Health Insurance Rant

[Airou]

Well, i wanted to let off some steam due to my current situation, but if anyone has any suggests im all ears and i would greatly appreciate any help.

So here it is, im 19 years old and i was born on 07/10/1989.

November of 2007 - I suffered a complete tear of the ACL, a sprain of the MCL, and total loss of one Meniscus, and partial of the other.

December of 2007 - I had surgery and replaced the ACL with cadaver ligament and everything was supposedly a "Success". Began therapy immediately for what was supposed to be 3-4 Months

December of 2007 - It was noted that i had a "1 Yr Warranty" on my surgery, to make sure everything was okay and all done. However it was also noted it could take up to 2 years to recover to 100%

April of 2008 - 4 Months after surgery i still had swelling, pain, cracks and pops in my left knee. Though i could run,walk, jump,etc. Was prescribed more therapy

June of 2008 - Doctor tells me that ligament is healed, just working out on my own should get it to 100%, to see him in a month or so. So i do as told. (Please note: I felt absolutely no difference in my knee, and no progression from about 2 months post surgery, until today. It has felt the same)

July of 2008 - I turn 19. Happy Birthday Jorge, we will no longer cover you medically. Now, instead of costing me 5 dollars per visit to the Surgeon, it now costs 140. For him to simply tell me, you need to keep working on it.

Intermission - Fuck you Amerigroup, Dec-July doesnt seem like a fucking year to me, i dont even get to atleast finish the whole treatment until im 100%.

July - October 2008 - Kept working on my knee very carefully because if anything happened, im screwed because i had no insurance.

November 2008 - I was approved for what was supposedly "Full Coverage" for preferred medical plan. Which i now assume was a play on words from the agent. I took a physical, passed and i was "Covered".

January 2009 - Saw my general doctor, told him about my knee and how id like to see some kind of orthopedic surgeon to take a look at my knee, since im still having alot of pain and not progressing.

February 11th, 2009 - I receive a letter in the mail saying "Your request for medical coverage to see an Orthopedic was denied for the following reason(s): Previous Medical History/Condition"

Awesome, so now ive got no way of assuring myself if im OK, and should anything ever happen to that knee, well all i get from my Insurance company is a big "Sux2bu". So im pretty fucking pissed.

To also note, that big 1 month gap from my injury to the day of surgery was spent dicking around with my insurance because the only Orthopedics they would cover me for were 80 year old men who dont operate anymore working out of a little fucking house/office who couldnt even fucking refer me to an MRI. I had to threaten with legal action (Which to be honest, i dont even think we know how to go about doing so) for them to finally get a surgeon from outside the plan to take a look at me. It wasnt till the week before my surgery that i found out what i even had (MRI was done a week prior). So im going to assume if my surgery was done the following week after an MRI, its a surgery that has to be done fairly quickly, but i had to sit around like a fucking idiot for a month.

So, fuck you insurance companies that dont give a fuck about your clients.

On a lighter note, im sorry for the anger in my post, and if anyone has any suggestions id be more than appreciative to listen.

 

[Pasquale]

That sucks, insurance companies can be real dicks about Pre-Existing Conditions.

I get my insurance through work. We used to have Lumenos, and they were the cat's pajamas of insurance companies. No problems with them ever, and I had a lot of shit done last year.

This year we have Cigna, and they are the Hitlers of health insurance. My payment every paycheck almost tripled, and I have to pay a 20% co-pay for everything now. They take forever approving anything, if they bother to approve it at all, and getting a straight answer from their customer service is more difficult than juggling enraged grizzly bears.

Hope you get your knee stuff worked out. Good luck.

 

[Tenkax]

Cigna sucks. They have no idea what their insurance sales people are selling. My old company had it. Cigna is the microsoft of insurance companies.

 

[Bladewind]

Previous Medical History/Condition"

"They" always put shit like this in the small print, and sadly "they're" very good at small print. Sucks but there's really nothing you can do about it, hope your knee gets better, I've had similar problems in the past but luckily my health insurance was through work so didn't have any problems.

 

[Mirewen]

Solution:

Move to Canada.

Hey, someone had to say it. I shudder to think what health care would cost me if I was in America. I've had MRI's, CAT Scans, Xrays, you name it, I've never had to worry about whether or not I was covered.

 

[Dejavu]

Dont worry we will have you fixed up soon no matter how much in debt it makes the country...

http://www.newsweek.com/id/183663

Sucks about your knee and the ins company dicking you over i would perhaps recommend a Patient Advocate... im just angry about other things...

 

[Celvantes]

You should have recourse to sue your original insurance company... but you need to read the fine print. If you indeed had one calendar year (365 days) after the original surgery in order to receive treatment to get you up to "100%" and they did not honor that, then they either need to refund all the money you (or your parents) paid into the policy or they need to get you to 100%.

