Health insurance - has anyone heard of this?

Discussion in 'Hot Entrepreneurs: Build Wealth & Share Links' started by 3timesoccermom, Feb 6, 2014.

  1. 3timesoccermom

    3timesoccermom The Original "Viral" Foodie

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    I got a letter yesterday from our insurance company (Aetna), which Hubs has through his job.

    It was regarding a claim I had made for a special boot for my foot, which was injured in October. What they wanted to know was, basically, was there someone else they could get to pay for it so they wouldn't have to!!!!!:mad19:

    They asked if the injury was caused on a job, by another person, on someone else's premises, etc. :noway: I was SO disgusted and irritated and in addition to filling out the questions I wrote a brief note saying I resented the question at all and that Hubs pays dearly for the coverage so would they please stop attempting to shirk their responsibility. :hot3:

    Has anyone else ever gotten something like this?? I received another one a year or so ago but don't remember what it was for. Unbelievable.

    I do know we are lucky to have the insurance.


    Apologies to mod if there is a better place for this
     
    Last edited: Aug 9, 2014
  2. mtimoney

    mtimoney New Member Trader Group

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    Re: ~ Health insurance - has anyone heard of this?

    yes it is pretty standard for all companies. You will get something like that every year, (because believe it or not peoples situations change) and any time you have a diagnosis that is related an injury. Not "shirking" there responsibility just making sure it doesn't get paid twice.
     
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  3. 3timesoccermom

    3timesoccermom The Original "Viral" Foodie

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    Re: ~ Health insurance - has anyone heard of this?

    Well thank you for the reply but I disagree - they were very much trying to pass on the responsibility to someone else. They even asked if we had filed suit on someone and if so, who was the attorney, how much did we get paid, etc.


     
  4. cybilx10

    cybilx10 Mod Of The Month Nov. 2010 - BRAT! Trader Group

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    Re: ~ Health insurance - has anyone heard of this?

    This is pretty much standard policy with most companies now. When my son was injured back in july I received paperwork from my company asking if someone else was at fault for my son's injury and if so who was the person, police report etc was needed so they could get that person or insurance to pay. They just dont want to be out this amount of money for something that someone else should have to pay for.
     
  5. Green is Gold

    Green is Gold Member of the Month 6/12 - Queen Of Circle Driving Staff Member Moderator Trader Group

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    Re: ~ Health insurance - has anyone heard of this?

    2 or 3 years ago, DH had his orbital bone shattered.
    We got the same papers you are talking about, which HAD to be filled out or they weren't paying the claim. (which still cost us thousands of dollars, after they paid their share)

    Every year we have to send back papers stating that yes, we're sure that no one in the household is eligible for coverage of their own, through a job or any other way.
     
  6. cybilx10

    cybilx10 Mod Of The Month Nov. 2010 - BRAT! Trader Group

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    Re: ~ Health insurance - has anyone heard of this?

    I remembered back a few years ago I was in a bad car accident. Drunk driver rear ended me and hubby and I got the brunt of it. My insurance paid all of my expenses but went after the other guys insurance to recoup the money plus the money I had to pay for meeting my deductible.

    And I agree with GIG's...I blew off filling out the paperwork on my son's accident for months. It was finally a final notice stating if I didnt fill it out, they would cease paying the bills that were coming in from that accident.. Um nope..hospital bill was around $30,000 no thanks on paying that one on my own!

    They are just trying to cover you and them and not pay any fees that could be at the result of someone elses fault.
     
  7. rbunnymom

    rbunnymom Member Of The Month Jan. 2009<br>(\__/)<br>(>'.'<) Trader Group

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    Re: ~ Health insurance - has anyone heard of this?

    This is standard practice for insurance. I recall getting them at least 10 years back, so it is not something new.
     
  8. wrenbe

    wrenbe Active Member Trader Group

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    Re: ~ Health insurance - has anyone heard of this?

    Yeps, I'm just going to echo what was said here. Its standard practice. Most of the forms are just that, forms. As such they may have irrelevant (to you) questions on them because they are relevant to someone else. Insurance sends these out when a claim is something on a list of diagnoses that should be flagged due to the possibility of it being caused by an outside factor (workman's comp, injury in an accident, etc). I understand being upset but unfortunately this is the way the world is today. Too many people took advantage of their situations too many times (received an injury at say Walmart by sliding on their sidewalk and received compensation from both Walmart and their personal insurance for the exact same injury treatment). And its not just people it's also the doctors. Some doctors will double bill--bill two insurance carriers for the same treatment and not tell the insurance carriers about each other. Because of the greediness of some the rest of us have to wade through paperwork that gets our hackles raised because we're having to explain and defend ourselves and our claims. It feels icky and wrong like they don't believe you but really its standard practice.

    My favorite story is a PCP I was going to for the first time and I have called and explained at the time I made the appointment, when I got to the office, and to the MD himself that I was there for new patient yearly physical. The MD decided to do some blood work because I had told him 1 yr earlier I had a faint that landed me in the ER--my PCP at that time had checked me over and decided all was well. This new MD assured me that the blood work would be just the standard yearly that was covered by insurance. Well I got a bill. When I called to inquire about the bill insurance told me that the PCP had billed it as an investigative blood work and that my appointment ad been with a specialist not a yearly routine exam. I tried to get the PCP to correct this and they refused, stating it had been investigative (1 year later mind you on an issue that had already been investigated by a previous PCP) and refused to acknowledge that my visit was just a routine physical. Basically I was given the option of refusing to pay it and taking him to small claims court (refusing would mean that it would go to creditors and unless I won at small claims court would hurt my credit) or just paying. I didn't have the time/energy/money (was in school) to fight it so I just paid. That MD got 3x the amount he would normally have gotten for my visit. I never went back.

