Insurance companies

[DZoolander]

For all the ragging on the healthcare.gov website last year - I've got to say that private insurance really ain't all that "with it" either...or else they're just the scum of the earth.

We had our son about two months ago. Of course - how it would be covered was of utmost importance to us...so we made several phone calls to our insurer (Blue Cross) - and their story was "For the first 30 days - he's covered under your wife's plan. After that - you'll need to apply for him separately."

Fine enough.

Well - our son was born - had a few respiratory issues after birth so spent about 3 days in NICU before being discharged. About a week after that - we get presented a bill in the mail for everything combined...around $70,000. Yep - you read that right - $70,000.

$30k for my wife/delivery
$40k for the 3 days spent in NICU.

(the actual amount comes out to be around $77... Dunno why I'm rounding down).

And - the $40k bill for our son comes back rejected/not covered...29 days after he was born. So - we call blue cross to find out why.

"Well, you didn't apply for a new policy for him"
"Well, you said that he was covered under my wife's plan for the first 30 days."
"No we didn't."

So, in a panic, we file for a new policy on the 29th day. They tell us "Don't worry about it. He's now covered."

"Is there anything else we need to send?"

"Once the paperwork is processed, we'll let you know and then you have to send his birth certificate."

A week passes, we call back... "It's processing"
Two weeks pass, we call back... "It's processing."
Three weeks pass, we call back... "It's processing."

Today comes along - the 59th day - and we call. "System is down. Call back later."

System is down the entire day - until around 3:30 pm.

"What's the status?"
"Well, you haven't sent the birth certificate...so we're unable to provide coverage."
"When's the deadline?"
"Today."

(mind you - it's 3:30 in the afternoon - and now they're telling us they need a copy of the birth certificate which is only available via the city registrar - and their system was down until 3:30).

"We've been calling for weeks, you've kept telling us not to worry and that it's processing, and now we find out that we need to provide you paperwork by today...and only because we called?"

"Ohhhhh, our bad. Don't worry. Just get the birth certificate in the next few days and fax it over when you can. It'll be okay."

"I'd like that in writing before I get off the phone."

(puts us on hold for a half hour...it's now 4pm)

"Oh, well, I just talked to my supervisor, and since we don't have the birth certificate we can't provide coverage. But - the healthcare.gov site will have open enrollment soon, on the bright side."

"How exactly is that the bright side, when the bill in question will not be covered by it?"

"Don't know what to tell you."

(Well - as God is my witness - today the birth certificate actually came in the mail.)

Soooo - faxed it over to them addressed how they told it to address it (URGENT!! DEADLINE TODAY!)

I did, however, videotape the process of writing the cover letter, showed the birth certificate, and me faxing it (prominently displaying the phone number and showing the successful fax...three times...lol) and posted it to youtube to get the timestamp...for when the next inevitable step comes.

"We didn't receive it."

----

I'm sorry - but insurance companies need to just be done away with. Either it's just utter gross incompetence - or it's downright dishonesty.

 

[mkgal1]

How frustrating!

That was clever to record the transmission of that fax (and get the time stamp).

Is it written in your explanation of benefits about newborn coverage? It's been 22 yrs for us.....but I did think that was standard (and since that's what you were originally told--it seems correct).

It really seems like the insurance company is trying to dodge payment for this and are looking for ways out of paying.

I'm envious of Canadians and their health coverage.

 

[mkgal1]

I found this (but it's about Florida) except the 30-day retroactive period is mentioned there:

Is an infant covered under the mother's insurance while in the hospital?

and this:

Health insurance companies typically require that a newborn be added to a policy within 30 days of birth. The U.S. Department of Labor says enrolling the child within that time frame should provide coverage retroactive to the date of birth.

Read more: http://www.bankrate.com/finance/ins...y-to-your-health-insurance.aspx#ixzz3Es3KdABE

 

[JCLover779]

Contact the state Insurance Commissioner and provide all these details?

You could decide whether to warn them you are going to and give them a chance to fix it (it likely will be fixed ASAP), or just contact the IC and file a complaint.

 

[mkgal1]

^ Good idea, JCLover.

 

[LinkH]

You'll have to look up your policy and see if the child is supposed to be covered. If there are no details of having to turn in a birth certificate by a certain day and the policy says your child is covered for 30 days, you probably have a good case. If your policy says you aren't covered, your case is probably weaker. If you had evidence of someone from B/C saying that the child was covered before you ordered more medical care for the child, maybe you have a case of detrimental reliance, but they could argue that you should have read your policy.

