Health Insurance Sucks

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bobscuda67

bobscuda67

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On fathers day I woke up with a side ache at about 6:30 am. Four hours later I could barley walk so my wife took me to the hospital. She helped me walk to the emergency room and I was admitted right away. They did the MRI of my abdominal and took a urine sample and was determined that my appendix was inflamed. By 2:00 it was the worst pain I have ever felt and I couldn't sit up or walk at all. I was in surgery at 3:00 pm and in recovery at 3:30 pm. I went home on Monday and back to work 2 days latter.
Today I received a letter from my Health Insurer saying my claim was denied. I haven't called yet but I will tomorrow and try to stay calm.
I don't know what I was supposed to do or what I did wrong? Should I have let it rupture and then go to the hospital?
Anyone ever had any luck appealing a denial? Did you have to hire an attorney?
I guess my car will be for sale if I don't win my appeal.
 
They are angry that you were proactive.
A ruputured appendix would have provided so much more money into the system that supports the parasites and their "industry".
Fight them by any and all means.
 
Darthomas said:
They are angry that you were proactive.
A ruputured appendix would have provided so much more money into the system that supports the parasites and their "industry".
Fight them by any and all means.
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Perhaps they were waiting for it to become terminal, ending their liability :rolleyes:

I hate insurance companies. My wife has fought with them for years.
 
I'm guessing "pre-admission" authorization was required for surgery.
But it was an undisputed emergency and policies have that exception.
Don't get to upset till you find out what's going on.
It's probably just a misunderstanding.
 
This is completely unfathomable to me. I mean, your appendix is inflamed, the doctors say it needs to come out, they take it out, and your "insurance" doesn't cover it?

I don't know how you guys live in peace with the medical system in the US. From where I sit it looks like it only really works for the very rich.
 
Wow .Glad you are ok.
If its like my BS optima plan they probably expected you to call their 24hr nurse/assistance hotline to explain sypmtons and receive permission to proceed while that is last thing on you and your wifes mind.
Went thru similar situation couple of yrs. ago when suddenly started having chest pains and thought big one was hitting.
Wife drove me directly to ER, was admited right away and spent two nights being tested before release.
To my surprise received word my healthcare would not cover because it was deemed not life threatening. That damn near caused me to be readmitted.
Had to explain to optima well god damn it sure felt like it was at the time and they backed off.
Just a shame but they want every cent they can get from the insured, patients be damed to make up for the uninsured even with the Affordable Health Care Act BS.
 
What kind of health insurance is it? I know there are several "types" down there. As far as I understand it, "private" health insurance is a lot easier to deal with? In any case, I'm sure like any insurance claim, there has to be a process to fight it and get it paid. A lot of insurance companies say "no" to every claim right off the bat, in hopes that some people won't fight it and they can save money.

But yeah, as a Canadian I find this odd. My buddy's apendex ruptured, he collapsed on the kitchen floor and he had to go to the hospital. They got him in immediately, and he was in recovery within an hour of it happening. And was back on his feet later that day. Couple days stay and he was on his way. Never paid one cent. Never had to file anything. Just had to show up at the hospital and that was it.
 
I have had this happen before and it turned out the doctors office had coded it incorrectly. Could not get them to straighten it out until I talked to the doctor directly and told him if he expected any money he best figure out the correct way to code it to make the insurance company happy. Problem solved
 
I have had good experience with insurance until the Obama care crap started. Citizens complain about, Dr's complain, hospital's complain. I don't understand what is happening in this country anymore
 
The denial said it was a lack of medical necessity. So I called the hospital billing today and they received the same denial. But they have filed an appeal and said not to worry about it now.
I have a so called "Cadillac Plan" private insurance that I pay about $1300 a month for, but have to fight for any benefits. And then the co-pays and deductibles are high and I have to make payments on it for months. I'm just working to pay for insurance.
 
bobscuda67 said:
The denial said it was a lack of medical necessity. So I called the hospital billing today and they received the same denial. But they have filed an appeal and said not to worry about it now.
I have a so called "Cadillac Plan" private insurance that I pay about $1300 a month for, but have to fight for any benefits. And then the co-pays and deductibles are high and I have to make payments on it for months. I'm just working to pay for insurance.
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First thing, I'm glad to hear that they fixed you up fast and correctly! Everything else is gravy. I hate the insurance companies too! When Hitlary gives us all a single payer system, everyone will be treated just like the VA does to us vets.

Hang in there for now and try not to worry over it. It will get worked out, I'm sure. Prayers sent your way!
 
Piss on that BS mandatory thievery, I just pay the fine every year because it's way cheaper and IF I have a problem I'll go to the ER and say No Habla.
This country is getting more and more all about the medical ripoff and profit system and our government is all about allowing them to do it.
F em.
 
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