Topic: How I lost my health insurance at the hairstylist's
Carol in PA
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posted
How I lost my health insurance at the hairstylist's By Downtowner
Quotes, edited:
Fatigue sort of goes with the territory, and like many working moms, you just push past it.
...and you collapse exhausted into bed, get up the next day, and do it all over again - it's a routine you dare not interrupt with reflections on your fatigue - there is no time.
[ 08-03-2012, 07:03 PM: Message edited by: Carol in PA ]
Posts: 6947 | From Lancaster, PA | Registered: Feb 2004
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nonna05
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WOW!!!!! Posts: 2563 | From Denver,CO | Registered: Aug 2011
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tickled1
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Oh no! Did I make a HUGE mistake? I appealed my insurance companies denial to cover my LLMD appointments. My God, what have I done?!!!
Posts: 2541 | From Northeast | Registered: Jan 2008
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posted
Double wow and scarey... criminal.
Posts: 396 | From EAPennsylvania | Registered: Dec 2007
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randibear
Honored Contributor (10K+ posts)
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posted
i went to one doctor and he claimed fraudulent visits, etc. this battle with insurance went on for almost a year. he was really bad. after that i got a letter from bc/bs saying they were flagging my file.
i stopped all claims.
i learned to not mention lyme at all on my insurance. oh i get prescriptions filled but that's it.
i also don't tell anybody about my lyme that i don't really trust. i never mention it to hairstylists, pharmacist, etc.
-------------------- do not look back when the only course is forward Posts: 12262 | From texas | Registered: Mar 2007
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tickled1
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Great, now I'm really worried. My husband was pushing for me to do this to get some money back in our account but I was apprehensive. Now I wish I hadn't done it. Haven't heard back yet from insurance so I guess I just have to wait and see.
Posts: 2541 | From Northeast | Registered: Jan 2008
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Keebler
Honored Contributor (25K+ posts)
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- Carol, thanks so much for this link. It's a MUST-READ for everyone.
THIS is the kind of news that the networks should be covering. But, oh, wait, they get paid by insurance companies & the pharmaceutical industry through advertising.
And, where are the top newspapers or magazines with this detail that is not all that uncommon?
She did suggest in the end that if she lives long enough to qualify for Medicare that she will be covered. That's another sad encounter for most with Medicare.
A great thanks to the author for the time, energy and courage to write that blog entry.
My deep appreciation for the folks who developed home computers and the world wide web.
Just how else would we ever learn some of the most important facts regarding our health care choices or how to take care of ourselves as best we can when all systems fail? -
Posts: 48021 | From Tree House | Registered: Jul 2007
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TerryK
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posted
Thanks for posting this very intersting story.
I actually wondered about this after my husband was laid off from 2 jobs even though he had glowing reviews. Long story but I was very concerned about this playing into the decision because I had been using the insurance a LOT.
He has seniority at his current job but I've worried about making claims against his insurance again because they are laying people off. I told myself I was just being paranoid but I guess I wasn't after all. There ought to be a law against this.
Terry
Posts: 6286 | From Oregon | Registered: Jan 2006
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randibear
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my sister worked as a drafting engineer for a company in ohio. she was always sick and had alot of medical bills.
we always told her go to work but she'd call in even when she had a headache or something. truly she abused her sick leave.
well her department was laid off. then later on they reorganized and recalled everyone but her.
she asked around and sure nuff, they said she was just too expensive.
that plus she was a union steward. everyone in the entire department got called back but her. and her friends, every one of them, had plenty of sick leave and never took off, always going in on weekends when called etc.
so really it was her fault but still she didn't get called back.
she ended up having to retire early and lesser benefits.
-------------------- do not look back when the only course is forward Posts: 12262 | From texas | Registered: Mar 2007
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Keebler
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- Randibear,
I don't see how it's "her fault" for using sick days when she had a headache or "something" that caused her to feel too unwell to work. That is not "abusing" but just "using' one's sick days as intended.
Often, when a friend or family member talks about staying home they will down play their symptoms so others don't worry or just to move off the topic. We can't know how bad it may really be for them.
