DragonRider Posted December 31, 2009 Share #1 Posted December 31, 2009 Charlene is devastated, I am mad beyond reason........I will give you the short version. As most of you that know Charlene, she has been waiting to have her back surgery now for over 2 years, it was scheduled for Mon. Jan, 4 2010. This morning at 10:45 am she gets a call from the Dr.'s office saying they have to cancel her surgery for reasons we still dont understand and agree with. The insurance company, Blue Cross Anthem faxed them and said they couldnt authorize it, the reason, new coverage, my company changed insurers, from BC/BS of Texas to Blue Cross Anthem. The coverage could not be verified before Jan. 1,(New Years Day). We just got all the info from them on Mon, Jan 28, so they got it as soon as we did. They are putting her file under medical review, could take up to 15 days or more to get it approved..........BC/BS had already authorized it and told us even though the coverage changed it wouldnt be a problem. WRONG!!!!!!!!!!!!! I spent 2 1/2 hours on the phone this moring with both insurance companies and every time I got put on hold after about 5 minutes I got disconnected and had to call back and start all over and when I finally got to someone every story was different to no problem to just a small problem, to sorry nothing we can do at this time........the nurses that review the files will not talk to anyone so we couldnt get them on the line.......I am so fed up with Blue Cross if I could find an office I would likely do something I would regret. Charlene is taking it better than I am, but thats not saying much, everytime she tells someone about it she ends up crying. We had a lot of people that were going to help us out and now they have to put those plans on hold till we get the approval. I was supposed to be on vacation till the 18th of Jan, now I have to go back to work till they approve it and hope my company understands what is happening and will let me reschedule it........... Our HR person is going to get an earful from me because we were told everything was ok to proceed, so I will be spending a lot to time in her office on Monday till we get some resolution. Luckily I was able to go to the ABC store and get some adult beverage, cause I am going to need it............ All I can say is, if anyone else has Blue Cross Anthem, better be prepared to go to battle with them if you need something covered by them........this is the third time in 4 years our coverage has changed and everytime it keeps getting worse, for 2010 our deductable went up by 50% and our out of pocket expenses went up by 50%.................... Well this helped a little to vent....... Hope everyone else has a great New Year!!!!! Link to comment Share on other sites More sharing options...
mini-muffin Posted December 31, 2009 Share #2 Posted December 31, 2009 Sorry to hear that Lewis. Your former insurance should never have told you it would be ok. Whenever they change stuff you start all over with a new ins. policy. I know Jeff's insurance changes periodically. It's a big pain especially since Charlene was suppose to get surgery. Good luck and I'd give that HR person a reaming. They should have known what was coming. Margaret Link to comment Share on other sites More sharing options...
Kregerdoodle Posted December 31, 2009 Share #3 Posted December 31, 2009 That really sucks..... hope that this new year is better and everything gets worked out.. K Link to comment Share on other sites More sharing options...
rumboogy Posted December 31, 2009 Share #4 Posted December 31, 2009 And while I don't intend on this turning into a political discussion...this is why HEALTHCARE REFORM should have been passed in it's original form (from about 3 months ago). As of right now the HEALTHCARE INSURANCE COMPANIES have won. I have been in healthcare for over 35 years and I see it FIRST HAND. As long as the Blue Cross/Blue Shields (and Usable, Athena, Humana's) of the U.S. are able to monopolize the healthcare industry with higher premiums, higher deductibles, and fewer services...our healthcare will always be in a mess...and I got news for ya...it's gonna get worse before it gets better...and all because the healthcare used scare tactics and inaccurate information, not to mention their powerful lobby. Not that it bothers me... Link to comment Share on other sites More sharing options...
Zfrebird4 Posted December 31, 2009 Share #5 Posted December 31, 2009 I am so far fortunate that I have good coverage with a secondary on Mericare A&B. That may not hold for this Sr though given OBOMMAHOOD, aka, OBOMMACARE, ... if it gets passed anything nearly close to what it not contains. The very wealthy and any who are retired will pay through the nose, and coverage will, most assuradly decline. My prayers for your both during this trama, and especially for your wife with any back pain along with the heart and head pain of this disappointment. Keep us posted, as the Good Lord also loves to hear prayers of rejoicing following prayers of petition. One of your many friend here in VR.com, JackZ aka DePreach (retired; non fundi!) Link to comment Share on other sites More sharing options...
Eagle77 Posted December 31, 2009 Share #6 Posted December 31, 2009 I know that is a real pain. I have been there done that only with my Daugher several years ago. I know most eveyone is against goverment health care but I have to say that since I have retired and went on medicare---along with a supplement neither my wife nor I have had any problem what so ever. I no longer have to deal with insurance companies. Medicare sets the amount they will pay, The doctor and hospitals accept it and the my supplement insurance picks up what Medicare doesn't pay. Hang in there I am sure it will get worked out. Link to comment Share on other sites More sharing options...
