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What good is health insurance??

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  • What good is health insurance??

    I am so upset right now.

    A few weeks ago I had to take my son in to the hospital because he had fallen and busted his lip open. I received a packet in the mail from the insurance company recently. The paperwork consisted of questions like:

    "where the injuries the result of an accident?" so I respond YES
    "were there drugs or alcohol involved?" so I respond "ARE YOU SERIOUS? HE'S 5 YEARS OLD!"
    Will there be any third party litigation? Um, NO.....who am I going to sue? the oak tree in the forest or the rock? (I didn't respond witht that answer, just no)

    please return this questionairre as soon as possible so we can further process your claim............

    today I get an explanation of benefits in the mail.....they are refusing to pay the bill for the hospital because his injuries are the result of an accident..... $230.... ARE YOU F*ing SERIOUS??

    What good is insurance if it doesn't cover you? My husband pays over $600 a month for this friggen insurance and it doesn't cover a g-dang thing. I am so MAD right now.
    I am going to call the insurance company tomorrow and ask them to send me a packet with an explanation of ALL the benefits. They won't cover my husbands chiropractor anymore because they think he goes as the result of an accident. They won't cover anything but well child visits. Sometimes they take their time on processing a claim so that my I have to pay under my deductible. For instance, I went to the chiro in September last year and my *year* ends in November. Well, the claim wasn't processed until December 12 so now it goes under my deductible and they don't have to pay it.

    I AM SO FRUSTRATED. We can't cancel the insurance because it comes right out of my husbands check from work and the only way he can cancel it is if *I* have insurance to cover the family. He pays over $600 a month......FOR WHAT!!?? NOTHING IS EVEN COVERED!!!

    Thanks for letting me vent

  • #2
    Re: What good is health insurance??

    refusing to pay because it's an accident ? Makes no sense? Does that mean if you were involved in a car accident they wouldn't pay?? I would call them and get clarification this , maybe file the claim again

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    • #3
      Re: What good is health insurance??

      That's what I was thinking too....what happens if we were in a car accident?

      I am thinking that YES, they would refuse to pay because there is a possibility that the other persons insurance or my insurance would cover me instead of my health insurance.

      I just can't get over it. I can't wait until tomorrow when I can call. They will probably just brush me off and get snotty about it. Well, I am fed up right now and I WANT AN EXPLAINATION!!

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      • #4
        Re: What good is health insurance??

        If the clerk you talk to gets ugly with you, ask to talk to his manager, they can't refuse that, all calls are monitored, at least that's how it works at my company.

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        • #5
          Re: What good is health insurance??

          They Probably Didn't Pay Because Of The "accident" Regular Health Insurance's Usually Won't Pay For "accidents" They Think Motor Vehicle Accidents. Here At The Clinic If It's A Mva, They Have To Pay And The Insurance Will Have To Pay Them, Because It Never Pays Us And The Patient Won't Either. I'd Call Or Have The Hospital's Billing Dept Call Or Do What They Need To Do To Explain The Accident Was A Child Falling, There's No Reason They Shouldn't Pay For That.

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          • #6
            Re: What good is health insurance??

            Originally posted by flutterby View Post
            That's what I was thinking too....what happens if we were in a car accident?
            THE AUTO INSURANCE WOULD PAY IT, YOUR HEALTH INSURANCE WON'T.

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            • #7
              Re: What good is health insurance??

              I am just wondering ? Why didn't the hospital bill your insurance company directly ? The most you should have paid was the co pay at admitting and the rest should have been billed directly to ins. company ?? No??

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              • #8
                Re: What good is health insurance??

                Originally posted by nuisance View Post
                THE AUTO INSURANCE WOULD PAY IT, YOUR HEALTH INSURANCE WON'T.
                I didn't know that, learned something new. Thanks Nu.

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                • #9
                  Re: What good is health insurance??

                  So hopefully when you explain to them that your son just fell and busted his lip, they will pay.

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                  • #10
                    Re: What good is health insurance??

                    Doesn't make sense to me, either. Aren't most injuries in the ER caused by accidents?
                    Hope you get it cleared up.

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                    • #11
                      Re: What good is health insurance??

                      oh......maybe that is what they meant when they asked if it was the result of an accident....I never thought of that......

                      All I could think was NO, I purposely busted his lip open.......I am sarcastic like that when I get asked a stupid question....

                      I didn't go to the ER. I thought that would be my only option but at the ER they asked me if I had checked in first (isn't that funny) and when I went to the window the man asked if I wanted ER or Clinic....I said "what do you think" he isn't allowed to tell me his opinion apparently. Just told me the ER is for life threatening and the clinic is more for sickness, so I chose the clinic.

                      WOWZA, I am glad I did choose the clinic, could you imagine the bill if I chose the ER??

                      I nevere received ANYTHING from the hospital/clinic I just got the questionaire from the Ins. co. and then the refusal to pay letter.....

                      Wish me luck for tomorrow. I hope I can keep myself under control long enough to try and understand.

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                      • #12
                        Re: What good is health insurance??

                        Stay calm

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                        • #13
                          Re: What good is health insurance??

                          Insurance company reps ask the strangest questions so you have to be very patient and insistant with them. Last summary I had surgery to remove my ovaries my insurance company sent me 3 letters asking if the surgery was the result on an on the job accident. I sent 3 responses and in my last one I asked them how they thought my office job caused cysts, they are finally leaving me alone. Do not give up

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                          • #14
                            Re: What good is health insurance??

                            Good advice, keep on the insurance people. Also make sure the clinic billed it properly. Alot of claims are denied because of the wrong coding.

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                            • #15
                              Re: What good is health insurance??

                              Flutterby, I'll bet that is what they meant by that. Although, sounds like they could have been a little more clear!! My first thought was yours also -- "No, it wasn't an accident, he busted his lip open on purpose!"

                              Don't even get me started on insurance companies. You pay out the a$$ every month, and then if you need to have any kind of surgery done, it's so dadgum high even WITH insurance that you can't afford to have it!! I paid over $1100 up front for my hysterectomy, and still owe over $1000, PLUS all the other bills from everyone who even so much as breathed on me while I was at the Surgery Center!

                              Socialized Medicine is sounding better and better each day to me..
                              Lauren ~The ultimate tragedy is not the oppression and cruelty by the bad people but the silence over that by the good people. ~
                              Martin Luther King, Jr.

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