Are You Angry With Your Health Insurance? John Q Has An Answer, But Don't Do It
Posted: Friday, April 22, 2011
by Fran Larson
http://www.franniesquotes.com/
I am hearing my patient, sincere husband in the next room, as he explains for the millionth time that the Insurance should pay for my pneumonia shot. I suppose they will – eventually, after Jim calls my doctor’s office a few more times and the Insurance Company a few more times. Each party says the other one is blame.
“Isn’t there some way we could patch those two together?” (I am recalling my days as a telephone operator when I could easily connect two people).
“If there was just a way we could patch these two together and let them ‘fight it out’, I insist.
This time Jim doesn’t answer, as he is in deep concentration as to his next move. At this point, we are on our third round of filling out paper work after receiving a letter that the Insurance won’t pay. Of course the Insurance Company proclaims that they will pay, after they get a fax of procedure codes, referral, etc (again).
To make matters worse, the clinic that did the procedure said to tell the Insurance Company that they need to fax procedure codes, etc. As of Jim’s telephone call to the Insurance Company this morning, the Insurance Company informed him that they “do not fax.” Therefore, Jim got the code from them and relayed the information to the doctor’s office.
I just want to say that this all begin when we were informed by the doctor’s office that we could go into a “minute clinic” (at CVS) because they did not have the pneumonia shot and I had been told that I needed it. The “minute clinic’s” sole sin was that they did not tell us that we needed a referral.
You may be asking yourself, “Why doesn’t she take care of her own Insurance issues?” The answer to that is that I am ordinarily a self-sufficient person, but I get so angry when I have to jump through hoops and I say things that are ugly in the heat of my frustration. Jim, on the other hand, could control his emotions and play the game with coolness and sophistication, all the while, knowing that it is a game that HAS to be played. When they tell him to jump through hoops, he will only ask “how high?”
I wonder if anyone has ever had an emotional break down, while acting as a liaison between the medical facility and the doctor’s office. It would cost the Insurance Company some money (if that happened. :))
I need to say this about the medical facilities. It is not their fault. I worked in the medical field for 17 years and know you could fax paper work, etc till the end of time and the Insurance Company will say that they did not receive it. Sometimes that do it as a stall (I believe) in payment. Maybe they think people will eventually give up (and some probably do).
I also know that when you work for doctors, you work tirelessly and without much pay. (Doctor’s cannot pay you much when they accept HMO’s, PPO's and Medicare). I also know that the two women who tirelessly work for my doctor took a week’s vacation and when they returned they were told the vacation was “without pay” and that the doctor forgot to tell them.
Why is it that as technology and the progression of our country goes forward, some things go backward and are more difficult?
Remember the movie, John Q? Denzel Washington plays the part of a blue-collar worker, Nick Cassavete, who finds that his insurance won’t cover his son’s heart transplant, so he holds a hospital emergency room hostage until doctors agree to perform the surgery.
Here are a couple of quotes from the movie, John Q that you could listen to (courtesy of http://www.hark.com/collections/jcpsdpqlgv-john-q)
Your Policy Has Changed, Mr. Archibald
Play
01:26
Employee Manager: Your policy has changed, Mr. Archibald. John Q. Archibald: Changed to what? Employee Manager: Yeah, we recently switched carriers from a PPO to a HMO. It's a less expensive po.
This Is an Appeal
Play
00:35
Rebecca Payne: No, no, no. This is an appeal. An appeal is for an already existing claim. What you needed to file was a grievance. You filed the wrong paperwork. John Q. Archibald: Wait a minute...
I Am Not Going to Bury My Son!
Play
00:09
I am not going to bury my son! My son is going to bury me.
I am not recommending what John Q did but I can certainly understand his frustration.
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Top-level comments on this article: (1 total)My thoughts are that they figure if you reach enough dead ends after hoop jumping that you will eventually figure it is not worth the $20 and give up paying the bill yourself.... I have come to that end once with a bill of over $200.... we talked, wrote, appealed and all because of some supposedly wrong ICD9 code got turned down. I had called the insurance office on another one and they had on tape their representative telling me exactly what to do and I did it. Then they said she was misinformed and I should have read my book. I called because the book was written in Greek to begin with and I wanted to get it "straight from the horses mouth" Apparently i spoke with the new horse on the block and our claim was denied. Yep, I can feel my blood pressure raising right now on your behalf! Love you Lady!
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