The dirty secret of health care. Optimize profits by making accessing benefits difficult.
I read this over the weekend and was livid! And it’s not just Cigna, either.
When my kids were young, I had to appeal payment decisions a number of times. Each time, the appeal immediately resulted in payment of the claim. I always suspected that it was a game on the part of the insurer, that they figured that very few people would appeal. Guess I was right.
When my daughter was born, extremely premature, there were lots of medical bills. The PPO required a referral from her PCP and I got one for a special doc, very outside any plan. I took notes on who approved, for what, etc. Of course it was denied. I started a with the calls and they said her PCP hadn’t approved, that only a Dr. Carlson had. Yes, Dr. Carlson WAS her PCP. They still had the doc from the NICU listed as her PCP, almost 9 months after she’d left the NICU.
I got very good at reading the fine print, taking notes, asking for a supervisor. When I’d call they’d answer “Hello, this is Jane, can I help you?” and I’d reply, “I’m pretty damn sure you can’t help me and I need to speak to a supervisor” and they’d insist they could help, I’d give my story and they’d say “Let me get a supervisor.” Another five minutes of my life I’d never get back, every time.
Once I got a call from a doctor’s office because the bill hadn’t been paid. I just said “Sue me” and she was shocked. She said “Oh, that would be so much trouble for you (me) and you’d have to hire a lawyer and and and…” I said “No trouble for me as I am an attorney and I like going to court. I wasn’t there when this procedure was done so make sure the doctor comes to court to explain the whole thing. Or, hey, here’s an idea, you could just re-bill the insurance company. What isn’t going to happen is me writing you a check for $17k. Ball’s in your court.”
My mom was recently in rehab. We got a bill from the facility, $6400.
Mom has a Humana supplement, not an advantage plan. Every single time, we are told no not covered and then we explain it’s a supplement not an advantage plan, oh ok, it’s fine.
I’ve called the rehab center now 3 times and left messages, no response. Mom called Medicare and they said the bill was paid in full but Humana said the claim was denied! Mom says just ignore the bill, Medicare says they paid it.
I said mom you can’t ignore a $6400 bill! I call the rehabilitation facility again and again no one calls back! I just need to know what’s going on so we can call and get this corrected!