I am sick of my health insurance .....

[Mskanga]

Not only they gave us the wrong information months ago as to where to submit a pre-determination, but also lost it 6 times after that, in the mail and via fax.
How can they lose so many ? I don't know.
But now that they finally got the one that I faxed to them, now they want the pre-determination in the form of letter from the doctor. I don't have a problem with that, I have a problem that now they are extending that wait time by another 30 days for them to make a decision!!!
I called them before we started this whole process to find out exactly how , what and where we should send everything since I live in a different state that the insurance is out of, and still they gave me the wrong information. Why can't they get their act together and do things right?
So I guess I have no other option but to wait another month. Nice to have insurance and be at their mercy to have something done!

 

[LindaG4458]

I can sympathize with you on this. We have been having trouble with ours covering obvious things. For instance, DH had a hearing test. He is retired,.They refused to pay for it because he might have workman's comp available to cover it! Several phone calls later it was fixed, but it is a pain to have to babysit them and every little thing.

The whole purpose is to avoid paying as long as possible. Maybe they think that, if you have to wait long enough, you'll decide not to have the treatment.

Anyway, best of luck dealing with them. I hope it gets resolved soon.

 

[OhMari]

I hate insurance companies too. It is almost like you have to know everything.

I took my 16 year old son for his 2 yr sports physical. It got sent to our insurance company as a 13-18 year physical.

The insurance refused to pay, cause they only pay up to 3 year old for well-being physicals. The insurance told me to call the clinic and have them recode it for an adult physical. When I called, she said she didn't have any other codes then the ones they used for 13-18 year olds. Grrrr.

I think insurance companies find ways not to pay. I was suppose to take him to a internest or a general practioner and they would of given him an adult physical. A general practioner is not going to change their codes either for any one under 18.

I don't get it, the medical field consideres you an adult at 18, but the my insurance company says you are an adult after 3 and you don't need no more physicals.

 

[Mskanga]

Mari , I got a better one for you. According to the insurance carrier, my kids are covered for yearly vision exams to the age of 17 but nobody can tell me if adults are covered at all even if we go to their in networkk providers until they get the bill. Say what? How am I supposed to know what is covered and what is not?
Anyway, I just got word yesterday, they placed a high priority on dd's pre-determination and I should know the decision within a week.
They actually have a letter from the doctor now that states , if the procedure is not done, it will cause a speech impediment in the future, I hope they can make up their minds soon.

 

[Microcell]

I work for an Ophthomologist. What insurance do you have if you don't mind telling the world, or PM me and I will tell you what I know about it. Usually you have to talk directly to your insurance about it, but I will tell you I have never heard of a vision plan that was not the same for the entire family- it is an "ageless" kind of thing.

I also want to point out that most insurance plans have Vision plans- the most common is Vision Service Plan. Anyway, these plans that usually talk about 5 dollars off a 60 dollar exam are more for going to an Optometrist, who is not an MD. With an Ophtholomologist usually they do not participate in these plans. You may find a new doctor on it who is trying to drum up business.

BUT it can be filed medically with an Ophthomologist- if the doctor you see is provider with your insurance plan, and you have a medical diagnosis such as Diabetes, strong family history of Glaucoma, cataracts, and sometimes dry eye syndrome, acute allergies. Then it would be treated as a medical exam. Anything other than just plain old near or far sightedness. I am my offices insurance processer so I know well what usually pays and what does not.

 

[Mskanga]

Microcell, the doctor who did the eye test is in their network, once the claim is submitted we will know what they pay.
Either way it goes, wether they pay or not , the fee is reduced to their negotiated rate and I had to have it done anyway, so we will see. But thank you anyway.