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Why do health insurance companies have to be so difficult?!?

Discussion in 'Off Topic' started by glockguy, Mar 18, 2011.

  1. glockguy

    glockguy Albany Oregon Well-Known Member

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    So heres the deal.. Me and my wife had a lil boy back in November.. instead of adding him to our insurance right after he was born she waited ... (about 2 months to be correct) being new parents is a little hectic and it didn't feel like a lot of time had gone by. We chose to add him to her's because her's is better then the one i get from my work and cheaper.. well when we go to add him turns out we are over the "31" days that were allowed to add a new child, no one at her work was aware of this rule, including upper management, So the insurance people told us we could write a letter of dispute to try to get them to add him.. well a month goes by and then we get a response... DENIED.... So here we have a little guy a little over 4 months old and hes denied insurance. Hes a healthy lil guy nothing wrong, actually doing amazing according to his doctor.. So now were attempting to add him to my insurance, as well as trying to get other insurance for him, through other companies...it just amazes me that someone can deny a new born insurance.. not to mention our DR bills for him are almost $12,000, and still growing...
     
  2. lonegunman

    lonegunman Eastern Washington Active Member

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    The doctor bills are for your wife and not the child, so they should pay them. I used to date a woman who worked for a major health insurance company. They are a diliberate pain in the a$$. They can deny him and deny him and you can finally enroll him on your next "open enrollment period". There plan is to aviod paying ANY costs associated with the insured while collecting as many preimum payments as possible. If they can cheat you out of a year they get thousands and expend nothing but a few dollars for deny letters.

    File a petition for review or contest their bull crap and then see if the state insurance comission can review this. Sadly, most heath insurance is immune from review by the insurance comission, but it is worth checking.

    Until them, add him to you insurance asap, if they ask why the delay, tell them youhave been swamped with new parenting skills and did not realize this was not automatic.
     
  3. iusmc2002

    iusmc2002 Colville, WA Active Member

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    Its amazing, if you work and pay for insurance, your insurance can screw with you nonstop over things like this. OR...... you could be a lifelong mooch on the government, and get your insurance covered by the state and everything is covered. Seems somehow wrong, doesn't it? Good luck fighting your insurance company, I hope you come out on top
     
  4. John Laughrey

    John Laughrey PNW New Member

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    Try this one on people. So my son who lives with my ex wife broke his leg. He is on my insurance since that is what the state mandates as per divorce decree. My ex also has him on her insurance since it is family coverage and she is remarried with step children. Long story short is my insurance provider required her to pay deductible, and hers required her to pay deductible. She paid it for both. Why you ask, because both insurance companies mandated that they be the primary provider. Her work states they have to be primary, mine states the State makes them be primary concerning child custody issues. Now the hospital has extra money and "get this" wants to return it to one of the insurance companies, they don't care which one they just want to square their books. So me and the ex both fight for 7 months to try to get my insurance to be secondary since he is living with her 8 months out of the year. They fight and fight, over us wanting to "return" money to them...WTF. I can understand them denying service, cheating you for money, or limiting benefits. But fighting so they "don't get money", that is utterly ridiculous. I finally had to get the judge who ruled on our divorce to amend the decree to state I am no longer obligated to carry insurance regarding my child. Insurance companies IMO are the Devil!
     
  5. glockguy

    glockguy Albany Oregon Well-Known Member

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    The bills are for both of them. He has to.go to the doctor once a month. Sometimes more to get a shot or two. But we can't add him till october an it wont go into affect till january.

    I have tried to add him to mine im still waiting on their decision. Iv Bein calling every week
     
  6. deadeye

    deadeye Albany,OR. Moderator Staff Member

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    If you have to go to someone else for the kids insurance until open enrollment on yours or the wifes try Rhodes Warden on Hill St. I went there to get my son and wife insurance until the wife got insurance at work. There are not many companies underwriting kids nowadays in the private policies.
     
  7. donMiguel

    donMiguel SouthKingWA Active Member

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    Curse that ObamaCare !!

    Oh, wait, this is one of the things it fixes...
     
  8. PlayboyPenguin

    PlayboyPenguin Pacific Northwest Well-Known Member 2016 Volunteer

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    Insurance companies are private businesses and can do what they want. You are not entitled to insurance. Go buy an independent policy for the child or accept the fact that he will have no insurance. That has been the position of the right all along.
     
  9. clarthom

    clarthom oregon Member

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    they are difficult because they are in it to make money not to help people that are in need of medical assistance. this is the root problem of health care in this country.
     