I always tried to sound cheerful on the phone to friends or family when I hear they sympathy or concern in their voice - like it was nothing even when I felt so terrible. Still do. Most people do.
I don't see her losing her job over taking sick days as anyone's fault. A headache can be very debilitating and, in some jobs, put others at risk when someone works during a headache or "something" else they feel should keep them home where they below when ill.
If more people could take their sick days, perhaps everyone would be better off and there
may also be far fewer traffic accidents or work errors. -
Posts: 48021 | From Tree House | Registered: Jul 2007
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randibear
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hon, there's a lot more to it than i stated but you started sooooo
she would call in, stay home for an hour or so and then go shopping. she'd stay out until the stores closed.
now if i'm sick i'm at home and never go outside. my boss would call at all hours and i always answered.
they would call and nobody would be home.
everyone in the family told her to work overtime, go in, but no, she wouldn't do it.
sorry but in her case, and i can site tons of examples, unfortunately she lost her job. even her best friends told her she was in trouble for using so much sick leave but she wouldn't listen. some days she'd only work a day or two a week.
in this case, believe me, i know what i'm talking about.
sick leave abuse in her case was very real.
in my case, with lyme, i was counselled without reason and had doctor's notices, but still counselled none the less. there are many people who work every day in chronic pain, like my friend who had five back surgeries, and worked every day.
they deserve everything they get. in my sister's case, her chronic shopping and continual absences did cost her.
but to get back to point, be careful what you put on your insurance claims.
in fact, my husband was told in an interview that they were afraid to hire him because "your wife sure does take a lot of time off and you might do the same". i was livid, absolutely livid. so he went to his old manager and this manager went to the hiring official and straighted his ass right out. also i had a friend, former military also, and told him about this and practically begged him to intervene. well he did and husband got the job. he only used about three days the entire time he was there for many years.
i don't speak to that hiring official when i see him out at all. jerk....
-------------------- do not look back when the only course is forward Posts: 12262 | From texas | Registered: Mar 2007
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Keebler
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- Well, with the added detail, that certainly does sound like she was not really ill. It's just that so often, employees are forced to work when ill. I did so often and it put others at risk, even with my driving to work when so dizzy, etc.
Still, if asked how I was, I just had to answer "fine" or that it could be worse. I never told anyone how sick I really was - except doctor after doctor who just couldn't believe me.
So, unless I see otherwise, I will always stand up for anyone who says they are ill. Because, most of the time, they are telling the truth.
Those who don't, well, karma usually catches up with them. -
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randibear
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Yes indeed. Everyone in her entire department was called back and worked for several more years. She was forced to retire early and lost thousands of dollars.
Like you only one person at work even knew how I felt. I always had to hide it. But finally I just couldn't take the viciousness and constantly having to defend myself wore me out.
Thank God I had enough years to retire
-------------------- do not look back when the only course is forward Posts: 12262 | From texas | Registered: Mar 2007
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poppy
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This is why there has been an effort at the federal level to change how insurance works in this country, the "Obamacare" that Rush Limbaugh and others say is a communist plot or something equally dastardly.
My feeling is that the Supreme Court decision was not the success that people think it was, because as maddog pointed out, they took away the state's incentive to participate. And it leaves the insurance companies running the show, even with the new rules, and many of those companies are now for profit, and more interested in their profit margin and their shareholders than in the clients they insure.
There are many more stories like the one Carol posted. A relative of an in-law had a child with cystic fibrosis and the husband had to keep changing jobs when they maxed out the policy. That was when insurers were still mostly non-profit and he could still get another job. Now, that would probably not be the case. That child died in her early thirties of the disease, which has no cure and most patients do not live this long.
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tickled1
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OMG, just found out yesterday that health insurance is auditing us. Scared to death. I never should have sent in that claim. I know that's what triggered it!
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posted
What claim did you send in? What for?
Posts: 532 | From Texas | Registered: Oct 2004
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tickled1
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I submitted my visits to my LLMD to be paid by my insurance. They said no b/c out of network so I wrote a letter stating that no one in network knows how to treat chronic Lyme. They denied again. Now all of a sudden being audited. If they denied it anyway why can't they just let it go. They are not out the money.