    THIS type of thing is why insurance checks on things. MDs are not always honest.
     
  9. 3timesoccermom

    3timesoccermom The Original "Viral" Foodie

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    Re: ~ Health insurance - has anyone heard of this?

    Thanks for the replies.

    Maybe it's because I'd not had an injury before but in all the years we've been insured I've only gotten 2 of these and they were only for me - never have received one for any other member of the family and this is the only company I've ever gotten them from.

    @cyblix10 - I shudder to think how scary that acident must have been.
     
  10. Cathy

    Cathy Happy Birthday Cathy!!

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    Re: ~ Health insurance - has anyone heard of this?

    Boy can I relate! My husband died in November and the bills and notices have been unbelievable...I hate going to the mail everyday because I find most of it confusing: "this is not a bill...etc" and then they include an LSASE? Just recently I was sent a notice by Blue Cross that a bill from March 2013, which had been paid by both Medicare and Blue Cross, is now being denied. I called and asked about it and they could give me no information, other than it was denied. They didn't even list what the bill was for! It was for almost $9,000! I mean why would they pay it and then say they were rescinding it and why oh why did it take them 11 months to do that? I don't know what to do about it :(
     
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  11. toolmansgurl

    toolmansgurl Active Member Trader Group

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    Re: ~ Health insurance - has anyone heard of this?

    [MENTION=372]Cathy[/MENTION] check with your local senior citizen center to see if there is an eldercare organization. Here they have liasons that work with you and the billers through insurance/billing problems.
     
  12. wrenbe

    wrenbe Active Member Trader Group

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    Re: ~ Health insurance - has anyone heard of this?

    Helpful hint with insurance if you really want an answer--call and ask for a supervisor, if you don't like the rep you talk to hand up and call back in 30 minutes and try again. Keep asking. Send letters. Be persistent. Right now insurance is trying to look good. They're making new programs for "select" companies who buy into them and are offering more "Cadillac" style services (compared to "Toyota" style services of yesterday). Keep asking for the person above whomever you are talking to. Eventually if you complain enough it gets to the VPs. The VPs have to sell the company to whomever supplies your insurance and don't want to look bad. They'll send word back down the pipe to take care of the problem to avoid the bad PR of you being upset and telling whomever you are getting your insurance through about it. Everything at the companies is recorded so try to stay calm, not cuss, and work on making the irresponsive reps look bad. Sometimes they also have chat options on their websites--use that when you're tired of talking. Just be persistent.
     
  13. JulieDB

    JulieDB New Member

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    Re: ~ Health insurance - has anyone heard of this?

    Yes but in my case it was a car accident. I think I had Blue Cross at the time. They wanted me to run it through my car insurance first. Which I did. Car insurance wound up paying for most of it and then Blue Cross paid for the rest.

    And although I don't have all of the particulars, my dad had some issues with certain things that Medicare initially paid for but then they billed him for them. Took my mom a while to get all of that straightened out.
     
  14. fperkins

    fperkins New Member Trader Group

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    Re: ~ Health insurance - has anyone heard of this?

    We have received many of these notices over the years. Hubby has Diabetes with a lot of foot complications and has had many foot surgeries over the years. He has received these letters from 2 different insurance companies. Maybe the walking boot is one of the things that sets off the flag to send this notice. We always just fill them out and send back, or call the number and answer the questions over the phone.

    I don't think Aetna was trying to offend you. We have Aetna and love it and we file a LOT of claims.
     
  15. disabledvetswife

    disabledvetswife Mod of the Month June 2012 Trader Group

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    Yep, as already stated, standard practice. It's coordination of benefits and payer of last resort stuff. When you get old enough for Medicare, if it's still around, that's standard practice.

    This is what I do for a living. If you get injured, if you have something stolen that insurance paid for, they always want other insurance to pay first. If you hurt your foot at home, some insurances want you to bill your homeowner's. If it's a car accident, your liability insurance. If at your place of employment, worker's comp.

    You would be utterly surprised at how many people think x-y-z should pay for it just because.

    Example: Medicare paid $17,000 for a person's powerwheelchair. Person left it on his front porch because he didn't feel like bringing it in. Someone stole it off his front porch. Before Medicare will buy him another one, he has to have filed a police report and prove he has no homeowner's insurance.

    ....and yes, some people submit bills to all their insurance companies, without telling the other one, and hope they get duplicate payments - because then it's like Christmas.
     
  16. disabledvetswife

    disabledvetswife Mod of the Month June 2012 Trader Group

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    Re: ~ Health insurance - has anyone heard of this?


    Who did you call? The provider? Call Medicare & ask them why it was denied. Honestly, you would've gotten an explanation of benefits from Medicare explaining the denial, but things happen: lost in the mail, thrown away by accident, etc. If you find out the reason for the denial, claims can be corrected & resubmitted, or appeals and/or hearings. Believe it or not, 11 months is not uncommon. Providers have 13 months to file a claim. Medicare has 14 days from the date of receipt to process the claim. Providers have another 30 days to appeal a denial. Medicare has another 60 days from receipt of the appeal to issue another decision. Provider has another......Medicare has another.....blah blah blah.

    :hugs:
     

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