I have just been discharged from the hospital. My physician is managing my chronic pain with pain medication. I have been suffering for years. Recently, upon release, I was told my insurance company had what they call a “formulary” and that was a chart of medications they would not cover or a quantity they would not pay for past. I will only receive two weeks of pain medication. The abrupt stop could cause seizures and brain damage. I will go to the E.R. and possibly be admitted for two weeks for pain care, costing the company a trillion times what my medication would cost. If they will not admit me, well, I hope I live to see you guys prevail against practices like this.
By the way, “formularies” are basically illegal under the he Employee Retirement Income Security Act of 1974 (ERISA) that states care must be given to a patient with their health care interests in mind above all things, including cost. Go fight!
I am 48 and have been a small business owner and “self employed” for nearly 15 years. For years i purchased my own health care coverage through American Family Insurance. It was not a great policy (it did NOT cover medicine) but it did give me peace of mind. Originally my quarterly premiums started at $500. So for $2000 a year I felt it was fair. For 10 years I payed into the plan. Each year, as expected, my premiums went up. 5 years into coverage I was diagnosed with skin cancer and was treated successfully. Over 9 years my premiums had crept up to a little over $1,300 per quarter… so annually I was now paying $6,200. Last year my premiums jumped to just about $3,700 per quarter!!! That meant my health coverage for me was now going to cost over $16,000 for justone year. I just can not afford this and still live. Plus I know the premiums would keep going up and up each year. Needless to say I had to drop the plan. Now I don’t even have the option to get health coverage due to pre-existing conditions. I don’t mind paying for coverage. Many of us uninsured are not “needy” we just want an FAIR opportunity and a way to fairly be included with affordable coverage.
ND BLUE CROSS is a great example of why we need healthcare reform.
While requesting RATE INCREASES a report was leaked yesterday that showed an audit by the insurance commissioner showed that of $418 million in the company’s administrative expenses over the past five years, “millions and millions of dollars in excessive expenses including trips, paarties, inappropriate investments and guaranteeded bonuses for top executives.
Anyone wonder why we can’t affornd health insurance anymore????????
My girlfriend has been dropped by Blue Cross/BS of Texas because she has breast cancer, an allegedly ‘pre-existing’ condition. She supposedly missed a cut-off date by 14 days for coverage from one employer enrollment to another. BC/BS managed to be paid the entire period by her previous employer (a health clinic/hospital conglomerate) - they gladly took the money. Her previous employer has conveniently disengaged themselves from the process but has ‘generously’ offered her a refund on her payment to BC/BS ($400) for the month in dispute. Thankfully her employer has been fighting leukemia and is sympathetic to her situation and has dedicated time and resources to help her find a solution. She is literally fighting for her life. Her chemo has been discontinued ($35K A MONTH). There’s a possibility she may have a brain tumor as well at this point but can’t afford the zillion dollars in tests. She goes to work four days a week. Her life is hanging by a thread and all I see on the news is a bunch of whining pro-death tea party twits complaining about socialism and losing their guns. This country is at a very crucial point; a decision about what is more important - profits or lives - will be made shortly. I’m not hopeful about the outcome but I will not tolerate my girlfriends continued fear and pain without a fight. We must stand up for ourselves.
I have been on Cobra is I’m reaching the limit, so Cobra will end by the end of this year. So, I started to look for an individual insurance because to go into HIPPAA, the premium is increased over 100%.
However, I got rejected by Blue Shield stating I have several health issue. Even though my doctors said the blood result tests are not significant enough to determine it is an issue and they wrote letters to the insurance company on my behalf, the insurance company basically came back standing firm.
I believe the insurance companies such as Blue Shield is scamming consumers. They said they have all these plan options, however, in reality, unless you have “PERFECT” health, no one will qualify.
So, now, I am stuck with either paying high premium for the HIPPA plan or go work (which is not easy, given the high unemployment rate).
We need to have national plan that ties to individuals and not corporations, so that we don’t have to go through all these approval process every time there is a change.
Principal Health Insurance Co. is sitting on my preauthorization for cancer treatment. I switched my Dr.s to the ones in their network, three of whom have recommended Cyberknife treatment. The insurance company says they might take 30 days to decide whether I can have this life-saving treatment. My tumor continues to grow and I am in pain. I was told that one of the insurance company’s NURSES will decide whether or not I can be treated!!! How do these people even sleep at night???
