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Rob43

An ER visit, a $12,000 bill — and a health insurer that wouldn’t pay

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Brittany Cloyd was doubled over in pain when she arrived at Frankfort Regional Medical Center’s emergency room on July 21, 2017.

“They got me a wheelchair and wheeled me back to a room immediately,” said Cloyd, 27, who lives in Kentucky.

 

https://www.vox.com/policy-and-politics/2018/1/29/16906558/anthem-emergency-room-coverage-denials-inappropriate

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I had that happen to me a number of years ago.  I had back pain, so I saw my doctor, and he set up an MRI for my back.  I had the MRI, then 12 months later, the insurance company said that the injury appeared to be the result of a car accident  and they refused to pay the bill for the MRI.  I wasn't involved in a car accident, so the letter that they sent to me, indicating that they weren't going to pay for the MRI, asked if I was involved in a car accident.  I called the insurance company and asked them why they thought the MRI was the result of a car accident, and the person I spoke to said that they do that for every MRI claim that comes in.  Once I explained that I wasn't involved in a car accident, the insurance company paid for the claim.  Insurance companies try to get out of every claim that they get, and I think that the government should fine these idiots for doing that.  I mean, if you go to the hospital with chest pains and shortness of breath, you think that you are having a heart attack, then for the insurance company to come back and say, well, your diagnosis wasn't a heart attack, but a panic attack (which resembles a heart attack), and then to deny your claim because you weren't having a heart attack, how were you to know that you weren't having a heart attack?  To decide on paying the claim after the diagnosis is ridiculous....I mean, sure after the diagnosis they can say that you weren't in trouble, but at the time it occurred, you had no way of knowing what was happening to you, so you went to seek medical help.  To say that the medical help you received wasn't necessary, after the fact, is ridiculous.

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A similar thing happened to me some years ago when I sorted to have my cataracts done, reported to the hospital to see the Ophthalmologists (eye surgeon) no waiting straight in before he set off to do his medical examination to my eyes, he asked me, are you currently insured and with whom? Have I got with me any documents, to verify this that I showed him, all were happy, and he proceeded to do his examination? He was happy cataracts had to be removed and were happy to do the operation as soon as possible. He was performing operations, at a near-by Hospital the following day and he was happy to do this operation day after next if I was happy with that date, the operation will be done.

Saw no problem with that, off I went to have my cataracts removed, got to the Hospital sharp and early, so said the cataract operation was done within 3 hours.

What I didn’t know at the time, a few things went wrong, firstly, incorrect verification documents shown by me, was incorrect, secondly, the Hospital he asked me to go too to have the operation, was not an authorised Hospital by my insurance company, and thirdly the operation had to be authorised by my insurance company, and given a procedure number, before the operation can continue.

Hence, the insurance company refused to make payment to the Ophthalmologists (eye surgeon). A sum of £1200.00. So obviously it was all my fault. Looking at the pros and cons, where this could have gone so utterly wrong. I went to see my Lawyers, who immediately took my case on, he put my mind at rest and told me, this can be sorted, probably without a court case. The Doctor and Hospital took the full blame, all I did was shown the incorrect verifying documents, of which the Doctor failed to look at this document thoroughly.

In the end, before all had to go to courts, a decision was made by all including the courts, mistakes were made, so letters were sent to my insurance company, and a ticking off to the Hospital, Questioned all paperwork had to be checked as Hospital procedure goes. My insurance company paid up in full, end of the matter.

As all concern made errors, my insurance was quite lenient to pay the bill without hesitation, and even sent me a £50 cheque for my inconvenience.

So, do have a good fight don’t let it happen to you. The patient always right.

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Back in the mid 90's I had a pulsing area in my left eye that synced to my heartbeat and loss of color perception and blurring  in the same general area. The neurologist decided a MRI was needed. The paperwork was submitted to the insurance company and they approved it so the imaging was done.

 

Seven months later a notice is sent by the hospital that the insurance part of the bill had not been paid.

I called them and they said the hospital needs to submit further paperwork. So I call the hospital and explain what I was told.

They are questioning this but resubmit the paperwork again. Several more months go by, now it has been over 10 months and again am told by the hospital that no payment by the insurance company has been made and payment is needed or they are turning this over to a collection agency. I call the insurance company and they have no excuse why it has not been paid. They said they would investigate.

