HMO motherfuckers.
December 19, 2006 at 9:42 am | Posted in assholes, navel | 3 CommentsReaders: do you, or does anyone you know, have suggestions as to exactly the best way to appeal a denied insurance claim? Specifically, from Blue Cross/Blue Shield HMO? Because someone completely vital to my existence might have motherfucking breast cancer right now, but the doctor can’t make a final diagnosis because the insurance won’t pay for the goddam MRI!
She has already appealed twice. Christmas is not her favorite time of year anyway. If you happen to be the CEO of Soulsucking Motherfuckers Insurance Company, or have any suggestions as to how to make this company pay up…
And this is WITH insurance, you know?
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A friend of mine did it by calling them EVERY. FREAKING. DAY. until they finally got fed up and processed the claim. That sounds really fucking annoying to me, bc it eats up YOUR time; but it worked for him. That’s all I got.
Comment by Amber— December 19, 2006 #
First off, let’s all say it together:
FUCKERS!!!!
Hi, it’s the friend of amber’s who went to war with Blue Cross/BS and got his MRI paid for. There’s a reason that they don’t want to pay for that final MRI… if it turns out that this person has breast cancer then they’re going to have to pay a lot of money to treat it. There’s subtext to their denial:
Dear Sick Person- please die before we have to pay.
With that in mind, I recommend the following steps to forcing them to do the right thing: (this is from a blog entry on my weblog when I was fighting a similar battle.)
Here are some things we have learned when dealing with insurance companies:
1. Document EVERY call. Date, time, who you’re speaking with, EVERYTHING that you discuss.
2. Make an org chart if you can. When someone says “I am going to transfer you to my boss,” then draw a little box around their name on the chart, draw a line up, and write their boss’ name down in a new box. It took my wife about a week to figure out who worked for whom and what their hours were(!) at our insurance company. Now when someone says “Well, I don’t know if you’re covered for that,” the missus shoots back, “Well, your boss, Janet Smith, said we were last week at 9:25 am on Tuesday April 18th.” You’d be amazed what happens when you do this.
3. Every state has an insurance commission, I think. Here is a link to the various state insurance commissions. These are the people whose job it is to provide oversight of the insurance companies operating in your state. If you have a complaint, you can go to them and get a case manager. It’s nice to be able to say “I wonder how [your insurance commissioner]’s office would rate the service you’re giving me” to someone at your insurance company.
4. Finally, hang in there. They make plenty of money. Your new job is to make sure they cover you and pay you some of it back. It’s a war, but it’s winnable.
If this person is in Georgia, the insurance commissioner here is John Oxendine, and here is his website.
Give ‘em hell, and keep us updated!
-p
Comment by patrick— December 19, 2006 #
Wow, thanks so much. I’m passing this along as we speak and will keep you posted!
Comment by petitpoussin— December 19, 2006 #