I have a radical idea folks. IF tomorrow EVERYONE with medical insurance, suddenly DROPPED covergae…we’d get the lousy bastards quickly.
You see, without people voluntarily paying for the insurance scam industry it would FAIL.
That is the kind of action needed by a nation-wide organization to truly bring about CHANGE, and QUICK.
Otherwise, perhaps wear an engraved piece of jewelry that says: “You save, you pay.” So if you fall ill, and someone tries to rescue you, they know THEY will have to pay the bucks for YOUR care.
We have fought both Blue Shield of California, the Department of Managed Health Care in Sacramento and to no avail, both the insurance and our so-called “objective” Department of Managed Health care have refused physical therapy for our 9 year old son who has orthopedic impairments. Both the insurance company and the Department of Managed Health Care stated that the therapy was not medically necessary, despite 85 pages of documentation and letters of medical necessity from doctors at Lucile Packerd and Children’s Hospital Oakland. We have been paying out of pocket for the physical therapy (upwards of $20,000 annually including premiums to Blue Shield) and with this therapy our son can now walk independently. I have written letters to my local constituents, Don Perata, Governor Schwarzeneger and Mary Hayashi. Only Ms. Hayashi responded and tried to help, but could not pursue as once a decision is made by the Department of Managed Health care it cannot be appealed. The review that was performed by the Department of Managed Health Care was inaccurate did not consider all the therapy procedures involved nor did a representative visit the medical site to see first hand the therapies being administered. These same physical therapies are currently vendorized by the California Department of Developmental Services and State Regional Centers of which after a two year struggle we did secure a one-time exceptions funding. How can these therapies be approved as medically necessary by the Department of Developmental Services but not by Blue Shield and the Department of Managed Heatlh Care. The incongruities amongst insurance and state agencies are infinitely apparent. If the single payer system operates like our Department of Managed Health care it’s a bust (little or no regulation of insurance’s company’s, back pedaling on policies of medical necessity), but if functions like the Department of Developmental services perhaps there is hope.
My insurance story is not nearly as horrible as these posters, but I feel that it’s just the beginning of my problems with them. I have bipolar disorder and went for a long time without insurance coverage until my state passed the parity law. At that point, they had to cover biologically based mental illnesses equally to any other illnesses. With regular therapy and medication, I improved so much that I was able to work full time (which I’d never been able to do before) and even go to law school at night. The insurance company paid all my claims without question. Suddenly, a couple of months ago, they started denying my claims, saying the doctor was “out of network.” I called and someone looked it up and said, “oh, you’re right, he is a network provider, hold on.” Another guy came on and told me the doctor was NOT a network provider and that I would have to file an appeal. I wrote a very curt letter, including numerous exhibits from both the law and their own policy, but they never responded. I sent a copy of my letter to my doctor’s accounting people who also called and fought with the insurance company. Finally I got the idea to just call every day till I got someone who I could reason with. The next person I reached told me that I belong to a PPO and my doctor was a contract doctor. We argued for over 40 minutes, with me asking why he was paid in-network for over 8 years, and reading all the information from their website to her as we talked. Finally she put me on hold, and came back to tell me that the claims were being re-submitted and paid. So I asked whether he was indeed a network provider and she reluctantly admitted that he is. I have a feeling this is only the beginning of the war. Had I not been so persistent, they would have gotten away with it. I think they deliberately deny coverage in the hopes that most people won’t fight it and then they can save money that way. Crooks!
I work a doctor’s office and do authorizations for medications which the doctor prescribes and the insurance company denies. First you have to pre-authorize the medication and 80% of the time the eighth grade non-health care person on the end of the phone line says it is denied. Then you appeal the denial. United health care requires the patient to either sign over their power of attorney to go through the process with the doctor (which our doctors’ will not accept) or write a letter stating why they whould get their medication. Not to mention all the Medicare Part D companies who change what medications they cover in January when the date patients’ can file by ended in December. And they don’t warn aqnyone about the changes. The patient goes to get their prescription filled and they can’t get it. So Sorry. Please run through our red tape and we may authorize the medication.
