What gives insurance companies the right?

[Baroque Brass]

I have a condition called Barrett’s esophagus due to acid reflux. This condition can become cancerous so I take a medication that’s $10/pill to control the reflux. As of January, the insurance company flatly refuses to pay for the med, even though the doctor said it’s required. The insurance company said I have to take another med that’s less expensive, but it’s not working. The doctors office sent another letter to the insurance company and they again refused. How can they do this? We’ve paid a health insurance premium for decades but they refuse coverage. The insurance companies dictate when a patient is discharged from the hospital, not the doctor. What gives them the power to make these decisions? We pay for car insurance but if we have an at fault claim, our rates go up. I hate insurance companies.

 

[Redbow]

I despise them also, our life insurance company just cut our life insurance in half with what we would be paid if either the Wife or I dies because I would not go back to work at 77 years of age. They can do whatever they want and I guess its legal.

 

[sinclair1]

In our limited exposure to claims with medical insurance, both times they hounded us for where it happened in an effort to try and pin it on a business or friend thru lawsuit.

My wife just got a shoulder replacement and I had a concussion. Both times they investigated if they should pay or force us to file a lawsuit to cover the bills.

Not sure what happens if you say it happened at a friends because we both were injured at home.

I suppose if you said work they would expect workman’s comp. I have hurt my back and other minor things at work and just went to the doctor on my insurance. If I get hurt due to my own stupidity, I expect my loser insurance company to pay because that’s why I have insurance.

 

[ryork]

the entire medical industry has become legalized racketeering. I absolutely loathe anything having to do with doctors, hospitals, pharmacies and insurance. While necessary, the system is broke and needs an overhaul. Unfortunately too many will buy into the govt solution cause it’s obvious bureaucrats know how to run everything so efficiently.

 

[georgia_home]

You can appeal decisions of the insurance companies. the state usually has something called an ombudsman

read the denial paperwork and look for the appeal info. I’ve been through this several times. Won about 3/4… but it really drags out.

also call the insurance commissioners office. They may be able to help you reach the appeal

also try single care and good rx … sometimes even if your insurance covers, they’re cheaper then the copay …

 

[JustUs4All]

The Medical Industry in this Country was ruined by the .Gov decades ago. I do not like Insurance Companies any more than the rest of you and feel that they take advantage of people in situations where they should not. But -

People nearly always have the mistaken belief that Insurance Companies are in business to pay claims to help and protect their clients from financial harm. This is the part of the business model that the Insurers with to call attention to through promotion and advertising but it is not the why.

The real reason Insurance Companies are in business is the same as any other entity, they want to to make a profit. They are in the business of paying only those claims that are necessary. Some Companies will pay a claim that is not necessary but not paying it would harm the business in some fashion.

Insurance is still very helpful for those people who are not in a position to personally bear the costs of the perils insured against. Most of us are probably in that position for at least some of the more costly perils we face in daily life.

Buying Insurance is a gamble of sorts and the edge always goes to the house. If we could all afford the risk it would be less expensive to pay for the covered costs out of pocket avoiding the cut that goes to the Insurance Companies. But then, if the Insurance Companies don't make money they go out of business and the insurance is no longer available to those of us who are otherwise unprepared to shoulder the costs of the perils.

 

[Dustin Pate]

My insurance quit covering my acid reflux medicine a couple years ago. I can get it cheap from Publix Pharmacy, either using their in-house coupon or GoodRX.

 

[deermaster13]

I have a med I have to take for my lungs. With insurance it is 600 dollars a month. Luckily i found a coupon from the manufacturer that helped tremendously. I would search the med you need and see if they offer any discounts or coupon thru them.

 

[leroy]

But yet illegals get it for free, have heard from some that have been here for years that have hospital stays, operations etc and say they had to pay 0!!

 

[ryork]

The Medical Industry in this Country was ruined by the .Gov decades ago. I do not like Insurance Companies any more than the rest of you and feel that they take advantage of people in situations where they should not. But -

People nearly always have the mistaken belief that Insurance Companies are in business to pay claims to help and protect their clients from financial harm. This is the part of the business model that the Insurers with to call attention to through promotion and advertising but it is not the why.

The real reason Insurance Companies are in business is the same as any other entity, they want to to make a profit. They are in the business of paying only those claims that are necessary. Some Companies will pay a claim that is not necessary but not paying it would harm the business in some fashion.

Insurance is still very helpful for those people who are not in a position to personally bear the costs of the perils insured against. Most of us are probably in that position for at least some of the more costly perils we face in daily life.

Buying Insurance is a gamble of sorts and the edge always goes to the house. If we could all afford the risk it would be less expensive to pay for the covered costs out of pocket avoiding the cut that goes to the Insurance Companies. But then, if the Insurance Companies don't make money they go out of business and the insurance is no longer available to those of us who are otherwise unprepared to shoulder the costs of the perils.

Unfortunately we’ve drifted away from a true insurance type product that is meant to cover catastrophic or significant costs. What we have now is the vast majority who feel it is someone else’s responsibility, the taxpayers and/or their employers, to cover all medical costs on their behalf including every doctors visit and antibiotics prescription.

But yet illegals get it for free, have heard from some that have been here for years that have hospital stays, operations etc and say they had to pay 0!!

Not just illegals, it is a significant portion of the entire population, legal or illegal. Its called cost shifting, some supposedly can't (won't) pay so the cost is shifted to you and I.

 

[Oldstick]

Very familiar with Barrett's esophagus. My wife's doctor had to send her up to the one and only place in GA specializing with it. She was diagnosed with it for several years before her GI specialist got extra concerned about how it looked and decided to refer her to Emory for further treatment.

Ask the insurance company if they would prefer to pay multiple trips and procedures at Emory Hospital in North ATL for endoscopies, biopsies and multiple ablation procedures using some kind of microwave probe to remove the pre-cancerous tissues.

 

[leroy]

Niece had wisdom teeth cut out Monday when they got to office they were informed they would have to pay 4000 if they were not prepared to pay they would have to reschedule, they did say that they should have told them ahead of time.

 

[dwhee87]

I have a condition called Barrett’s esophagus due to acid reflux. This condition can become cancerous so I take a medication that’s $10/pill to control the reflux. As of January, the insurance company flatly refuses to pay for the med, even though the doctor said it’s required. The insurance company said I have to take another med that’s less expensive, but it’s not working. The doctors office sent another letter to the insurance company and they again refused. How can they do this? We’ve paid a health insurance premium for decades but they refuse coverage. The insurance companies dictate when a patient is discharged from the hospital, not the doctor. What gives them the power to make these decisions? We pay for car insurance but if we have an at fault claim, our rates go up. I hate insurance companies.

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[Baroque Brass]

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Thanks, I’ll check into that.

 

[Baroque Brass]

After calls from my wife and the doctor’s office, they’ve approved the med. it should only take justification from the doc, it shouldn’t be a battle for the patient.

 

[K80Shooter]

After calls from my wife and the doctor’s office, they’ve approved the med. it should only take justification from the doc, it shouldn’t be a battle for the patient.

Be prepared to go through this every year or renewal period.

 

[Milkman]

I’ve got a new curveball on one of my meds. 90 days by mail is over $700. But 30 days is $145.

That’s opposite of what the normal is.

I would call and speak to them about it but my Madarin is a little rusty