I don't know how much Prepaid legal costs. It's an MLM to have legal service. I think you can get lawyers to write letters for you for free or cheap. It used to be $17 a month 10 years ago. You could sign up for one month just to get a letter written. If the company is supposed to cover it, you could have a lawyer write a letter to Blue Cross/ Blue Shield's legal department and hopefully clear things up that way.

 

[DZoolander]

Agreed.

I don't think we're going to need to go the legal route - because in both cases (original sending of application and today) we fell within the deadlines despite the errant information being given.

What troubles me, though, is the perception that I have that they intentionally give misleading information in the hopes that therefore coverage will be declined. Kind of like why I ended up videotaping the process of faxing it over, displaying what I was faxing beforehand, making sure the phone number being sent to was clearly shown, etc...and then posting it onto a impartial third party (like youtube) for the timestamp.

Do I think that's probably going to be used at some point to prove delivery? At this point - yep - I do.

 

[JCLover779]

That was a smart move to do the time stamp. I'm not techy enough to have thought of that.

I suspect you are correct that you will need the info to provide proof. And it sure does appear that they are hoping to get out of paying the claim. It's awful how much they put people through (time wasted) for the few times they will actually be successful in that. How many people do they think are *really* going to just let a $40K medical bill go? Enough that it's worth their time to try it, sure, but what about yours?

(I've had my own time wasters from insurance companies, though each bill I have to resubmit...and resubmit...and resubmit...is in the hundreds, not in the 40K range.)

 

[faroukfarouk]

How frustrating!

That was clever to record the transmission of that fax (and get the time stamp).

Is it written in your explanation of benefits about newborn coverage? It's been 22 yrs for us.....but I did think that was standard (and since that's what you were originally told--it seems correct).

It really seems like the insurance company is trying to dodge payment for this and are looking for ways out of paying.

I'm envious of Canadians and their health coverage.

What I find puzzling is that when someone in the US proposes a system that kind of resembles the Canadian one, many Christians seem to denounce the proposal strongly.

 

[DZoolander]

Because Christians here in America are attached at the hip (primarily due to being given lip service on the abortion issue) to the GOP - who are vehemently opposed to any kind of "socialized" medicine.

 

[DZoolander]

That was a smart move to do the time stamp. I'm not techy enough to have thought of that.

I suspect you are correct that you will need the info to provide proof. And it sure does appear that they are hoping to get out of paying the claim. It's awful how much they put people through (time wasted) for the few times they will actually be successful in that. How many people do they think are *really* going to just let a $40K medical bill go? Enough that it's worth their time to try it, sure, but what about yours?

(I've had my own time wasters from insurance companies, though each bill I have to resubmit...and resubmit...and resubmit...is in the hundreds, not in the 40K range.)

Oh, it's always a hassle.

Earlier this year I went in for my physical. My doctor is part of my network, of course, but apparently you have to second guess and question the doctor on where he's sending labwork off to - in order to assure that they're part of the network as well.

My doctor sent in my bloodwork - apparently to a non-network lab - so I got socked with a $1,200 bloodwork fee (can you believe that - $1200 for a routine physical blood panel). I called and raised hell - and got it reduced to $0.

Imagine that. "$1200, whoops, ok, $0."

 

[faroukfarouk]

Because Christians here in America are attached at the hip (primarily due to being given lip service on the abortion issue) to the GOP - who are vehemently opposed to any kind of "socialized" medicine.

Probably true.

What baffled me was the prospect of many people for 'religious' reasons backing Newt Gingrich giving President Clinton a really hard time legally about Monica while it turned out that Gingrich himself was doing his own extra-curricular activities.

Like you say, if it's GOP, then it 'must' be right, whether it's about insurance, or whatever...

(But what do I know? I'm a mere Canadian...we get the US news up here too...but don't worry, we have some strange politicians up here as well.)

Congrats. on your addition to the family! May God bless you guys richly!

 

[DZoolander]

What's fascinating to me about the whole political dynamic of it is that everyone knows insurance companies are corrupt as hell. They truly are a parasitic organism - living off the system but contributing nothing to it - but people will defend it passionately for nothing other than political reasons.

There really is nothing more dishonest than medical billing. Hospitals don't believe they're going to get paid what they require - so they inflate prices exorbitantly in order to hopefully eek out some marginally decent negotiated rate. That $40k bill I got is just a pipe dream for the hospital - basically them just lobbing out a number in the hopes of getting maybe $10k from the insurance companies. That really is what the negotiated rate generally works out to be... 20-25% of what the amount billed is.

The problem is - what to do with that amount that is "billed". It can't be treated as a dishonest number - which is what it actually is. So - that number is put into actuarial tables...dealing with price/cost of medicine...which then inflates insurance prices...which then drives additional people out of the pool...which means hospitals have fewer people paying them...which inflates prices...and on and on it goes.

