One such encounter went like this:
Me: “Hi. I’m calling about my daughter’s ambulance and hospital charges. I haven’t been able to reach my grievance coordinator about the appeal.”
Representative: “I can help you.”
**Me: **(Genuinely excited.) “Great!”
Representative: “Oh, I see your daughter turned 18. I can’t discuss her information with you.”
Me: “I sent a release of information form by mail, fax and email. I also faxed our conservatorship papers.”
Representative: “I’m sorry, it’s not on file. What office did you send it to?”
Me: (I give the information.)
Representative: “That’s the wrong fax number. Let me give you the correct one.”
Me: “I’m not inventing numbers out of the ether. This is the third new fax number I’ve been given. Are the address and email inaccurate too?”
Representative: “I’m sorry, but I can’t discuss your daughter’s claims with you without this information. Can you put her on the phone to give verbal consent?”
**Me: **“I can’t put her on the phone. She’s currently in a treatment center and has no access to a phone, which is why I have a conservatorship to help with her medical care.”
Representative: “I’m sorry, ma’am. There’s nothing I can do without the forms or her verbal consent.”
Me: “Who do you think pays the insurance premium and all her providers? I’m just trying to settle her claims, and I don’t know what we owe without access.”
Representative: “I can only answer general questions.”
Me: “OK. From the bills I’ve received, we’re being charged out-of-network fees for the ambulance, ER, ER doctor and hospital.”
Representative: “Was this out of state?”
**Me: **“Yes.”
Representative: “Hang on, I have to transfer you.”
I was on hold for another 15 minutes, and then got cut off. I called back, was transferred twice and then repeated a version of the above conversation before resuming — with a grievance coordinator!
Grievance coordinator: “The ambulance and ER facility were both out of state and out of network.”
Me: “A treatment center called for an ambulance. I wasn’t given a choice of who responded or where they took her.”
Grievance coordinator: “They used out-of-network providers.”
Me: “They dialed 911. No one stops to ask the closest ambulance what their network status is.”
Grievance coordinator: “They did transfer her to an in-network hospital, but the physicians were not participating providers.”
**Me: **“Under the No Surprises Act, insurance must cover all providers in the case of an emergency, whether they are in network or not — even if out of state.”
(There was a long silence.)
Me: “Are you still there?”
Grievance coordinator: “Yes, ma’am. Once you get the conservatorship papers to us, we can look at those claims. Is there anything else I can help you with?”
Me: “Apparently not.”
“Death panels!” the conservatives shouted. “The government will have death panels!”
The rubes ate it up, not realizing they had death panels the entire time and paid more for them.
And the only death panels were all the insurance company death panels that already existed all along the way
rubes
I call them Rubels
Seriously. The real Obama Death Panel is a lone worker mass-clicking “not covered” all the way down a spreadsheet that has your care as a line items.
I also like doing this juxtaposition:
Repubs under Obama: “death panels are going to kill our grandmas.”
Repubs under Donald: “sacrifice all grandmas to the rising line.”
Not to mention the part of the bill they were referring to was paying doctors for end of life counseling, like living wills, which help people die with comfort and dignity.
Conservatives love to say free market works, shop for best price, blah blah… When you are having a heart attack, you don’t stop 911 from sending help until you shop around for the best ambulance service… You take the closest one, go to the closest hospital, and get service from the doctor on call.
Fuck insurance, we should have Medicare for all by now.
Conservatives are all liars. I mean, you know that. But the academic theory of the free market valuing things correctly requires an assumption that people can go without the goods and services being valued. It’s not even a misrepresentation on this one. It’s just a straight-up lie.
As an American, I’m legit terrified of sustaining some kind of injury or extended illness. The society we have constructed, and that we tolerate, is an absolute abomination. Let me say it again. The United States is an absolute, top to bottom, left to right shit hole. We do not value people, life, or well being in any meaningful or equitable way. This is an economy masquerading as a society.
When I started my first “real” job, where I got health insurance, it was an absolute nightmare trying to find a therapist through their network. I remember having to call them to figure out if they would cover visits to a specialist in trauma. Sat on hold for an hour and 45 minutes, just to get some random woman who would NOT give me any information until I told her “why” I needed to see a therapist.
After trying unsuccessfully to skip past the question, she kept asking, so I said fine, and trauma dumped all over her. I’ll save you the details, but I could tell she was shaken once I finished. After all that bullshit, she still couldn’t even tell me if the provider was covered or not, and instead sent me a 90 page non-searchable PDF listing a bunch of random therapists in random order located all over the state (which was negative help). I was so upset I just hung up on her.
Medicare for all. Health insurance is a scam that bankrupts Americans, puts barriers between you and care, and actively harms all of us collectively.
As someone who is taking Kaiser Permanente to court over their refusal to release documents, let me confirm that grievance coordinators are the most useless wastes of oxygen ever to steal air on this planet. Even having your lawyer send them the actual text of the law they are currently violating, they will refuse to do anything not explicitly outlined and approved by their policy. Fuck the law. Fuck common sense. If it’s not policy, it doesn’t matter.
Courts should find insurance companies liable for billing mistakes that you have to spend your time and resources to correct. Compensation should be 100 dollars a minute.
Brilliant. Unfortunately the insurance lobby owns Congress.
Hey - we should get our own lobby and outbribe them
Kickback congress for 1% of those fees.
Thank you for the information on the “no surprises act”, didn’t know that was a thing.
Also, south park actually did a skit like this, but I feel like it’s in bad taste given the seriousness of what OP is going through.
I worked for a company who went with a cut rate insurance provider one year who basically denied or screwed up every claim. This required calls, faxes and hours wasted any time anyone had a medical procedure. The kicker was that the insurance company hours were the same as our company hours so all of this had to happen during company time. They went with a proper provider the next year.
Before switching providers I had similar experiences, to the point where I’d start every call with “Please transfer me to a manager. You can help me by transferring me to a manager. No I need to be transferred to a manager. You’re not a manager so you can’t help me,” and so on and it was the only way to get whoever answered the phone to give me straight answers on the first try.
Causing long term damage (requiring further treatment) is probably their ideal outcome.
Death is so… “you’ll stop paying us”
Just call them up and make it clear that you are mentally unstable enough that you might go to the person’s you are talking to home. If they are afraid of what you might do paperwork gets done fast.
Be creative with it. Last time the insurance denied one of my daughter’s claims I accused the adjuster of getting off sexually on the act, in graphic detail until they agreed to process the claim
Any important conversation I like recording it. I know you can do this on Android, idk about iphones.
Should call it death insurance not health insurance.
That’s called life insurance.
I get providers and insurance companies flagrantly violating ADA all the time with me and my housemate’s care. They don’t give a shit and nobody is holding them accountable if you don’t have money for a lawyer to threaten them officially.