BEER30 Posted January 1, 2010 Share #7 Posted January 1, 2010 Sad to hear this news . But may I ask if you got the approval in writing ? If so , I would shove it in their face , set your terms on moving forward without delay . If they do not , Scream "BAD FAITH" right in their face and threaten to sue the crap out of them . They hate them 2 little words "BAD FAITH" . I've been down this road before with my back injury and it worked too , telling them off . Oh by the way , have a letter on "BAD FAITH" intent in hand . Give them a copy of it when you tell them off . Best of Luck to Charlene and the rest of the clan . And by the way , HAPPY NEW YEARS ! BEER30 Link to comment Share on other sites More sharing options...
rumboogy Posted January 1, 2010 Share #8 Posted January 1, 2010 I know that is a real pain. I have been there done that only with my Daugher several years ago. I know most eveyone is against goverment health care but I have to say that since I have retired and went on medicare---along with a supplement neither my wife nor I have had any problem what so ever. I no longer have to deal with insurance companies. Medicare sets the amount they will pay, The doctor and hospitals accept it and the my supplement insurance picks up what Medicare doesn't pay. Hang in there I am sure it will get worked out. I really don't think almost everyone is against government healthcare...in fact, my guess is that EVERY ONE of us that is 65 or older would not turn down a medicare payment to a hospital or physician. The government has been a part of healthcare since 1965, so it's nothing new. Eagle77, you made the best argument...you've had no problems with the "government ran" healthcare. You'll notice that the non-government insurance companies prefer to insure younger and healthier individuals as opposed to us older folks...that's not by accident. OK...I'm off my "healthcare" soapbox. Dragonrider...I do hope your wife gets the help and surgery she needs. Wally Link to comment Share on other sites More sharing options...
Dano Posted January 1, 2010 Share #9 Posted January 1, 2010 Yeah, try having Anthem BC/BS as your Cobra administrator------ I'll stop there Link to comment Share on other sites More sharing options...
Yammer Dan Posted January 1, 2010 Share #10 Posted January 1, 2010 Sorry to hear that Lewis. I thought I was going to get to keep my insurance with the retirement. Not sure about that now. They are kicking. Have I ever mentioned I HATE INSURANCE COMPANIES... Link to comment Share on other sites More sharing options...
Condor Posted January 1, 2010 Share #11 Posted January 1, 2010 Wouldn't your older BC/BS be on the hook since it's an ongoing claim, and the operatiion's already been approved by them. I think you need to go bang heads.... Link to comment Share on other sites More sharing options...
DragonRider Posted January 1, 2010 Author Share #12 Posted January 1, 2010 Bang some heads, I would likely end up in jail, cause once I start, I aint stoppin...................... Wouldn't your older BC/BS be on the hook since it's an ongoing claim, and the operatiion's already been approved by them. I think you need to go bang heads.... Link to comment Share on other sites More sharing options...
Aussie Annie Posted January 1, 2010 Share #13 Posted January 1, 2010 I can't comment on your insurance cr**p, but I can sympathise with Charlene. I've been waiting for my specialist appointment since May last year and they keep changing it :bang head: Please pass on these hugs to Charlene from me, it wont stop the pain, but hopefully will make her feel better. :bighug::bighug::bighug: Link to comment Share on other sites More sharing options...
Venturous Randy Posted January 1, 2010 Share #14 Posted January 1, 2010 Lew, I truly feel for you and Charlene. And, this is one of the main reasons I have used the Veterans Administration exclusively for the last ten years. Plus the fact that we have a big nice VA here in Johnson City and they have taken very good care of me. Plus, both of my parents are buried in the cemetery. RandyA Link to comment Share on other sites More sharing options...
autopilot Posted January 1, 2010 Share #15 Posted January 1, 2010 Dragonrider, You have my sympathies; moreso your wife. The situation really bites! Link to comment Share on other sites More sharing options...