...and all simply to keep insurance companies in business.

 

[DZoolander]

Probably true.

What baffled me was the prospect of many people for 'religious' reasons backing Newt Gingrich giving President Clinton a really hard time legally about Monica while it turned out that Gingrich himself was doing his own extra-curricular activities.

Like you say, if it's GOP, then it 'must' be right, whether it's about insurance, or whatever...

(But what do I know? I'm a mere Canadian...we get the US news up her too...but don't worry, we have some strange politicians up here as well.)

Congrats. on your addition to the family! May God bless you guys richly!

It's their "team" - and that pretty much sums it up.

and thank you!

 

[faroukfarouk]

What's fascinating to me about the whole political dynamic of it is that everyone knows insurance companies are corrupt as hell. They truly are a parasitic organism - living off the system but contributing nothing to it - but people will defend it passionately for nothing other than political reasons.

There really is nothing more dishonest than medical billing. Hospitals don't believe they're going to get paid what they require - so they inflate prices exorbitantly in order to hopefully eek out some marginally decent negotiated rate. That $40k bill I got is just a pipe dream for the hospital - basically them just lobbing out a number in the hopes of getting maybe $10k from the insurance companies. That really is what the negotiated rate generally works out to be... 20-25% of what the amount billed is.

The problem is - what to do with that amount that is "billed". It can't be treated as a dishonest number - which is what it actually is. So - that number is put into actuarial tables...dealing with price/cost of medicine...which then inflates insurance prices...which then drives additional people out of the pool...which means hospitals have fewer people paying them...which inflates prices...and on and on it goes.

...and all simply to keep insurance companies in business.

The lobby of the Willard Hotel at prayer...

 

[Inkachu]

Ahhh, Ezoo, I feel for you!! Our whole health care system is a mess. Insurance companies are a flippin' joke. Even MY blood pressure was going up, just reading your story lol.

 

[Mayzoo]

Hubby has a job and I am a SAHM of a special needs kiddo. Hubby has no insurance through his job. I am unable to be covered by the healthcare.gov site since I am unemployed. To be covered I have to prove to them I have no income. They have no problem insuring hubby with no proof of his income. To prove that I have no income I can provide them:

My w-2
My paystub
or a letter from my boss

Taxes "unacceptable proof". SS statement "unacceptable proof"



So, I have to pay the penalty since I cannot get insurance. We did find a way to get our kiddo covered though, so I am happy about that, but she does not qualify for any subsidies since the adults in the house are not on her plan. Hubby refused to be insured since I am inelligble (emotional/stubborn not logical decission).

Insurance is a joke, and I can laugh about it now only because we finally got kiddo insured. I was not laughing when I thought they were going to prevent kiddo from obtaining insurance.

 

[DZoolander]

Why couldn't hubby just get a family plan that encompasses all of you - since his company doesn't offer any?

 

[faroukfarouk]

Hubby has a job and I am a SAHM of a special needs kiddo. Hubby has no insurance through his job. I am unable to be covered by the healthcare.gov site since I am unemployed. To be covered I have to prove to them I have no income. They have no problem insuring hubby with no proof of his income. To prove that I have no income I can provide them:

My w-2
My paystub
or a letter from my boss

Taxes "unacceptable proof". SS statement "unacceptable proof"



So, I have to pay the penalty since I cannot get insurance. We did find a way to get our kiddo covered though, so I am happy about that, but she does not qualify for any subsidies since the adults in the house are not on her plan. Hubby refused to be insured since I am inelligble (emotional/stubborn not logical decission).

Insurance is a joke, and I can laugh about it now only because we finally got kiddo insured. I was not laughing when I thought they were going to prevent kiddo from obtaining insurance.

Sorry about your problems.

It's almost like Laurel and Hardy, isn't it?

 

[Mayzoo]

Why couldn't hubby just get a family plan that encompasses all of you - since his company doesn't offer any?

Because until I can prove to them I earn nothing, I am not eligble. I gave them our taxes and my SS statements for the last 8 years, and they rejected those as proof. My lack of income is a hard stop for the healthcare.gov site. Hubby got mad and said if I could not be insured, he would not get insured either.

We cannot afford a private policy for all three of us. We were already paying 450 a month just for kiddo. For now it is cheaper to pay the penalty. Eventually it will be cheaper to get the family private policy. We qualify for subsidies, if we could ever "prove" I have no income. But, of course, I do not have a w-2, paystub or letter from my employer, so we are kinda out of luck there.

We have considered making me a paid employee of the household and getting me a small income on a 1099 just to get around this issue. It is something for the future as we ran out time playing games with them earlier this year.