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  • Stupid insurance company

    I've spent the last two days arguing my my health insurance company. My son has been having increased pain and muscle spasms surrounding the hardware that's holding his hip together. We discover that he's got a new bone tumor, which, if not for the hardware, wouldn't be that big of a deal. But it just so happens that this tumor is directly underneath the large metal plate that bridges the top of the straight part of the femur and the femoral head. This is pushing the plate into an odd spot and "hooking" the iliotibial band, which just creates a huge domino effect of pain/spasms and general misery. Surgery to remove the existing hardware, excise the tumor and redo the hardware is indicated. Should be fairly straight forward, right?

    Nope. Doc does a basic pre-op exam. He's not thrilled with the child's spine. Sometime in the last year (since his last operation), the upper part of his spine has straightened out. X-rays confirm the deformity, but give no indication of why, or any evidence that traditional intubation methods would be safe (and intubation is required for general anesthesia). So doc orders an MRI of his entire spine. Insurance company says no. Mama bear goes on a rampage. Granted it was a very polite rampage, but there's no way either the surgeon or the anesthesiologist are going in blind, and even if they were willing, I wouldn't consent. Beyond that, whatever's causing the spine to be deformed needs to be diagnosed and addressed.

    So I got to spend the day on the phone with an ever escalating series of people trying to talk some sense into them. Apparently they stop reading "in preparation for hip surgery", and deny the authorization because you don't need a spinal MRI to operate on a hip. Most of these people needed to get out of customer service years ago. I get that calls centers suck. I really do. I've had a call center job. But at some point, you really need to actually listen to your customers or learn to read the doctor's notes. After being sent to the third different "supervisor", I finally got somebody to actually read the entire document. MRI is finally approved and scheduled, but seriously, it should not have been this difficult.

    Okay, vent over.
    At the conclusion of an Irish wedding, the priest said "Everybody please hug the person who has made your life worth living. The bartender was nearly crushed to death.

  • #2
    ohhh not fun... i wonder what they would have said about my dads first ekgs? see he went in for a hernia operation. as they prepped him the did a quick listen to his heart. they then stopped what they where doing. my father always had had a slight heart murmur but it was suddenly much much worst. so much worst they had to do surgery after all but this time to do a artificial valve.

    but first it took him a few months of tests to get an idea just how bad it was.

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    • #3
      Oh, I don't mind having to justify the need at all. I get that. What I got frustrated with was the fact that the reps stopped listening and/or wouldn't read all of the supporting documentation. It's like they were on a script and simply refused to go off that script, even though the evidence of need was quite plain.
      At the conclusion of an Irish wedding, the priest said "Everybody please hug the person who has made your life worth living. The bartender was nearly crushed to death.

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      • #4
        Quoth patiokitty View Post
        Mathnerd, I think you can blame doctors who have padded bills for their patients over the years by submitting bills for work that was never done and then getting paid for it.
        While that happens and is a big problem in health care today, I honestly don't think that's what motivated the insurance company in this case. Insurance companies are in the business of making money. They make money by denying claims. By not reading the chart in full, they have an excuse to deny mathnerd's claim.

        Yes, she got what she wanted and needed in the end. But the executives for the insurance company will count that interaction as a "win" for them because they got to delay handing out money for the claim for a little bit longer . . . meaning they got to reap the benefit of the investment that claim money was in (interest, rising stock prices, etc).
        They say that God only gives us what we can handle. Apparently, God thinks I'm a bad ass.

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