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Dispatches from the Insurance Claims Front

 
 
jespah
 
Reply Fri 15 Mar, 2024 05:24 pm
Welp!

Today has been... a day.

But I'll back up and tell you all about how insurance has become just the weirdest thing for us (RP and me).

Background information: RP and I have similar but not identical last names. From 2017 to 2023, I worked for a business credit outfit. From 2001 to 2020, RP worked for an engineering firm. After he was laid off due to Covid, er, stuff, we got insurance through my employer. This was a small company, and insurance consisted of an agency. We had this insurance from 2020 to mid-2023.

Then in July of last year, I was laid off and, within less than a month, RP was hired back by his old firm. We reupped his old insurance and cancelled mine, which was costly and covered just about nothing.

Here it is, 8 months later. Insurer still thinks we have other coverage. It routinely holds up payments to providers who are in its network because it's decided we have other coverage.

Earlier this month, I called and complained and got a CSR who, while I was on the phone with her, filled out a form essentially saying Stop claiming they have other coverage. Go home, carrier, you're drunk. She sent it in and everything while I was on with her.

I even went to a doctor on the 6th for a checkup and the doctor's clerk said she was no longer seeing the note about us having some sort of other coverage. So far, so good.

But wait, gentle reader....

Today, I noticed 2 outstanding claims. Both of them said they were waiting for information from me about other coverage. So, I open up the carrier's chat function (because even though the note online says you can clear things up on your profile, you can't!) and I talk to (I kid you not) "Cher". For, I guess, when you believe in life after coverage, or something like that.

Cher says there's some other carrier stepping in and claiming they'll pay?

Er, what?

So, I explained to her, we don't pay premiums to anyone but you. Why would some other carrier be essentially volunteering to pay our claims? Are they, perhaps, trying to turn back time to when I was still employed by the other place?

Why is some other insurance carrier claiming, "I got you, babe" for no apparent reason? Normally, it would just be "bang bang, we're not covering you!"

So, I am confused and kinda frustrated.

Stay tuned as the beat goes on.
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Type: Discussion • Score: 5 • Views: 287 • Replies: 16
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edgarblythe
 
  1  
Reply Fri 15 Mar, 2024 07:29 pm
After I retired I signed up for one of the free supplemental things - originally called Texan Plus but now called Welcare. I did it to cover my bases even though I was not going to a doctor or taking any drugs. A woman sat in my living room and signed me up. Fast forward to December 2023. My sis in law asks about my benefits because she also has Welcare. She says, "You're not getting any benefits." With my permission she calls up and instigates a change in my plan to match hers. After I'm signed up they inform me that because they weren't giving me benefits if I can't prove I had a drug plan I am being fined for every month since 2008. I checked on it online. If I calculate correctly the total fine is $667. I guess it will come out of my SS check, possibly this month.
roger
 
  1  
Reply Fri 15 Mar, 2024 08:33 pm
@edgarblythe,
I hope I misunderstood that, because it doesn't make a bit of sense, to me.
edgarblythe
 
  1  
Reply Fri 15 Mar, 2024 08:55 pm
@roger,
It's government. Doesn't have to make sense.
roger
 
  1  
Reply Fri 15 Mar, 2024 10:51 pm
@edgarblythe,
Sadly true.
0 Replies
 
bobsal u1553115
 
  1  
Reply Sat 16 Mar, 2024 05:13 pm
@edgarblythe,
Umm ... where in that recounting did the government get involved?

This is typical insurance crap. They know that there is a point this will be settled by so many days or weeks. But there is an actuarial table that tells them statistically so many people pass on in the interim and maybe they don't have to pay out.

This is a business version of Las Vegas. You bet against yourself and the insurance companies take that bet at the odds they set.

In the end this will be resolved. I believe Jesspah Esq is qualified to sort them out. Her advice here has been superlative. I am inclined to think her letter writing skill are particularly good.
edgarblythe
 
  1  
Reply Sat 16 Mar, 2024 06:00 pm
@bobsal u1553115,
government - insurance - medicare
Call it what you will they work together. It's easy to find out. I just googled and this popped up.

Martinez was without creditable prescription drug coverage from August 2020–December 2022, her penalty in 2024 is 29% (1% for each of the 29 months) of $34.70
roger
 
  1  
Reply Sat 16 Mar, 2024 06:27 pm
@edgarblythe,
Just by the way, VA health care counts as credible coverage.
edgarblythe
 
  2  
Reply Sat 16 Mar, 2024 06:39 pm
@roger,
My VA health care was not pursued. I haven't been signed up for it.
edgarblythe
 
  2  
Reply Sat 16 Mar, 2024 07:18 pm
@jespah,
Sorry for not making a new thread. Didn't intend to hijack this one.
bobsal u1553115
 
  1  
Reply Sun 17 Mar, 2024 12:41 pm
@edgarblythe,
Edgar, if there was one thing I could ask you to do, I'd want you to go down and sign up for VA.

