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BillBrasky Memorial Political Chat Thread

Mdmh, do you have an hr rep that can help? Someone should have a relationship with the plan admin that can make a(some) call(s). Exceptions are made and your rep should have contacts that can help. Do you have someone higher up that might like to know your Healthcare option is failing? I would hope you could get them on your side as an advocate with a louder voice.

Our healthcare system sucks. So, purposefully, complicated.
 
vtwhat etc said:
Novant just threatened to send my outstanding balance ($57) to collections, after having BC/BS deny my claim/coverage thrice.

The charge stems from the blood-work done during my routine/annual physical, which absolutely should be covered.


BC/BS coded their decision & subsequent reviews as 'over-use of testing benefits' on my end.

So, amazingly, even though I paid LabCorp out-of-pocket for my ONE Covid19 test... I guess LabCorp still ran something through my insurance.

I've had 1 Covid Test & 1 annual physical... And, my 'top-of-the-line' policy covered neither. Fun!
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This kind of shit is super frustrating. I think the insurance companies randomly select a certain number of claims to deny in the hopes that the claimant doesn’t pursue it. It’s probably just easier for most people to pay out of pocket and avoid the frustration of spending hours on the phone and writing letters to appeal a randomized denial.

BCBS just denied psychological testing for my daughter, 6 months after the tests were administered, because in their opinion the tests were not medically necessary. This is a kid that spent 5 months in 2019 in a residential mental health hospital and has had 6 emergency hospitalizations in the last 3 years for self harm and suicidal ideation, but some how additional testing is too much and not medically necessary. So far I’ve spent 3 hours on the phone with these people and now I have to get copies of her records and write a letter requesting an appeal. It’s the same goddamn insurance company that some how was completely unaware of her previous hospitalizations that they paid for. I think the point is the frustration so that some percentage of us will just pay the drs directly out of pocket.
 
Wow birdman, that’s really tough. I’m sorry that your family is going through that.
 
And I’m sure birdman’s situation is far from unusual. But nobody is out there publicly fighting on their behalf. Politicians are fighting for insurance companies. Politicians are fighting for their preferred way to deliver health care. But nobody is out there making these stories public and building a coalition to fight the insurance companies while making it clear there is a better way.
 
PhDeac said:
And I’m sure birdman’s situation is far from unusual. But nobody is out there publicly fighting on their behalf. Politicians are fighting for insurance companies. Politicians are fighting for their preferred way to deliver health care. But nobody is out there making these stories public and building a coalition to fight the insurance companies while making it clear there is a better way.
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uhhhh, what?
 
Sorry birdman. That really sucks.

You need to involve your hr rep or whomever owns the relationship with your bcbs. They should be able to escalate and have better contacts that are closer to decision making than a front line customer service representative.

Was the facility in network? Was there a pre approval requirement? Why did it take so long?
 
deaconson said:
Sorry birdman. That really sucks.

You need to involve your hr rep or whomever owns the relationship with your bcbs. They should be able to escalate and have better contacts that are closer to decision making than a front line customer service representative.

Was the facility in network? Was there a pre approval requirement? Why did it take so long?
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Thank you and others for your comments. It is essentially sorted. I had to suffer through 2 different customer service reps, who were clueless and simply repeatedly read the eligibility criteria to me before I finally got in touch with a manager who got the NP on the treatment eligibility review team to call me back. When I asked her how a patient with my daughter’s history could be denied this testing, she asked me to explain the history. At the end of my retelling she apologized and said that they didn’t have any of that info when they reviewed her case and that if they had know they wouldn’t have denied it...but I still have to send them a letter requesting the appeal and “it would be best if I sent the records too.” It’s total bullshit but she told me it would be resolved. I have a really big employer and so I am guessing when the manager saw my affiliation he put me in touch with the treatment evaluation team rather that piss off my employer’s hr department, cause that was my next step.

I appreciate y’all’s sympathy. My main reason for brining it up was to point out the absurdity of the coverage rejection process.
 
My wife is 7 months pregnant and just got diagnosed with gestational diabetes. Her testing and treatment are not covered by insurance because she is not obese. WTF? That makes no sense to me.

Edit:

Her treatment/meetings with a nutritionist isn't covered because she isn't obese.
 
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Meanwhile the homeless in NYC are living it up in 5 star hotels on taxpayer dime and have sued bc they feel being moved to another facility would be too traumatic. Costs to house them range from 50-60k a year. This city is going to shit.
 
You know one out of every 5 homeless rickshaw businesses fail within the first 6 months
 
Found a nice mix of local organizing and early release Air Jordans for MDMH. One of my former students is the deputy director of Chicago Votes and she was honored by a local store with a pair of new Jordans for her work to get a polling place in Cook County Jail.

1a88ece3edb0f34058d2178e4848cf09.jpg


More on Chicago Votes here:

https://chicagovotes.com/staff-board/
 
birdman, that is horrible. I am so sorry you are having to go through that and I can't imagine.
 
Katie Porter’s sister
 
I've always found it pretty obscene that a provider can't provide a simple data point like cost of a prescription or a procedure without having to ask the insurance company first for every single patient. It took me 2 weeks just to get a quote for the cost of an MRI on my back recently.
 
Political Chat Thread - All Topics & Rants Welcome

myDeaconmyhand said:
Katie Porter’s sister
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Being double insured can cause this and is bad, as each carrier can claim the other is responsible so you can get screwed.
 
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