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Rumigirl
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OMG!! This is really scary. I am costing my husband's health insurance through his employer soooo much $$ for this darned disease, esp with IVIG on top of IV, LLMD (well they don't reimburse for him or my neuro, even though I have out of network benefits).
If he were to lose his job, and therefore our insurance, because of this, we would be totally up the creek. It's unreal how hard it is now!
I'm not sure what I'm going to do as a result. Deeply depressing/scary. ANd I have been fighting a terrible battle with insurance for many, many years, due to the health issues. So it's not like I'm just realizing all this. But the surcharge??!! Now what?!
As it is, for '12 our premiums went up by 14%, our deductible doubled to $2,000 per person, our co-pays skyrocketed, "Usual and Customary" charges decreased (what they base payments
on), our med deductible increased 2.5 times, more and more meds aren't covered, or they severely limit the # of pills, or the co-pays are $75 for even a generic sometimes . . . ANd the HR
person had a heck of a fight to negotiate what they did get for the firm. ALl because of high usage (not just by me).
Posts: 3771 | From around | Registered: Mar 2008
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philly78
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tickled...I've been submitting my LLMD appts to insurance for the past two years. I do get reimbursed as well.
Just because you're being audited, does not mean they will drop you. It just means you're being audited. It helps determine your risk classification.
People are audited all the time. It is standard procedure.
I work in the healthcare field and you wanna know who the majority of people are that get unexpectedly dropped from their insurance? It is those insured by the state. You won't here much about that in the news or on the blogs but I see it happen EVERY DAMN DAY!
The entire purpose of that blog post is to appeal to your emotions. I remember when that made the rounds on political message boards when it was written back in 2009. Just my opinion, but I think the article in way over the top. While I would not wish that experience on anyone, I do find it very hard to believe.
-------------------- When faced with pain you have two choices....either quit and accept the circumstances, OR make the decision to fight with all the resources you have at your disposal. Posts: 1000 | From PA | Registered: Mar 2011
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poppy
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Rumigirl, I am wondering if the health insurance company is for profit or non-profit? That might explain what is happening with your costs and denials increasing. Nowadays, I think there are more for profit than non-profit, and the stockholders are getting the benefit of these denials.
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tickled1
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philly, Thanks so much! I am now somewhat relieved.
My husband says the only reason he is staying in the job he hates is to provide our family with health insurance so he says if they can him over it good riddance! Poor guy...
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tickled1
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He is a good man. We got married very quickly-about 6 mos. after our first date. I started to get very symptomatic right before our wedding.
I became pregnant with our daughter almost right away and by the time she was a year old I was mostly bedridden with neuro symptoms.
We have been married almost 8 years and he has stuck by me the whole time and doesn't go out just comes home to his family every day and provides for us by going to work every day to a job he hates.
He has had his moments with my illness like in the beginning when I couldn't get answers he said "how many doctors have to tell you nothing is wrong with you before you believe them?". I try not to hold this against him but blame the doctors with their big egos that couldn't dx me so they made it out to be my fault or all in my head.
He now knows I am genuinely sick and is very supportive. So is my mother and I thank God for them every day. Not all of my family is supportive but most are now, even the ones that weren't in the beginning.
I pray that he doesn't reach a point where he decides it's just not worth it to stay. He lost the woman he fell with so quickly. Many men wouldn't have stayed.
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Rumigirl
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poppy, our insurance is for-profit---hence the denials, etc.
philly, do you really think this is not believable? Are you a nurse, or an health administrator, or what? Just trying to figure out how much this sort of thing happens. It definitely scared me.
When I told my husband about it tonight (when he was too tired to hear such a scary story!), he felt it was something he couldn't worry about, because it is beyond his control.
tickled, he stays because he loves you! But I know what you mean, I feel the same way sometimes---it is so hard on a marriage. It is no life for either of us. And my husband does the same, staying at a job he doesn't like for the income and health insurance, instead of doing what he loves and used to do (being a musician).