However, if there is a stipulation in the policy that says that you aren't covered after you turn 19 NO MATTER WHAT (365 days after a surgery or not), then you're SOL, and you'll need to find an insurance company that will take care of 'pre-existing conditions.' This usually means higher premiums, so your best course of action is to go after the original company.

What people fail to understand is that it's not a matter of being compassionate or heartless. Insurance companies are BUSINESSES. An insurance policy is nothing more than a contract between you (the customer) and the provider (the company) as to what kind of coverage you get for a monthly premium. The riskier you are, the more you are charged for insurance because you have a higher likelihood of drawing on the company's resources. You are using the company to share the financial risk of illness or injury with a large group of people... which in turn brings average health care costs down for everyone involved with the company.

If a company intentionally does not uphold a policy, then they are liable to be sued and could potentially face criminal charges (due to the life-and-death nature of their business). However, if a customer did not fully understand his policy, and expects something that the company does not owe him under the policy terms... that it is the customer's fault, and it isn't a matter of the company not being 'compassionate.'

If a company has poor policies, then vote with your dollars and *don't* buy from them. There are hundreds of insurance companies out there all vying for your money. Someone has to have the kind of services that you want.

 

[Airou]

Thanks for the feedback. I really do appreciate it.

I wasnt really ranting so much as to the fact theyre "heartless" because im sure im not the only one with these issues, so im not special. Its just, i would think there would be some kind of law or rule that you cant leave a customer whom you provided a surgery for, out in dry when the process isnt complete. Atleast untill a doctor says your healed back to normal.

Its like, what wouldve happened if they screwed up during my surgery, or missed something, you get the point. Doesnt the company hold some kind of accountability and to atleast see to it that the wrongs are corrected?

Perhaps theres no rule, but thats what i think is pretty fucked. Had i known these i probably wouldntve played football, its not worth it. I shouldve known better.

 

[Rappa]

Both my old and my new insurance companies have dicked me over in the past 6 months or so. Back when I was first getting diagnosed/treated for allergies I had to go to the hospital for blood work and a ct scan. Several months later my old insurance company still has not paid this bill and it looks like they have no intention of doing so. I offered to pay but the hospital wants to continue persuing it with my old insurance company (even though the hospital sent a collection notice to me...) so we'll see how that goes.

So far my new insurance company hasn't paid for a single allergy shot yet this year. Like the hospital, my allergist is telling me "it's fine, they'll pay it, just keep waiting". So I keep waiting, knowing that if the insurance company won't pay that I'm going to have a massive bill to pay off. They also wouldn't approve my 5mg xyzal prescription and insisted that I take 180mg allegra for a month instead to see if it is "sufficient". So far I've felt really lethargic on this stuff. I'm not very happy about any of this.

They also didn't approve my old prescription for protonix for acid reflux and insisted that I take nexium instead. So they want me to take cheaper allergy meds but also want me to take more expensive acid reflux medicine? The mind boggles.

 

[Firestreak]

Insurance companies generally have to regard pre-existing conditions because of people who have no interest at all in health insurance until the day they get sick. It certainly does suck though when you need to switch from one company to another.

From what I understand though, in my state, Connecticut, it's illegal to do that, I could be wrong though. I'm sure the companies will still screen as best they can and trump up another reason not to cover you, but if you lie about pre-existing conditions on your application, I don't think they can check your history. Once you're already in, you then declare it a "new condition".

As to what system should be used, I could go both and forth on the arguments. I think in the end, both systems have their advantages, and in both you have people getting screwed. My best suggestion to offer is... always have health insurance if you need it or not, and the decent kind, not the low end stuff. If it's cheap, there's a reason. The high end stuff isn't pricey just to boost the profit margin.

 

[Keryan]

I could not agree more. Most companies will offer you a choice of medical insurance, the more expensive one tends to be a lot better. Some of the good insurances allow you to buy coverage on your own for like $500. Make sure to research on your options before signing with one. You might want to try looking up what the state codes are in regards to what the insurance comapnies can and can not do. Some state require treatment no matter if it is an old or new occurance. I think you should look and see if your medical can actually deny you that Doctor visit just because it is a prior ailment. A lot of people play a game of knowing your rights. If you do not know what you are intitled to, they will not give you it. Yet if you know your rights and show them you know it, they will do what they should do.

As for the nations with universal medical coverage~ some of those places put you on a waiting list just to see the doctor. There have been cases of patients actually dying because they could not get in to see the doctor sooner. Also when a doctor gives a bad diagnosis, other doctors have been known to refuse to change the diagnosis even though it is clear that the first doctor was wrong. So yea they can be seen for free or next to no money for anything, but will they see seen in time, or treated accuratly? Or be stuck where you can be seen rather quickly, and by ethical rule treated, and have to pay the bill. MInd you quack doctors are everywhere, and some of them run the insurances. Medical insurances are not in the bussiness to treat sick/injured people, they are there to make money. You may try talking to teh othorpedic anyway~ Some doctors do allow a payment scale~ Meaning you pay x amount per month for the planned treatment.