8 replies to this topic

[Marnie]

I will not go into details about my recent change in insurance companies (already bored you with that). . .but after thinking that things had gone smoothly, the mailbox yesterday, informed me otherwise.

I got a bill from the new HMO, even thought I paid the $4000 out of pocket in early September when I picked up my Sprycel at the HMO pharmacy.  This bill was from the oncologist, and the HMO is not going to pay it, because I "didn't inform the oncologist that I was in remission."  Moron.  Obviously, he 1) has no understanding of cml, 2) doesn't know how to read a BMB report, 3) doesn't have a clue what PCR is, 4) didn't hear a word that I said when I met with him and 5)  didn't bother to read through the medical history and the explanations that I dropped off at his office a month before I was even scheduled to meet with him.

Now I will need to spend I don't know how much time on the phone and putting together paperwork to go throught he appeals process.  AND. . .I'm only with this company until the end of December.  I was very upfront with the guy at the appointment and told him that he would be an "interim" doctor for me.  I think that must have made him mad.

To add to this. . .also in the mail was a bill for $2000+ from Children's Hospital (!!) saying that they didn't have information on my child (I have none) so couldn't submit the bill for the lab pathology.  I guess my BMB doc (the new/old one, and the one I"ll be going to in January) had the BMB samples sent there. . .how weird is that!!

AND THEN. . also in the mail was a bill from the HSA (health savings account) piece of crap plan that my school district moved to.  The district had put $1300 into the account for each employee, I had to use mine immediately, so the money was in the account for about 3 days. . .but I still got a freaking bill for a monthly service charge. . .$2.50!!!  I wonder if I will continue to be billed even though I won't use the account any more because there's no money in it.  Probably!

[jrsboo]

That totally sucks.  I am sorry that this is happening to you.

Caroline

[Marnie]

Well. . .one bill (the big one) was taken care of with an easy phone call.  The hospital billed the wrong insurance company. . .no wonder they wouldn't pay!!  I called the insurance company (the old one that was great) and once again, they were wonderful.  The person I talked to called the hospital, figured out the mistake, and I think it's taken care of.

The second one may take some time and a nasty letter.  I've gotten the run-around today.  Customer serivce blames the pharmacy.  The pharmacy blames customer service.  So tomorrow I will call customer service back, find someone else to talk to, and if that doesn't work, send the not-very-nice letter that I've typed up explaining in detail how their oncologist screwed up and doesn't know his job.  Wonder if I'll end up in appeals court??  Is there an appeals court?  And if so, that poor doc is going to come out looking like the moron he probably is.  I don't even have to be mad, all I have to do is explain what happened in painful detail.  Sure glad I documented everything!  Sheesh!!

I am really tired of having to deal with things over and over and over.  What a freaking pain!

Marnie

[Tedsey]

I feel for you Marnie.  Sorry you have to deal with all this.  Hope things get sorted out quickly.  Glad you got a big portion of it out of the way.  How I wish, from the bottom of my heart, that one day, $1300 bucks in a health savings account will be more than enough for us (because there will be a cure).  Yeah, for healthy folks, 1300 smackaroos is probably enough for a year or more.  It totally hit me when you mentioned that you used it up right away.  It made me think of our huge deductable that gets met immediately.  Luckily, the online pharmacy lets us use a payment plan so we can afford the sprycel I take.  Don't know what we would do if we had to pay up front.  Don't know what I would do without insurance.  And they are cutting our benefits.  How scary.  All this and fearing an early demise.  May we all have a place in heaven reserved for all we have to go through in this life.

Hugs,

Tedsey   

[Susan61]

Hi Marnie:  Have not been around for awhile, but actually been on the phone constantly with my mothers insurance issues.  They are just a bunch of idiots, and if they cannot find what they want on the computer they have no idea how to figure it out.  I am constantly on the phone with insurance companies etc. due to constant mistakes.  You just have to keep following up on every little thing to be sure their figures are right etc.

Susan

[Marnie]

Well. .. I was getting ready to send off my letter (which included some not very nice thoughts about the oncologist and his lack of understanding of cml).  But, I decided that before I get the ball rolling, I should contact our HR person to see if there was a liason person with whom I could speak.  Sent an e-mail to HR with a very short explanation. . .she got on it immediately, got ahold of a person at the HMO, got back to me saying that I should NOT pay any bills that they might send to me and that they would take care of it immediately.

I'm kind of bummed that I probably won't get to send my letter.  The doc won't have any way of knowing that he's a moron

I guess that being on the contract negotiations team had its benefits.  Admin is very much aware of my situation, and about how I feel about the new health care package, and they realize that I am a bit like a pit-bull who won't let go.  I guess it's a good reputation to have. . .or at least it gets things done.

Marnie

PS  Susan. . .sorry that you are continuing to deal with the fallout from your mother's current health situation.  Sometimes it seems like it just never ends. . .

[Susan61]

Thanks Marnie, and I am a lot like you.  I fight till I get the right answers and results.  If you read back to some of my old postings, you will see how I fought to get into the trial in N.Y. for the Gleevec back in  2000.  My biggest issue is when you get a bill do not pay it till you check it out.  My mother has paid medical bills she did not owe.  She is one of those who feels she better pay it right away or they will put her in collections.  I showed her how much money I saved for her when she started letting me check things out, and only to find out they were mostly mistakes and she owed nothing.  You keep on  doing what you have to, and straighten out these people.  Keep us updated.

Susan