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tickled1
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Thanks Rumigirl
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philly78
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It scares me too Rumigirl but in my own opinion I think this particular story was a bit over the top and yes....in MY opinion unbelievable.
I've worked in healthcare for quite some time now, and yes....many doctors are *******s and they treat us like we're crazy but that isn't limited to lyme patients.
Yes...insurance companies can be a pain and they can deny treatments and cut people off but that is not the norm....at least not in my experience.
My MIL has had lyme and cos for 11 years now (because she keeps getting rebit) and she has yet to have a problem with insurance. She has been submitting her bills the entire time.
We hear about the sad cases of people getting screwed byt their insurance companies but many times, we don't hear all the info or it is distorted in such a way to fit the writers agenda.
I remember reading a news story about one such case and I knew for a fact it was represented in the media falsely as I knew the person personally.
We have so much to deal with already. Docs not believing in chronic lyme....not being able to afford treatment...etc. I said what I did because I hate to see people worry so much about something that is not the norm. Don't we worry about enough crap already?
Oh...and btw, I am an ER nurse. I read these boards a lot even though I may not post quite as much as I used to. I can't tell you how many times I hear our registrations clerks tell people...."oh you were dropped from your insurance" People are shocked to hear this. And you know what? 99% of the time, it isn't private insurance companies that are dropping them. It is those on public assistance/medicaid/medicare.
I just wanted to give my own personal experience. Just as the person in this article did.
-------------------- When faced with pain you have two choices....either quit and accept the circumstances, OR make the decision to fight with all the resources you have at your disposal. Posts: 1000 | From PA | Registered: Mar 2011
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randibear
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Sorry phillygirl but it was Bc/bs that told me they were Going to flag my file. I stopped submitting anything to do with lyme. Bills don't get paid but doc does
Thank heavens I submit prescription and have No problem. I only submit dr bills for colds etc
-------------------- do not look back when the only course is forward Posts: 12262 | From texas | Registered: Mar 2007
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tickled1
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Shoot!
How long ago did they flag your file randi? What was the reason they gave you?
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Catgirl
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This is why we need universal health care.
-------------------- --Keep an open mind about everything. Also, remember to visit ACTIVISM (we can change things together). Posts: 5418 | From earth | Registered: Mar 2011
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philly78
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I highly doubt that universal care will be paying for our lyme treatments. Just saying.
I'm sorry that happened to you Randi. I submit to BCBS as well and have had no problems. I submit for both my son and I. We don't get reimbursed the entire amount but that is to be expected and I knew that going into it.
My MIL has BCBS as well with no issues. She has been in treatment for over 11 years.
There are a lot of people in this area that I have met over the course of the past two years who are dealing with chronic lyme. So many that I find it somewhat hard to believe really. Maybe that comes into play? Who knows.
-------------------- When faced with pain you have two choices....either quit and accept the circumstances, OR make the decision to fight with all the resources you have at your disposal. Posts: 1000 | From PA | Registered: Mar 2011
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tickled1
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Philly, have they ever audited you? I have BCBS and that's who is auditing us after I submitted my LLMD visits. They denied b/c out of network. I appealed and wrote letter saying there is no one in network that can handle chronic Lyme and they denied again and now audit. They denied it anyway so I don't know why they can't just let it go.
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philly78
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I haven't but my MIL has but nothing came about of it. I have been audited in the past with another insurance company and it was unrelated to lyme. Nothing ever happened though. I was seeing a psychologist who was out of network at the time. I had been to several in network before finding one that was actually worth seeing! They didn't like it I guess that she was out of network.
I do have out of network coverage with BCBS at 80% though. Maybe that is the difference?
-------------------- When faced with pain you have two choices....either quit and accept the circumstances, OR make the decision to fight with all the resources you have at your disposal. Posts: 1000 | From PA | Registered: Mar 2011
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tickled1
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I don't have out of network coverage. But they denied it anyway so they should just leave me alone. Relieved to hear though that nothing came of you and your MIL being audited though. Hopefully that will be the case with me as well.
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