Thursday, March 26, 2009

Health Insurance Claim Denied!

I decided to tackle an insurance company for a patient today. Actually, this was worse than an insurance company. This was a company that health insurance companies use to review and then deny coverage. They do the ultimate dirty work. 

English is not this patient's first language and I'm convinced he was lied to and taken advantage of by his insurance company. He was referred to a specialist last year by one of our doctors and had a procedure done. He says he called his insurance company before the procedure to make sure it would be covered. They told him it would be covered but then he got a bill for $4,000 with a letter saying he hadn't finished his 9 month waiting period for a pre-existing condition. He was 3 days short of his 9 month waiting period. He has now lost his job and has no more coverage and no money. He's been sent to collections. 

First I talked to a woman who kept repeating what his letter, which I had in front of me, said. "After a careful review by our company, we have determined that you did not comply with the 9 month waiting period for a pre-existing condition and therefore your claim has been denied." But he called and was told this would be covered. He doesn't have a penny to his name. Trust me, he never would have done this if someone didn't tell him it would be covered. Surely you must have record of this conversation." I said. She wouldn't acknowledge or deny such a conversation but just kept reading what was in the letter. Then she transferred me to someone higher up the predator chain. 

This woman, who had already been briefed of the conversation by the first woman was ready for me. She told me she couldn't discuss this case because I wasn't the patient. I imagined her face looking like a cross between a bulldog and a pitbull. "But I have the letter right in front of me and his English isn't very good," I pleaded. She repeated, like a robot, that he did not wait his full 9 months and therefore the claim is denied. "He's 3 days short of his 9 months! You're kidding, right?" Sadly she wasn't. This conversation could have been right out of Michael Moore's movie, "Sicko". "He can go through the appeals process again if he wants but it will just be denied again." The more I tried to explain his situation, the more I realized she didn't care. She couldn't care because if she did, she couldn't work at a place like that. 

"Can I ask you a question?", I said. "Do you LIKE your job?" She replied by demanding to know if I like my job. "I love my job. But then again I'm an advocate for my patients." Then she said, "I know you're just mad because your clinic won't be paid for this procedure." "No, that's not true. I'm doing this for HIM. He didn't even have his procedure done here. I'm just advocating for my patient." She replied by demanding to know my name again and telling me she doesn't like my attitude. 

MY attitude?! Doesn't she get it? She's the one with the attitude and most people in America would think so. I got off the phone and was cheered by a couple of co-workers. I wonder how people can spend their day denying the poor their medical coverage. I suppose one can only do this if they don't have an ounce of empathy. I wonder what would happen if all the money spent to deny claims were used for universal healthcare. I suppose she'd be the one out of a job.


K. said...
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Nicole said...

That company's response and actions are undeniably repulsive, amoral, and downright psychopathic. This is the reason there is a bill in congress right now to outlaw denying insurance to people based on preexisting conditions, and why so many people despise insurance companies. Insurance is supposed to PROTECT people from disaster, not CREATE IT in their lives. Bless your heart for helping that guy out. Love your blog, BTW.

Molly The Dog said...

Hi Nicole. Thanks for your comment. Yes, the more I think about her telling me she doesn't like my attitude, the more I want to laugh and cry at the same time. It's an honor to me that you read my blog.

K. said...

Geez, just reading this makes me want to shower. Possibly the man could get in touch with his congressman. He or she may be able to help.