 

A month goes by and still no action by the insurance co. We do not want our credit dinged and use part of our savings to pay the remaining hospital bill. Now I am researching what we can do and contact the state insurance commission.

We talk a bit and after they are given details am told my company self insures and uses the insurance company to handle the administration of it . So I cannot go to the insurance commission and instead need to go to the department of labor.

But first they told me call the insurance company and tell them you are going to do this.

 

So I call the insurance company and while talking to them and not getting anywhere mention that I am submitting a complaint.

Suddenly things changed, shortly after I hang up I am called back by a representative, I assume a higher up who asked me to please wait they were sending a check out that very day. The next day I was home during the day since I was working the midnight shift and the doorbell rang. They overnighted  a check from Connecticut  to Florida for the full amount.

 

I guess the insurance company had just assumed I would get delayed for a while longer dealing with the insurance commission and then get told they could not help me.

So it took a little over a year before the insurance company paid the claim.

I had a tumor of the optic nerve sheath, due to the risk of blindness they avoided treating it for about 2 years then I had it removed when the visual disturbance increased.  Interesting way they did the surgery, they went through my nose.

 

 

 

 

Edited by Kenton
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It's not right that Americans have to jump through hoops to appease insurance companies and get screwed in the process. Health care should be a right not a privilege. In my opinion you will never get good health care coverage as long as insurance companies are involved

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I disagree. You will never get really good anything unless someone is going to make a buck. In our society money gets things done. I'm not saying I like it that way. But, my experiences tell me that if you want something good you will have to pay for it in some way.

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Well I live in Canada and I never pay for doctors visits even specialists. If I go into the hospital for any reason I don't pay. I don't pay for any tests done in the hospital including MRI's Or CAT or PET scans. In fact I pay for nothing the hospital does or meds and things like kleenex. My bill is 0 when I leave the hospital. I don't pay for lab work or Xrays either.

 

And no it's not free. I pay a 1 time yearly premium on my income tax and the provincial and federal government pay too out of general revenue. We pay slightly higher taxes than the USA so that we can have the peace of mind of never having someone hassle us for money and we always have access to a doctor and medical care..

 

Our doctors and hospitals are paid set fees for what they do. There is no gouging like some doctors and hospitals in the USA. Our health care is cheaper because we don't have to pay a middle man (insurance companies) who like making a profit off our our misfortunes.

We have no private hospitals and there is no jumping ahead because you have money. Those who need treatment first are treated first. Our system is not perfect but it far outweighs the system south of our border.

Edited by dowling gram
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Well I live in Canada and I never pay for doctors visits even specialists. If I go into the hospital for any reason I don't pay. I don't pay for any tests done in the hospital including MRI's Or CAT or PET scans. In fact I pay for nothing the hospital does or meds and things like kleenex. My bill is 0 when I leave the hospital. I don't pay for lab work or Xrays either.

 

And no it's not free. I pay a 1 time yearly premium on my income tax and the provincial and federal government pay too out of general revenue. We pay slightly higher taxes than the USA so that we can have the peace of mind of never having someone hassle us for money and we always have access to a doctor and medical care..

 

Well! What can I say DG, love your system, you see, we have a similar system here, you pay your NHS (National Health Service) kind of, pay as you earned, of course, until you’re retired? No payment to no one, when you’re in Hospital, difference is, you get no special treatment, waiting times before you get on to a Hospital bed, is horrendous, sometimes waiting times can stretch into the next day before you actually get a bed or see a Doctor, Hence, your time is spent in the corridor waiting. As like yourself, nothing is free, you’re paying for it while you’re in continuous employment, until you’re retired and this continues until you are decease.

 

That’s why our NHS is in absolute despair as we speak, a total lack of government funds.

But I do love your health system.

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Buddy Maybe your health system needs overhauling. Those retirees who can pay should have to pay. I'm a senior and I pay my share. Anyone who earns over $20,000 a year pays something on their income tax for health care. The more income you have the more you pay. The pay as you go comes from taxes on everything you buy and on every service you get. It's called the GST--goods and services tax. It was instituted to help our health care and pay down our debt. The richer you are and the more big ticket items you buy the more you are taxed.
 