  10. billdeserthills

    billdeserthills Cave Creek, Arizony Well-Known Member

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    This is true, Insurance companies are private business & on top of that they own many of the skyscrapers, so apparently they do pretty well for themselves. In Arizona, you would next go to DES & apply for acess, which is state funded insurance, or buy your own policy.
    I do agree that it sucks, obviously the insurance co is gonna get a good chance to screw you
     
  11. STNOSU

    STNOSU Corvallis Member

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    OHP might be an option but if you do sign them up be careful. I know when we had our son my wife had insurance that covered the whole family, while my work policy only covered me. I could of added a spouse or a child but they wanted 200 a month for it so we declined. We figured after deductibles we would have to pay about $1500 to $2000. Well when we are checking in when she was in labor we filled out everything they told us to, we didn't look good enough at what we were signing and one of the forms was an enrollment form for OHP. We were asking what everything was as we were signing and were just told this is what everyone has to fill out etc, so didn't think twice about it. About 4 months later we get a notice saying you have OHP and if you have other insurance etc bring proof in. We brought our paperwork in and everything was supposed to be fine. The whole time the wifes insurance was paying everything after we paid our 200 deductible and we were not getting any bills. After almost a year we get a notice saying we owed the state $4900 for monthly premiums since we didn't tell them we had other insurance (which we already did). We went in and showed them everything we had and the lady we originally talked to messed up and didn't file anything. We went to the hospital and our pediatrician and asked if OHP got billed for anything, both said negative. They both told us they usually get stiffed so anything that our insurance didn't cover they wrote off since it was easier than getting OHP to pay. We appealed like the paperwork said and were denied and then were garnished for $4900.

    I have heard other people have good luck with them but we got shafted. We also never used the WIC stuff everyone gets.
     
  12. billdeserthills

    billdeserthills Cave Creek, Arizony Well-Known Member

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    Damn, I would be pissed about that! Where do they get off not believing you & your wife over the word of one person?
     
  13. MrNiceGuy

    MrNiceGuy between springfield and shelbyville Well-Known Member

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    That's a shame.

    WIC is one of the only social programs that I like. It's also one of the hardest social programs to abuse.
     
  14. STNOSU

    STNOSU Corvallis Member

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    Yeah, the lady half assed apologized to us but it didn't stop my wife from getting garnished. We tried to use WIC in the beginning but ended up just paying out of pocket for whatever it was a lot less of a hassle.
     
  15. bugeye

    bugeye Oregon Well-Known Member

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    We spend about $8,500 a year per person for health care in this country (including the uninsureds) and we get treated like poop when we need some service. If any system yells out that it is totally broke it is this one. Too bad no force is strong enough to fix it, and the govs reforms just leave these same scumbags in charge. Of course it is the only way you could get any reform at all in America, land of more sacred cows than could possibly exist in a computer generated Hindu Heaven.

    Our system has plenty of money in it, but even though these are matters of life and death, greed takes preference.
     
  16. gaijinsamurai

    gaijinsamurai Beaverton Well-Known Member 2016 Volunteer

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    A few weeks ago, The Oregonian ran a story about a woman with Bluecross/Blue Shield (BCBS)health insurance. She paid her premiums every month for ten or fifteen years, and was healthy. But finally, she was hospitalized for some reason, and when it came time to pay her hospital bills, BCBS refused to pay. Their reason? They claimed that someone called their office and informed them that the policyholder had died. Without verifying if it was true, they cancelled the woman's insurance coverage just before she was hospitalized. They admit that they cancelled the policy based on erroneous info, but now refuse to reinstate her policy, because she now has a PRE-EXISTING CONDITION, based on her hospitalization during the time her policy "lapsed".
     
  17. 2506

    2506 Seattle Well-Known Member

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    If anyone needs any help with this sort of thing, feel free to pm me. Part of what my firm does is get people into (or more likely out of) life & health insurance as part of an overall financial strategy. What we've found--which is typically the case for just about everything in life--is that most folks don't plan, they react.
     
  18. billdeserthills

    billdeserthills Cave Creek, Arizony Well-Known Member

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    My healthcare provider informed me that they would remove the riders they have on me if I had no medical issues for a year. It has been three years now & the underwriters dept. decided not to. Pisses me off because I had no riders with my old coverage.
     
  19. Kevatc

    Kevatc Oregon Well-Known Member

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    +1


    On a side note and for what it's worth ...

    I was at a medical symposium just last weekend and one of the presenters was from Canada. He mentioned off the cuff that he really enjoys the comic relief that some news outlets proclaim as news regarding the health care system in Canada. As a provider and user of the system himself he had nothing but praise for it. They have a health care system. We have a medical-industrial complex that thrives on the economics of care rather than on the delivery of efficient and appropriate care.

    Depending on the outlet the US is down in the 20's in terms of it's health care delivery system. Isn't there something we can learn form those 19 or more countries that seem to do it better?
     
  20. billdeserthills

    billdeserthills Cave Creek, Arizony Well-Known Member

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    Yeah, I have heard about the wonderful socialist health care pkg in Canada, However that doesn't explain the many Canadians I see visiting the doctors here in America every year. Funny, when I speak with these Canadian residents they always tell me how bad the health insurance is in Canada, and about the 6 month to one year wait to see a doctor for the most minor of problems. I sure hope you don't begin believing the representatives of the crappy Canada Insurance over the actual word of Canadian Citizens... I sure know who I'm gonna believe.