I have just been discharged from the hospital. My physician is managing my chronic pain with pain medication. I have been suffering for years. Recently, upon release, I was told my insurance company had what they call a “formulary” and that was a chart of medications they would not cover or a quantity they would not pay for past. I will only receive two weeks of pain medication. The abrupt stop could cause seizures and brain damage. I will go to the E.R. and possibly be admitted for two weeks for pain care, costing the company a trillion times what my medication would cost. If they will not admit me, well, I hope I live to see you guys prevail against practices like this.
By the way, “formularies” are basically illegal under the he Employee Retirement Income Security Act of 1974 (ERISA) that states care must be given to a patient with their health care interests in mind above all things, including cost. Go fight!
I am 48 and have been a small business owner and “self employed” for nearly 15 years. For years i purchased my own health care coverage through American Family Insurance. It was not a great policy (it did NOT cover medicine) but it did give me peace of mind. Originally my quarterly premiums started at $500. So for $2000 a year I felt it was fair. For 10 years I payed into the plan. Each year, as expected, my premiums went up. 5 years into coverage I was diagnosed with skin cancer and was treated successfully. Over 9 years my premiums had crept up to a little over $1,300 per quarter… so annually I was now paying $6,200. Last year my premiums jumped to just about $3,700 per quarter!!! That meant my health coverage for me was now going to cost over $16,000 for justone year. I just can not afford this and still live. Plus I know the premiums would keep going up and up each year. Needless to say I had to drop the plan. Now I don’t even have the option to get health coverage due to pre-existing conditions. I don’t mind paying for coverage. Many of us uninsured are not “needy” we just want an FAIR opportunity and a way to fairly be included with affordable coverage.
ND BLUE CROSS is a great example of why we need healthcare reform.
While requesting RATE INCREASES a report was leaked yesterday that showed an audit by the insurance commissioner showed that of $418 million in the company’s administrative expenses over the past five years, “millions and millions of dollars in excessive expenses including trips, paarties, inappropriate investments and guaranteeded bonuses for top executives.
Anyone wonder why we can’t affornd health insurance anymore????????
My girlfriend has been dropped by Blue Cross/BS of Texas because she has breast cancer, an allegedly ‘pre-existing’ condition. She supposedly missed a cut-off date by 14 days for coverage from one employer enrollment to another. BC/BS managed to be paid the entire period by her previous employer (a health clinic/hospital conglomerate) - they gladly took the money. Her previous employer has conveniently disengaged themselves from the process but has ‘generously’ offered her a refund on her payment to BC/BS ($400) for the month in dispute. Thankfully her employer has been fighting leukemia and is sympathetic to her situation and has dedicated time and resources to help her find a solution. She is literally fighting for her life. Her chemo has been discontinued ($35K A MONTH). There’s a possibility she may have a brain tumor as well at this point but can’t afford the zillion dollars in tests. She goes to work four days a week. Her life is hanging by a thread and all I see on the news is a bunch of whining pro-death tea party twits complaining about socialism and losing their guns. This country is at a very crucial point; a decision about what is more important - profits or lives - will be made shortly. I’m not hopeful about the outcome but I will not tolerate my girlfriends continued fear and pain without a fight. We must stand up for ourselves.
I have been on Cobra is I’m reaching the limit, so Cobra will end by the end of this year. So, I started to look for an individual insurance because to go into HIPPAA, the premium is increased over 100%.
However, I got rejected by Blue Shield stating I have several health issue. Even though my doctors said the blood result tests are not significant enough to determine it is an issue and they wrote letters to the insurance company on my behalf, the insurance company basically came back standing firm.
I believe the insurance companies such as Blue Shield is scamming consumers. They said they have all these plan options, however, in reality, unless you have “PERFECT” health, no one will qualify.
So, now, I am stuck with either paying high premium for the HIPPA plan or go work (which is not easy, given the high unemployment rate).
We need to have national plan that ties to individuals and not corporations, so that we don’t have to go through all these approval process every time there is a change.
Principal Health Insurance Co. is sitting on my preauthorization for cancer treatment. I switched my Dr.s to the ones in their network, three of whom have recommended Cyberknife treatment. The insurance company says they might take 30 days to decide whether I can have this life-saving treatment. My tumor continues to grow and I am in pain. I was told that one of the insurance company’s NURSES will decide whether or not I can be treated!!! How do these people even sleep at night???
