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Thread: Health Insurance

  1. #71
    Senior Member Aruba4ever's Avatar
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    Wow, so sad you got crushed with all those bills. Insurance is a joke IMO at this point. It is a 100% business for profit and a poor one at that.

    Quote Originally Posted by Andrea J. View Post
    i coached age group swimming/red cross water safety instructor/lifeguard training instructor/certified pool operator......for a non profit youth agency (Boys and Girls Clubs of America, Waltham, Ma)
    33 yrs ago i opted to go onto my husband's plan. he was in management 30 yrs at raytheon, andover, Ma. he had great benefits and i was on his insurance til he retired. due to an error that he made while processing his paperwork for retirement (and raytheon could not fix the error) we lost our health coverage. by the time the error was discovered, we were 3 months in to retirement and a visit to the doctor our claim was denied. that is how we found out we had no coverage. he is now on medicare with a united healthcare supplement and i am on blue cross with a monthly cost of over $1300 and a $7,000 annual deductible. we have paid in excess of $125,000 since fall of 2008.

    in sept, 2014 my husband had to go by ambulance to hospital with crippling back spasms.
    he was kept for 72 hours, had a CT scan, an MRI and pain meds and muscle relaxers.
    his deductible was $7000. then the insurance denied most charges saying that in their opinion he did not need to be hospitalized.
    it was a nightmare.
    we had to pay a huge sum of $$ to the hospital and doctors. $35K




    QUOTE=Delphi35;329671]I am curious as to what you all do...or did before you retired...if you don't mind my asking or sharing. I currently work in the medical field and have absolutely abhorrent benefits and retirement. I also have a job change coming up in the next few months. My husband and I actually got married earlier than originally planned because I was bleeding out money in healthcare premiums for an asinine policy that covered nothing up until the 12,500 dollar deductible (per person). Not only is hubby's policy cheaper as a "family' than what I was paying for just myself and my kids the deductible is low and covered expenses are better so I haven't even seen a bill since we switched over.
    I hate the current system...you can't even call it a healthcare system...its a for-profit marketplace.
    [/QUOTE]

  2. #72
    Senior Member WaltVB's Avatar
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    When you are denied coverage on a claim, call the insurance company and request to speak to the HIPAA representative. When they come on the line ask for the names and qualifications for all of the members on the board that denied your claim. This is one of your patient rights, do not argue and do not accept any answer but the names and quals of the board members. Be nice, but be firm. Most times the rep will consult your case and overturn the denial and accept the claim instead of giving out this information. This is because most "medical claim boards" are manned by high school graduates (not college) looking for key words in the claim that can be used for acceptance/denial and have no working knowledge of the industry and in fact most have no medical background at all. The insurance companies use these kids because of their bottom line (minimum wage employees save money over certified doctors). You usually have to dispute the decision within 60 days of treatment.

  3. #73
    Super Moderator Jacki's Avatar
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    Quote Originally Posted by WaltVB View Post
    When you are denied coverage on a claim, call the insurance company and request to speak to the HIPAA representative. When they come on the line ask for the names and qualifications for all of the members on the board that denied your claim. This is one of your patient rights, do not argue and do not accept any answer but the names and quals of the board members. Be nice, but be firm. Most times the rep will consult your case and overturn the denial and accept the claim instead of giving out this information. This is because most "medical claim boards" are manned by high school graduates (not college) looking for key words in the claim that can be used for acceptance/denial and have no working knowledge of the industry and in fact most have no medical background at all. The insurance companies use these kids because of their bottom line (minimum wage employees save money over certified doctors). You usually have to dispute the decision within 60 days of treatment.
    Wow! That's some info to copy/paste & keep in your back pocket! Thanks!
    Jacki ~ loving Aruba from NJ

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