Something similar came up in the colonoscopy thread: many providers require that a second person accompany the patient, wait there during the procedure, and drive the patient home afterward (getting home by public transportation, taxi, or ride share is not allowed). I.e. getting a colonoscopy requires the unpaid time or labor of a second person who drives a car.
Thatâs not exactly the same. Have you seen âfunnyâ videos of loopy people coming out of anesthesia? But that is subject to another thread.
Yup, been there with âinsurance approvalâ dragging out for months and requests for a series of âdiagnosticâ procedures done to the tune of 2/3 of the cost of the actual procedure (in addition to multiple imaging). Absolute absurdity.
My daughter has breast cancer caused by a genetic mutation. The mutation is through my husband.
Our son needs to be tested. To see if he carries the mutation, and he has a one year old daughter. Both men and women have a higher cancer risk. Because my daughter has this mutation, all of her family members, including aunts, uncles, cousins were told they could be tested for free. Free.
Son fills out questionnaire, waits 4 months. Gets blood test. Finds out that the insurance information is old, they need to update his insurance or they will not process his test. Not sure if my son gave the wrong insurance information or if it didnât get updated during the appointment with the geneticist.
Itâs free! Because his sister has cancer!
My husband and I were tested, never received a bill. And I wonder why our family members are reluctant to test.
My husband and all three kids have a rare bleeding disorder. As I understand it, each of DHâs siblings and kids has a 50% chance of having the disorder. Itâs not a problem until you have a serious accident with bleeding, or require certain types of surgery. Then it can be life threatening if youâre not treated appropriately for it. We informed DHâs four siblings and other relatives and said they should get tested. To my knowledge, none of them has. So odd to me.
Ambry will usually do the genetic marker test for free within 3 months of the initial person getting the results.
Except that my son was unable to get an appointment with the genetic counselor in that time period. Itâs frustrating.
Theyâve hit their deductible so the test should be covered. If not we were told the test was $450.
I was not aware of the 3 month time period. I guess itâs a way for ambry to get out of paying.
We might be talking about different things. The lab that many hospitals send their blood work to is called Ambry. We did so for genetic testing for Lynch syndrome that is found in many ovarian, breast, and GI cancers. Once one in the family has Lynch that person is sent a letter from Ambry, the lab, that genetic testing is free for 3 months to anyone related to that person. They look for this specific marker. They send out kits and you can arrange this to be done in your house or you can go to your doctor office to have it done. Itâs a wonderful service.
My new favorite is the âthird party consultantâ who makes decisions for the insurance company. I turn in a request for coverage, they give it to the third party who says No. I appeal. Another No. I call the insurance company who says they canât answer questions because they didnât make the decision. I call the third party who say they canât answer questions because they arenât my insurer. This happens for procedures, medications, you name it. Quite the racket theyâve got going on!
Iâve wasted hours and more hours on filling out paperwork and making phone calls.
Just marvelous! 
Iâll PM you as this is probably only information that is pertinent to me.
Very helpful information. Thanks
In my mind, that experience warrants an email and report to your state insurance commissioner.
It can be extremely frustrating being in an endless loop with insurer and some other party. The last time this happened it was with a durable medical equipment (DME) company that provided me with a device that cost under $200. There was an endless back in forth between me insurer and DME. The insurer tried a conference call to have all of us on the call at the same time. That didnât help. The DME kept saying the paperwork was faulty.
I finally asked them WHAT about the paperwork was faulty and could they send me whatever form they wanted and information about whom they wanted to complete said form and where it should be sent.
The insurer got nowhere with them trying to get the issue resolved, despite numerous attempts. I somehow WAS able to get the form, get my MDâs office to complete it and send it to DME and they FINALLY processed the claim correctly. Because we had been arguing about all of this for about a year, they didnât even want me to pay my co-pay on the claim and it didnât go to collections as DME had threatened!
I later heard from others in the DME business that the DME company I had been trying to work with had fired all their workers with any healthcare training and just replaced them with inexpensive clerical people that had no idea how to provide any service for patients. I can certainly believe this after our awful experience with them. Sadly this is one of only two DMEs in our state the provide nearly all the durable medical equipment in our state. They bought out a small local company (as they are doing around the nation) and pretend they are the small local company even though theyâre a national huge company based out of TX now.
Thatâs something I hadnât considered but will definitely look into. Thanks for the suggestion!
State insurance commissioners are interested in knowing about misbehavior of insurers. They do have power to investigate and sanction so others can be spared similar misbehavior.
Just saw this on our local news⊠a man trying to get reimbursed for his late wifeâs medical equipment. 2 years they have been playing games with him requesting more information and just recently told him there was no claim submitted. 
Disgustingâshould definitely get the insurance commissioner on that case. Insurers and others will play games at the expense of beneficiaries unless they are called to account and penalized with bad faith lawsuits and/or actions by insurance commissioners.
And yet another case where patient/beneficiary was billed improperly when provider failed to submit timely bill to Medicare and supplemental plan.
Wow. This is a really good article with important information. Thanks for posting it.
So many insurance resources are devoted to gate keeping access and cost reduction. There are are many cracks to fall through. The burden of navigating the barriers is shifted to patients and their care providers who are asked to document the necessity of a particular treatment with criteria that varies by insurance company and moment in time. Patients are vulnerable when they are ill, donât have resources or familiarity with âthe systemsâ, speak a different language, work a job that doesnât allow for endless hours on the phone or are tangled in endless red tape.
The system is broken and when it goes wrong, it can be devastating. Due to an error of a large insurance company, our well insured son had all medical claims denied for 18 months while on our policy. He could only access care because we were able to pay providers out of pocket for that time, as I was repeatedly told the problem was fixed, only to have the next claim denied. I had been a provider for this insurance company, the insurance was theoretically excellent, obtained through one of our stateâs largest employers, and there was a higher level administrator assigned to resolve it. Really brought home what can go awry.