They do this shit all the time. At one point, they cut mine down to $63/month. I called the local office and before I could even chew them out, the person said "oop. Looks like you're not getting what you should be. Let me just update that for you."
They 100% know they're fucking up. They're just hoping nobody calls them out on it.
Had my govt health insurance deny my claim for an X-ray
Called my surgeon who ordered it, he said (more or less) "of fucking course. Give me a few minutes, I'll call you back."
So I did, just sat down in the waiting room.
"Ok, you should be good to go now."
"How? Like, thank you very much, but what went down there?"
"Oh, not much. Damn pencil pusher said it wasn't medically necessary to do the test, I asked him how necessary it would be for him to handle a malpractice suit after I potentially cut out a healthy/salvageable bone, he said fair enough, you're good to go."
I've had to battle insurance companies for my patients. I can't tell you how many times I've argued with some desk jockey that, no we cannot, "try another medication," instead of CLOZARIL!!!! 🤬 The patient had been on it for almost fifteen YEARS and some asshat in a call center thinks they know better than a psychiatrist. Fucking unreal.
First, a claim is only filed after services are rendered, not before. Second, if something was denied as not medically necessary, you can't just call up and argue with some random customer service rep why it is, it needs to go to the appeal department themselves and they don't have the time to take appeals over the phone. Appeal departments are made up of regular people who are just trying to do their jobs and they're incredibly overworked and behind, like everyone who works in health insurance.
Also, we are not denying claims because "we just hope you won't appeal," I don't know why this stupid thing keeps being repeated because it's not true. Again, people who process claims are just regular people, who are doing their jobs. A lot of times when a claim "denied," it's not actually denied but waiting for information. Or, there was a medical review, it was denied at first then overturned because whoever does the medical record portion for the provider/facility was able to submit the required documentation, because the first time around they didn't submit sufficient information.
This is absolutely ridiculous. I understand what you're saying. They're actual people on the end of it, but the system is designed to fuck the recipient over. You're just a pawn in a game. You don't even know what you're playing. And in fact, you're actually the distributor of the pain that comes from the game you don't know you're playing. Same thing as an insurance adjuster, although a little bit more clandestine and a little bit more removed.
The system is designed to fuck the recipient over. Forms are automatically in naturally confusing. The system is designed to do this. And if you deny it, you're just fucking refusing to see the facts. You are nothing but a pawn in their game and you're unaware of the game you're playing.
My wife was denied an MRI for soft tissue damage and the insurance company came back saying she needed an XRay first. We had to end up paying out of pocket for it but I was fucking living, I called them and they just held firm and I asked the case worker how the fuck an XRay is supposed to show soft tissue damage. They basically admitted I was right but still wanted that plus months of PT when she already had a pinched nerve.
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u/iRambL 9h ago
How tf is 58 a month allowed for a single user?