Health Care is a joke

[antnee]

this is the only country where you pay for health care (very high dollars I might add) and you still can get the proper care or satisfaction you need. I am still fighting with Horizon about what they call "a Pre-existing injury" How can my wife have a pre-existing injury if she never went to any doctor for back or neck trouble. In my case yes 10 years ago, I saw chiropratic care for my back but that was 10 years and it is still called pre-existing???
Another problem I have is they ask you to fax a document and you do, but they never receive them. Just where do those faxes go. I verify the number 3 times before sending. I wonder if someone is just standing there recieving them and throwing them out

 

[AZKathy]

You mean health care insurance? Isn't Horizon an insurance company?

 

[Eeyore1954]

Antee -- I am so sorry you are experiencing this with one of the "Blues." I have coverage through BCBS of IL for over a year and so far, it's been wonderful. The drug co-pays can get to be a bit much sometimes, but I guess it's better than paying full price.

Today many health plans stretch the idea of "pre-existing" in order to avoid paying claims. It's a method of "managed care" (i.e., reducing their costs/expenses while increasing the patient's expenses/liability).

One thing you may want to point out: HIPAA (Health Insurance Portability and Accountability Act) of 1996 includes very specific limitations on what a health insurance can define/exclude as a "pre-existing condition." If Horizon continues to debate this point, you may need to contact your state insurance commissioner and request an investigation. It's very important to fight this (even though it can be frustrating and time-consuming) -- otherwise the insurer will continue to stretch this over and over.

As for faxes -- what you mentioned happens in our office frequently. There's a recycle bin under the fax machine and often faxes wind up in there. I usually fax something then immediately call and advise them I've faxed it, ask them to go check and verify that they have it in their hot little hands. Also, keep or get a verification of your fax (a report that shows the date, time, phone number faxed to, etc.).

 

[LGM]

Well I think the way it used to be was better it you were sick you called a doctor and they made an appt. for you they used pen and paper not computers that keep crashing. As for faxing I agree I have had the same trouble I finally kept a log the piece of paper you can print that says the fax went throug ok and started throwing that in there face and they seemed to have found the fax, Strange isn't it. We are susposed to have the best health care in the world yet it would be easier for me to walk into a hospital and see a doctor than get an appt. with a doctors office. I think we still have alot of work to do. I feel everyone is entitled to health care but this system we have now it not working properly---it definalty needs alot of work!!

 

[luvwinnie]

My pet peeve is that if we go out of network to a dr., we do get 80% back...but if he sends me for a test at an IN-NETWORK place, we are penalized and have to pay 20%! How is that legal? THey have a contract with this place? it should be the same as if my in network dr ordered the test.

 

[Mskanga]

I don't waste my time figuring them out anymore, I would be insane at the end, it took me 2 years for aetna to pay for my daughter's dental work , first they didn't have a pediatric dentist and they allowed me to go out of network, then they faxed the wrong fee schedule to the doctor , I found out 18 months later!! But I insisted, didn't let them off the hook and they paid!!!

 

[Tony-NJ]

on healthcare. A very soar subject with me.