ADC Posted January 1, 2010 Share #16 Posted January 1, 2010 Sorry to hear this Lewis I hope and pray it all works out soon and I have anthem bc/bs but I haven't run into any problems yet. Arthur Link to comment Share on other sites More sharing options...
b2dad Posted January 1, 2010 Share #17 Posted January 1, 2010 I say that with all sincerity...because Pat has been fighting insurance companies all year long. I have BC / BS Anthem, (and really haven't had any trouble out of them, but never really had a claim either) but because SHE works, they force her to buy her insurance where she works which then becomes her primary insurance. Although it's basically a good policy, she's been fighting for reimbursement of a "covered" expense since last April. (The doctor office would not bill the insurance company and asked for the money up front) Insurance keeps telling her it's covered and the check is in the mail, however, she never receives a check. She spends over an hour on the phone every week with them arguing some point. Recently the hospital charged us $21 for 3 meals they claim they provided me while she was in the hospital...which I NEVER GOT. She called the hospital to dispute the charge and BAM...they took it off the bill. Now my question is: Why can't the insurance companies work that fast? I sympathize with your problems and I know this doesn't help the wife with her pain. Hang in there and keep calling / bugging them. I think eventually we will all wear them down and they will have to approve the surgery / pay the claim!!! And meanwhile...the pain goes on. You are in our thoughts and prayers. Don Link to comment Share on other sites More sharing options...
Snarley Bill Posted January 1, 2010 Share #18 Posted January 1, 2010 hang in there buddy, same thing happened to me. my blue cross anthem changed. just put the new card in my wallet this morning. luckily nothing scheduled in the near future. they will get yours straightened out. bill Link to comment Share on other sites More sharing options...
Guest Ken8143 Posted January 1, 2010 Share #19 Posted January 1, 2010 Lew -= I am so sorry for your troubles. I could go on and on about some of our insurance glitches but I won't. I find it is best to get EVERYTHING in writing, put it in a folder, and NEVER throw it away. I don't pay nothing without the bill AND the explanation of benefits and after I am sure things match up in a way I can understand. And if you can get contact going with one person, like the claims manager that handles your account, and get a positive relationship going, that can be helpful. Hope that things get resolved PRONTO. Bad Faith are strong words - they can cause folks to snap to attention - Fraudulence is another word. Insurance Commissioner. Very best wishes and pass along our care and love to you dear wife. And wouldn't it be fun to take a 1st gen run through their front lobby? Lay down some patches on the marble floor in the foyer? And do the Evil Knievel over a few desks? Hey man, let it rip! We will come visit you.... Link to comment Share on other sites More sharing options...
ediddy Posted January 1, 2010 Share #20 Posted January 1, 2010 Lewis, Sorry to hear about your problems. I don't know how big your company is or where they are headquarted but someone in authority with your company could call the insurance company and tell them if they can't do better than this they will place coverage with another company. You can also go on line to the georgia insurance commissioner and file a complaint. The insurance company will have to answer the complaint and explain to the commissioner why they took the action they did. The health insurance companies in georgia are very concerned when the insurance commissioner gets a complaint since united healthcare just got fined $750,000 for not paying claims on time. A couple of years ago double cross double shield got fined $300,000. To the people that want the govenment take over the health insurance industry, if you think this is bad wait until the government takes over. Thats all I'm going to say. Link to comment Share on other sites More sharing options...
jarrejx Posted January 1, 2010 Share #21 Posted January 1, 2010 (edited) We are praying for a miracle for you & Charlene. Know that Jesus' authority far exceeds that of Blue Cross. Edited January 1, 2010 by jarrejx wording Link to comment Share on other sites More sharing options...
rumboogy Posted January 1, 2010 Share #22 Posted January 1, 2010 To the people that want the govenment take over the health insurance industry, if you think this is bad wait until the government takes over. Thats all I'm going to say. The government has been involved since 1965. I hear FAR fewer complaints from those on Medicare and Medicaid than I do Blue Cross, Humana or any other private insurance. It's a pretty sad commentary that the CONSUMER has to threaten a company for benefits that they have paid for in advance. I'm just saying ANY healthcare reform that limits how the insurance companies treat patients is better than the present system (which is only getting worse)...and that includes a more widespread government health plan. Link to comment Share on other sites More sharing options...
mraf Posted January 1, 2010 Share #23 Posted January 1, 2010 VENT AWAY! Insurance companies suck. Hope you get it straighted out soon for your families peace of mind. Link to comment Share on other sites More sharing options...
Eck Posted January 1, 2010 Share #24 Posted January 1, 2010 Lewis, I am sorry to hear this news, but like Beer30 said: set your terms on moving forward without delay. I personally would not reschedule and just press on with the arrangements already made. Once the new insurance company does their review it will all be covered anyway.. and most likely they would have it straightened out before you got the first bill. Link to comment Share on other sites More sharing options...
royalstarjac Posted January 1, 2010 Share #25 Posted January 1, 2010 Lewis, Sorry to hear of your troubles. If it was me I would be contacting your HR person at home. By phone or in person if needed, holiday or no holiday. It's their job to handle these situations. JMO. Link to comment Share on other sites More sharing options...
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