Tuesday, February 22, 2011

Yet Another Argument With Good Ol' "And.Them."

It is no secret that I hate "And.Them."
And it's also no secret that I have
numerous reasons
to hate "And.Them."

So, the lovely insurance company is denying all of my claims except for my PET CT and MRI. Why? They claim my cancer is a pre-existing condition...This is no new information. I knew that my initial office visit with Dr. Cool Guy was being denied prior to my surgery. I thought it had been corrected since Dr. Cool Guy sent my notes to "And.Them" to prove that it was not a pre-existing condition. "And.Them" actually CALLED ME to inform me that my surgery by Dr. Pink was approved; however, when I received my Explanation of Benefits today, it has been denied.

Please tell me how that makes sense.

So, I called the lovely folks at "And.Them." The poor girl tried her hardest to get me off the phone without giving me a direct answer. She actually told me that she did not see my medical records in my file. That would have been all fine and dandy except that I had just gotten off the phone with my "And.Them" RN Case Worker who informed me that there is a big note in my file that lists certain codes which have been determined not to be pre-exising. When the girl insisted she did not have any of my medical records to review, I made her call my case worker. She did. And suddenly, 45 minutes later, her attitude changed.

"I will reprocess these claims. Based on the information in your file, there should not be further problems. You will hear from us in 30 days."

 I wanted a direct answer. I wanted the problem to be fixed today. But, I figure I harassed her for an hour, hopefully she will do her job and correct the problem. (Although I am sure the higher ups of "And.Them" would prefer she ignore me.)

It infuriates me how they treat their customers. Aren't I already experiencing enough stress?

What makes me even more angry is knowing that there are millions of people who don't bother fighting "And.Them." It is intimidating to call them because they make you feel like the lowest of the low. If you have someone who is not experienced in the horror of insurance companies, you can't blame them for not trying to fight. It makes me so, so, so angry. I want to ask them how they sleep at night, but I can only imagine the smart ass answer they would give me...Gotta give them credit. The people who work for them definitely know how to make you feel like crap.

What is the point in having insurance if they are not going to protect you?


Mitter Bob said...

Chelsea, I'm your Dad's uncle. I have followed your blog with interest since I learned of it. Twice now you have complained about insurance denial due to a 'pre-existing condition'. The Healthcare Reform Act of 2009, also known by its detractors as 'Obamacare' would have insurance cover all pre-existing conditions. Now there is a move to repeal this Act. You are a prime example of why it should not be repealed, altho modified, perhaps, in some respects. The primary objective of healthcare insurance companies is to make money, and to do so, denial of coverage is also a major goal of their's. I would be interested to know your position on this matter.

Chelsea said...

I wish I knew more so that I could give you an educated response. I know from my own experiences and from people I have met through cancer forums that dealing with the insurance company is extremely stressful. Our doctors basically have to go to war for us. I have had to fight for every little thing. I imagine when I begin treatment it will be a hassle as well. How they can even TRY to claim my situation is pre-existing baffles me......