doctor visit for him to look at me for a minute and tell me that I had a sinus infection cost me $79.  And the prescription he wrote for antibiotic was $99!  I was on my way out of the store with prescription in hand figuring I was just going to have to live with the infection when the pharmacist said she would call the doctor and get a cheaper antibiotic.  Which cost  me less than $10 and cleared up the infection just fine.  So the bottom line is no matter what issue I'm having, I'm not going to the doctor. 

I wish you well with your insurance company.  I always laugh about the big fuss they made a few years ago about the goverment having death panels.  The insurance companies have had those for years.

 

[calico2222]

A lot depends on who your company contracts to carry your health insurance and what policy they can afford. My company has decent insurance (but I pay out the butt for it). DH's company has basically "emergency" insurance meaning it's handy to have if you are basically healthy and just need to go to the doctor for sinus infections, broken arm, etc. Our deductible is $2500 for both of us under my insurance, where if we went with DH's offered policy it would be $5000 deductible each. HUGE difference. Of course, being on my insurance also means I will probably have to work for this company until one of us dies because of the "pre-existing" clause in most policies (DH has Crohn's disease and diabetes). So even if we had won the lottery and I could have quit (such a NICE dream) no private insurance company is going to cover any of those expenses.

Back to your situation, definitely call the company tomorrow. I sounds like they are basing this on "well, there's no evidence that is WASN'T a pre-existing condition, so we'll just go with that". Probably just getting a written statement from your parent's insurance company will cover it but check to make sure. Gotta love all the red tape.