[IP] Re: I hate insurance companies
At 02:25 PM 2/5/2010, email @ redacted wrote:
>Hi RoseLea and others,
>
>My company just switched us to BCBS of KS I think it is (the company
>is in MO, I live in PA! Go figure!)
>
>Anyway...I've always heard terrible things about BCBS in general (my
>Mom and Dad are on BCBS) and it's just started with me! They are
>denying my Accu-chek strips as well for quantity. My doc has to "pre-
>auth" the amount (I should be getting around 900 per 90 days as you
>mentioned) and faxing back-and-forth forms, etc. You'd think that if
>the doc wrote the script a certain way, that would mean he authorizes
>it to be filled that way! Ugh! That would be too logical and
>efficient I guess? :-\
>
>So, we'll see how this goes. I haven't yet seen what they are going
>to do about my MM pump supplies - tubing and sensors. I can only
>pray that they don't hold that stuff up too! I've had lots of
>insurance companies over the years (company changes, job changes) and
>this is the first time I've run into this, so I guess I should count
>myself lucky.
>
>Good luck to you! JJ
Good luck to you too, JJ. Another trick they're doing that I find
real interesting is paying my claim for insulin with additional
co-pay for me saying that the pharmacy is non-participating. I don't
have any prescription coverage with my insurance, but due to
Michigan's Diabetes Cost Reduction Act, my insulin is covered in my
contract as a "diabetes supply". That makes it subject to my
deductible and co-pay. However, I've called the help idiots about
this numerous times and they always assure me that the pharmacy is
participating in network, their webpage lookup states the pharmacy is
participating in network and the pharmacy tells me that "yes" they
are participating with BCBS of MI. So when I ask them why on my EOB
they say the pharmacy is non participating and they charge me an
additional out of network co-pay, they can't answer. I hear them
shrug their shoulders while they say, "I don't know." That's as far
as it goes. I haven't submitted these claims to appeals yet, but
plan to do so soon. My pharmacy which was a satellite attached to a
major hospital in my area has recently closed because they say they
didn't get enough prescriptions to cover the cost of the
location. So, they've transferred all my prescriptions and
information over to the local Walgreens. I went to Walgreens today
and filled my prescription. The receipt will go to BC tomorrow in
the mail. I'm waiting for them to tell me on my EOB statement that
Walgreens is non-participating. Then heads will fly!
Surprisingly they've paid for my pump supplies so far with no
questions, except for the time Animas kept billing me telling me the
insurance hadn't paid them. The insurance said they did pay
them. Animas said, no they never received anything from the
insurance. This went on for months until I finally got an insurance
help idiot (who in this case wasn't as much an idiot after all) on
the phone and he sheepishly admitted that they processed the claim
and issued a payment but they had never sent it. Yep. Never sent
the payment even though the claim had been processed
correctly. That's getting more and more common too.
Interestingly, a friend of mine used to work for BCBS of MI. She
recently retired after taking a buyout. She said that she had no
choice, it was take the buyout or get laid off. She had worked for
them for more than 30 years. Thing is, they got rid of all their
more intelligent/experienced higher paid employees and filled those
spots with low paid not so intelligent/experienced people. Hence I
think that's where are all problems are coming from now. No one
there knows what they're doing or what they should be doing.
Always a battle, as even dealing with this disease/condition isn't
bad enough, the insurance company has to make matters worse.
RoseLea
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