I have a radical idea folks. IF tomorrow EVERYONE with medical insurance, suddenly DROPPED covergae…we’d get the lousy bastards quickly.
You see, without people voluntarily paying for the insurance scam industry it would FAIL.
That is the kind of action needed by a nation-wide organization to truly bring about CHANGE, and QUICK.
Otherwise, perhaps wear an engraved piece of jewelry that says: “You save, you pay.” So if you fall ill, and someone tries to rescue you, they know THEY will have to pay the bucks for YOUR care.
We have fought both Blue Shield of California, the Department of Managed Health Care in Sacramento and to no avail, both the insurance and our so-called “objective” Department of Managed Health care have refused physical therapy for our 9 year old son who has orthopedic impairments. Both the insurance company and the Department of Managed Health Care stated that the therapy was not medically necessary, despite 85 pages of documentation and letters of medical necessity from doctors at Lucile Packerd and Children’s Hospital Oakland. We have been paying out of pocket for the physical therapy (upwards of $20,000 annually including premiums to Blue Shield) and with this therapy our son can now walk independently. I have written letters to my local constituents, Don Perata, Governor Schwarzeneger and Mary Hayashi. Only Ms. Hayashi responded and tried to help, but could not pursue as once a decision is made by the Department of Managed Health care it cannot be appealed. The review that was performed by the Department of Managed Health Care was inaccurate did not consider all the therapy procedures involved nor did a representative visit the medical site to see first hand the therapies being administered. These same physical therapies are currently vendorized by the California Department of Developmental Services and State Regional Centers of which after a two year struggle we did secure a one-time exceptions funding. How can these therapies be approved as medically necessary by the Department of Developmental Services but not by Blue Shield and the Department of Managed Heatlh Care. The incongruities amongst insurance and state agencies are infinitely apparent. If the single payer system operates like our Department of Managed Health care it’s a bust (little or no regulation of insurance’s company’s, back pedaling on policies of medical necessity), but if functions like the Department of Developmental services perhaps there is hope.
My insurance story is not nearly as horrible as these posters, but I feel that it’s just the beginning of my problems with them. I have bipolar disorder and went for a long time without insurance coverage until my state passed the parity law. At that point, they had to cover biologically based mental illnesses equally to any other illnesses. With regular therapy and medication, I improved so much that I was able to work full time (which I’d never been able to do before) and even go to law school at night. The insurance company paid all my claims without question. Suddenly, a couple of months ago, they started denying my claims, saying the doctor was “out of network.” I called and someone looked it up and said, “oh, you’re right, he is a network provider, hold on.” Another guy came on and told me the doctor was NOT a network provider and that I would have to file an appeal. I wrote a very curt letter, including numerous exhibits from both the law and their own policy, but they never responded. I sent a copy of my letter to my doctor’s accounting people who also called and fought with the insurance company. Finally I got the idea to just call every day till I got someone who I could reason with. The next person I reached told me that I belong to a PPO and my doctor was a contract doctor. We argued for over 40 minutes, with me asking why he was paid in-network for over 8 years, and reading all the information from their website to her as we talked. Finally she put me on hold, and came back to tell me that the claims were being re-submitted and paid. So I asked whether he was indeed a network provider and she reluctantly admitted that he is. I have a feeling this is only the beginning of the war. Had I not been so persistent, they would have gotten away with it. I think they deliberately deny coverage in the hopes that most people won’t fight it and then they can save money that way. Crooks!
I work a doctor’s office and do authorizations for medications which the doctor prescribes and the insurance company denies. First you have to pre-authorize the medication and 80% of the time the eighth grade non-health care person on the end of the phone line says it is denied. Then you appeal the denial. United health care requires the patient to either sign over their power of attorney to go through the process with the doctor (which our doctors’ will not accept) or write a letter stating why they whould get their medication. Not to mention all the Medicare Part D companies who change what medications they cover in January when the date patients’ can file by ended in December. And they don’t warn aqnyone about the changes. The patient goes to get their prescription filled and they can’t get it. So Sorry. Please run through our red tape and we may authorize the medication.