#insurance sucks

[tinybluealien]

ask for it in writing. and honestly, just asking for the name, npi, and specialty of the medical director who denied it is often enough, especially if you've appealed and they denied the appeal.

a depressingly lot of the time, the medical director who signed off on the denial? practicing out of specialty, and may not have a valid npi anymore. if the npi isn't valid, it's often because they were sued for malpractice of some kind and their state medical board told them they're no longer allowed to see patients.

insurance doesn't want you to know that, because if you do, you can sue, or use it to argue in front of the state medical board as a final appeal (yes, that IS a thing. if you exhaust your appeals, you can appeal to the appropriate state board and try your luck.).

so instead, insurance will often just reverse your denial, rather than admit they have someone incompetant or dangerous or practicing far out of scope making decisions on whether you are actually allowed to get the care your doctor says you need.

because the dr making the preauth decision for your appendectomy isn't supposed to be a podiatrist. the dr making the preauth decision for your c-section isn't supposed to be an ENT. but insurance companies don't get audited about that, and they don't want you knowing it.

so ask. make sure you have all your i's dotted and your t's crossed and your office notes and testing all in order and when they deny your appeal - asl for the name, npi, and specialty of the medical director who made the decision to second guess your doctor and deny you the care you need.

more often than not, they'll reverse the denial, rather than admit that they aren't following the rules.

[awfullybigwardrobe44]

I continue to have complications with medication, and now my insurance isn’t covering what I need it to cover because they think they know more than my doctor 🙃 Plus I am afraid I am going to have to have a certain type of painful procedure so please pray I don’t have to and that there’s another way

[bellobambino]

bad user interface kills people

i have worked with insurance and the government and lawyers and estates and hospitals for my whole life and I have some stories about how fucking terrible these institutions are.

Here's one of them.

I used to have Medicaid under Aetna while I was considered in the same 'household' with my ex boyfriend at the time. I was the head of household just for administrative purposes.

Anyway. Things didn't work out with him. I moved across state lines, and I had to remove myself from all other accounts that were accessing my medicaid benefits.

I called up Aetna and explained the situation. I told them please remove me from the account, and transfer the head of household to my ex, who was still living in the state and reliant on the benefits.

He said there was no way for them to remove me from the account (he reeeeally tried) and the best bet to keep my ex's healthcare coverage was to simply change my mailing address on the account to match the address I had on file with Medicaid. He said once that's updated, I just need to notify Medicaid that the change was made and it should be all good to go!

He must have pulled that idea out of his ass, because I don't hear anything about it for a week or two, and I'm assuming it's fixed and I can move on with my life.

And then my ex calls me. He was beyond furious. Because he went to his audiologist appointment just for them to say ... yea your insurance isn't effective anymore. And he assumed i hated him so much that I went through the trouble to forcibly terminate his Medicaid coverage. (we did not end on good terms and that would be kinda par for the course for me but i digress)

anyway, I spent the next 3 days on hold with Aetna and Medicaid.

Turns out, if you change the Head of Household's (HoH) address, it automatically applies that address to everyone in the account. So my ex's address was changed to out of state, their system database immediately considered him ineligible because of it, and ceased all coverage.

I know this is getting long, and maybe boring, but bear with me, it gets worse.

When he called, they wouldn't let him change his address to regain coverage. Because he wasn't head of household.

I called and told them to transfer him to head of household. They said they can't transfer HoH within the account, they can only add and remove members from the account. I said dawg... I first thing I tried to do to solve this shit last time was to simply remove me from the account. Now its possible?

They pulled some convoluted policy out of their ass to blame the confusion on. They said they'd look into the issue and call me back.

Well a week later (without either of us having any coverage due to this madness), Aetna Man calls me and says okay so i figured it out. In the program we have, you have to actually assign another member the Head of Household role before you're able to remove the existing Head of Household. It's a system issue, it seems.

I almost walked into the river. I spent 2 entire weeks PLUS with a lapse in healthcare coverage for me AND an innocent party. Because Mark or whoever had Boomer's First Computer Interface disease.

Still took an entirely separate series of phone calls to get them to change his address back to the one he lived at after their mistake.

im very much filled with hate.

[ldysmfrst]

Hello, dearest readers,

Thank you for your continued support.

I am still in the hospital because of a few things.

My kidneys are not doing well (but very slowly improving) because of the antibiotics I was on to clear up the sepsis.

Apparently, those two meds are great for infections but highly toxic, and now I have a minor/moderate kidney injury.

My original Hospitalist Doctor, who was off for a couple of days, has returned.

She found out that I can’t leave the hospital because they are still fighting about wound care.

We thought I had been accepted into Valley Presbyterian Hospital for daily wound care, but they will not let me start until September.

So now they are trying to find somewhere to go for wound care that the insurance will cover between now and September.