They've spent more than a million dollars on me since 2012. After one hell of a fight with colon cancer, bladder cancer and a cancer detected in my prostate after it was removed for the bladder surgery and over a year fighting with Brucelosis, I am cancer free.

I think VA is good model of single payer national health care for everyone in the US.

Please consider it. You earned it.
edgarblythe
 
  1  
Reply Sun 17 Mar, 2024 02:34 pm
@bobsal u1553115,
I knew some men who had experience with the local VA. It wasn't pretty. When my father in law was taken there because of collapsed lung they wheeled him into the hall and said take him home and make him as comfortable as you can. But one of his other sons in law who was a police detective said, "Y'all better take him in there and take care of him."So they took him in and he lived two or three more years. They didn't like that. He was getting all that free oxygen. Even though he had experienced two collapsed lungs, they put him on a treadmill. One of them said, "Do you know how much that oxygen costs?" as they took it away. We got him oxygen but the stress killed him.

Not many years after I registered with the Va because I had an esophageal soreness. I told the doc and he wrote down, "sore throat" and made me an appointment for more than a week off. I didn't keep the appointment and never went back. That was in the 90s, not sure when exactly.
bobsal u1553115
 
  1  
Reply Sun 17 Mar, 2024 05:53 pm
@edgarblythe,
The first job I had after leaving the Navy in '73 was at VA. The first thing out of my mouth when I got home was, "no matter what do not let me be put in a VA hospital."

As a kid I knew VA was where one went when there was no where else to go.

A keen memory was when I was 14. My dad had a masonry company and every summer from 12 I was a mason's laboror. A guy that worked for my dad was Turk Turkovich. He was the youngest of six sons and he lived in the basement of his mother's home with the understanding when she died he'd inherit it. One morning we picked Turk up. He came out of the house in cleaned and pressed work clothes and a brand new pair of work boots. He carried a big grocery bag like a giant sack lunch and got in the truck.

We drove north out of Akron towards Cleveland, where most of our jobs were and continued into Cleveland, went East on Lake Shore Drive. It was a quiet drive and nobody talked. I was curious, but we were eating up the work clock, so I kept quiet wondering where we were going. We got off the Drive at what was Wade Park VA (now Carl B. Stokes VA). We turned into the long driveway, lots on either side, up to the circular drop off and stopped, and Turk got out. "Bye", says Turk. "See ya", says my dad. Turk closed the door and the old man pulls out.

About half way back down the drive, passing turn ins for parking, I ask my dad, "don't we need to wait for Turk?"
He said, "Turks not coming home."

Many years later, I lost my Cadillac health insurance because my manager managed to short my hours. Just before I was scheduled for a procedure.

My wife who gets her insurance though her retirement from CIA, recomended I go to VA. I adamantly refused. I heard too many stories, I'd seen 60 Minutes expose in '73.

She got the paper work, fills it out and tells me to sign.

There is no wining an argument, so I decided to shut up and let her see for herself.

Boy has VA changed. If you haven't tried VA since the nineties go again and see for your self. I've only had two primary care physicians and the the first one is still with VA, she now works with Women Vets.

Both doctors have advocated for me. They saved my life. Let me say it again: they saved my life. I've never waited more than a week or so for anything, 90% of the within a week. I've had a Rear Admiral surgeon call me at home after a surgery to be sure it went well.

Texas Va system is very highly rated in the VA system and the fact is, if you don't want to go to one in the Houston area, the one in Temple is great hospital. Or even get to a civilian hospital if the hospital has a connection to VA. And the VA system as a whole was rated #3 in the country for customer satisfaction, Only the Mayo Clinic and another system that escapes my mind were rated better.

Please consider it. I promise you, you will be pleasantly surprised.
jespah
 
  2  
Reply Sun 17 Mar, 2024 06:02 pm
@edgarblythe,
No prob. Hopefully this coming week my carrier will get their **** in gear.
0 Replies
 
jespah
 
  2  
Reply Sun 17 Mar, 2024 06:05 pm
@bobsal u1553115,
My dad gets his hearing aids through the VA. It's something ridiculously low, like 10% of retail...?
edgarblythe
 
  2  
Reply Sun 17 Mar, 2024 06:44 pm
@bobsal u1553115,
Not planning to go to a doctor. Haven't done so since the nineties. Not signing up.
0 Replies
 
bobsal u1553115
 
  1  
Reply Mon 18 Mar, 2024 05:34 pm
@jespah,
I got mine for zip. Get glasses every year.

More importantly: they kept me alive.
0 Replies
 
 

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