I don't agree that just those who earn a salary should pay for health care. There are many rich or well off retirees who can afford to pay.

 

We do have wait times but they are kept in line by the vigilance of the opposition parties. Every so often the subject rears it's head and the party in power scrambles to adopt policies that will shorten them.

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21 hours ago, dowling gram said:

Buddy Maybe your health system needs overhauling. Those retirees who can pay should have to pay. I'm a senior and I pay my share. Anyone who earns over $20,000 a year pays something on their income tax for health care. The more income you have the more you pay. The pay as you go comes from taxes on everything you buy and on every service you get. It's called the GST--goods and services tax. It was instituted to help our health care and pay down our debt. The richer you are and the more big ticket items you buy the more you are taxed.
 

I don't agree that just those who earn a salary should pay for health care. There are many rich or well off retirees who can afford to pay.

 

We do have wait times but they are kept in line by the vigilance of the opposition parties. Every so often the subject rears it's head and the party in power scrambles to adopt policies that will shorten them.

 

Thanks very much DG for your input to my post, on our degrading health care. (NHS). I do so agree “there are many rich or well-off retirees who can afford to pay “which, kind of puts me in the well-off bracket, as a retiree, I’d be more than happy to pay into a system like yours, if the benefits of having a health care in our country, was of a better quality.

 

Absolutely hate those waiting times at our Hospital, March 2017, admitted to Hospital approximately 20.00 hrs in the evening, never got a bed before 09.00 hrs the next day.

Appalling!!!

 

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I know that where I live isn't like living in a larger city, so my experiences may not be typical of other areas here.  When I go to the local hospital to have my four month blood work done, I walk into the registration area, there is a box there that has buttons on it, where you push the "Registration" button, and a number pops out.  That is your number in line to be waited on.  Usually, I don't even have time to sit down before my number is called.  I walk up to one of the 5 registration desks, and they take my insurance information, then hand me a form to take to the lab, which is in the same area.  I sit down, and less than 5 minutes later, they call my number, and I get up and walk into the lab.  They draw my blood, and I am finished.  I walk back out to my car, and I look at my watch, and I have been there for less than 15 minutes.  The longest I've had to wait to have my blood drawn, was when I was there at lunchtime, when they changed personnel.  That time it took about 10 minutes before they drew my blood, but even so, it was no big deal.

 

The US has some of the best medical facilities and some of the best health care in the world....if you can afford it.  If you have the money, you can get top notch service, but if you don't have money, then you get slow, less that perfect service.  You will still get taken care of, but maybe not by the best doctors.

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8 hours ago, Hammer said:

The US has some of the best medical facilities and some of the best health care in the world....if you can afford it.  If you have the money, you can get top notch service, but if you don't have money, then you get slow, less that perfect service.  You will still get taken care of, but maybe not by the best doctors.

3

 

Yes, the US has one of the best health systems, and one has to agree with you:

 

Our NHS accident-and-emergency waiting times have been gradually getting worst I’d say over the past 5 years, and to be quite franked with you, I have very little time for them, following the poor service and performance we’ve been receiving in the UK, our media been given them a terrible time, as they so deserved

Waiting times for emergency care have slipped from, 4 hours getting to the Hospital, registration in, to see a Doctor, and in my experience can sometimes go into the next day before one sees a Doctor. Year after year I see those times literally deteriorating.

 

Our NHS is missing many of its key targets with more patients getting stuck in the Hospital waiting rooms and corridors, honestly, some are dying before they get beds. The latest figures show.

Data from NHS UK showed in September the health service missed its A&E target to see, treat or discharge patients within 4 hours.

 

13 months ago Hospital performances have dropped below 95 %, at the end of September, 1.9% of patients had been waiting over six weeks for diagnostic tests - nearly twice the proportion that should be suffering such delays.

 

The performance also fell short on access to cancer treatment, diagnostic tests and ambulance response times.

 

To make matters worse, Hospitals have been struggling to get patients out when they are ready to leave.

 

We’re faced with somewhat of a diabolical and dilapidated system which in my view needs a complete overhaul, by our current government, where an acceleration of funds is required

 

Can we match the USA health care system? NO! Nowhere near there at this current time.

Edited by buddy7
Word!

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