My insurance is fighting it because they don’t want to cover anywhere.

So even if my kidneys are good to go, I can’t go anywhere.

I still have major brain fog and what not which the doctor says may take a while to get over since when she first saw me I was “one foot in the grave,” and I need to give myself a break.

To be perfectly honest, I am getting clearer every day but exhausted easily.

So we will see.

I am not giving up on you guys or my love for writing anytime soon!

💜💜💜

[mugloversonly]

My insurance denied my top surgery because it wasn’t deemed “necessary”

My doctor: this will be good for the patient

Me: this will be good for me

Insurance: isn’t there someone you forgot to ask

[hotpotatoshealthjourney]

I’ve woken up feeling worse every single day this week. No idea what is causing all this, and my neurologist is out of town so I can’t even ask until next week. Woken up with new symptoms several days, which is always concerning, especially today when I had the same new symptoms I had yesterday, which means 2 days in a row. That’s usually the standard where they say get it checked out.

I don’t even know if they’d let me have more steroids rn though since they just did that recently, so I’m at least going to wait until my doc is back in town to ask her. I have pt tomorrow and I have no idea if I’m even going to be able to do much of it. I haven’t even been able to shower all week. It’s been very frustrating. It hasn’t been any hotter than the rest of the summer so I don’t think it’s a heat thing. Genuinely no clue.

Not a fan, that much I can tell you. I am so so tired. Been sleeping soooo much but still soooo tired. Gonna probably go take a nap soon. I’ve mostly been sitting here staring off into space doing nothing since I woke up like an hour ago. Can’t focus, can’t even eat cuz it takes too much energy.

On the plus side, my insurance out of pocket max is net, so I’m basically getting free healthcare and meds till the end of the year which is great. Need to schedule a bunch of chiro and massage and acupuncture appointments. Also gonna get prescriptions for all the dme (durable medical equipment) that I need and get it all now while it’s free. Normally insurance would only cover 30% but right now they’ll cover all of it. Time to get the things I need but can’t normally afford! And it lasts until the end of the actual year. This is a huge relief for us cuz medical bills have been insane this year.

Keep sending happy thoughts and asks please. It really does help. Love yall.

[phoneboxfairy]

So... as the title of this link suggests, I'm trying to raise funds for that cataract removal I've needed for a while. Here's a link to the gofundme. Please share for a signal boost.

https://gofund.me/9dbf4016

[starr-angelofnarnia]

Seeking out needed medical care is hard enough without insurance fucking stuff up and making it harder

[dirtielemon]

an initial hour of being on hold only to be not listened to and now i have to go and be on hold again it has been 30 mins so far hopefully i can either explain myself more fully or get someone willing to listen to me

[alumort]

dont you love it when you know youre gonna get fired from your job because everyone else also will, and the stress is a lot and the year is about to end and your blood pressure is low and your cramps dont go away, your knees give up and you dont break your head every day solely because you work from home

[overly-obsessed-fangirl1]

FDA: this medication is approved only for people over 5

Insurance: we will cover this medication but only for children under 5

[mindrottinglystupid]

Insurances sucks

They pay for absolutely nothing useful and don't give medicne to the people that actually need it. It's so infuriating to me bacuse there was one medicine that helped with my migraines, it helped more than I could have ever imagined. But they wouldn't pay for it because it was

1) Too expensive (we pay you enough stfu)

2) it was new and hadn't been proven helpful yet

Complete bullshit.

Not to mention, because I can't absorb or keep food down, I need help getting nutrients, literally to survive. But they won't pay for that either because its "unnecessary."

Honey how is that unnecessary? Hm? I'm doing it to keep myself alive. Got something to say about that?

[funsimplethings]

[dawneternal]

insurance decided not to cover my ADHD meds and I can't afford to pay $400 soooo until my next psych appointment I will either be writing EVERYTHING or nothing at all 🤷

[ldysmfrst]

A little about me:

I am a mother of two beautiful children. One of which is special needs, and on 3/28, they lost 75% of their vision. I have had to take time off work to accommodate many MANY doctor appointments.

I started a Ko-fi if you feel the heart to donate to help with the costs of appointments, medication, and house modifications, which insurance doesn't cover.

If you are unable to then your thoughts and prayers are more than enough.

[ofsilentthings]

Gonna be backed up for a bit fulfilling comms (thank you all again!) so the next chapter of TVAW is going to have a small delay. But don't worry, I haven't forgotten! Rickard needs to actually use the money he raised in the auction, and surely Astarion AND Taviana won't leave him alone for long....

I'm still taking a few more emergency comms if you're interested. Basically need some cash to bridge the gap for a dental implant. (Thought insurance would cover more than 20% but that falls harder than Djura when you push him off the tower haha).

Thank you all for staying with me and being proof that there are still some cool humans on this planet :)