Insurance companies deciding which healthcare services are essential

https://catchafallingstarbook.wordpress.com/2015/05/28/pirates-sell-insurance-as-an-act-of-evil/comment-page-1/#comment-1347

I am practically bankrupted by five ER visits in the last four years. Only one of those was mine. Health insurance does not approve ER costs for a whole list of health problems…

Aetna… er, I mean Faetna, decided that we could only use doctors that were associated with the same hospital where we visited the ER. Well, I asked them to give me names of the doctors who qualified. I got three names. I made an appointment. We were filling out the paperwork in the doctor’s office twenty minutes before seeing the doctor. The receptionist interrupted after I had half-way finished the mountainous paperwork to tell me the insurance had rejected payment. This doctor that THEY had recommended to me was not a part of the approved network. They took Faetna insurance, but Faetna refused to pay. The same day I called the other doctors on the list. No doctor recommended to me by the insurance company was part of the required plan. There were no doctors in the city who did qualify…

Okay. It can’t get worse. We still had the therapist who was working miracles for my son. He took Faetna insurance. There was no problem there, right? But wait. The pirate captains of Faetna took another look. They started rejecting his claims too. Soon there was a huge yellow envelope full of demands for clinical records to justify the need for the therapist. I went to the ER, to the wonderful doctor, to the hospital in Denton where they were still taking my money away from me, and to the therapist himself. We gathered documents. The lovely hospital charged me $50 for paperwork and made me drive all the way there to Denton twice to accomplish it. I got all the materials compiled, overnighted them to the insurance company’s disapproval department, and everything should’ve been fine. But. of course, it wasn’t. The claims for services were denied. I am expected to pay out of pocket. They found no clinical evidence that the services were essential and they insisted I pay the bills without help from them…

Under comments:

authormbeyer
May 28, 2015 at 8:44 pm
Am I a great satirist or what? As soon as I posted this post I received an email that the Pirates of Faetna… er, Aetna? were so ashamed they reversed their decision about the therapist and agreed to pay for continued visits. Of course, the therapist called them yesterday and made the case himself. Maybe that helped.

silentlyheardonce
May 29, 2015 at 3:25 pm
I’ve heard horror stories from Aetna. But it’s insurance itself. I use to get extra help to pay for my medications. I got extra help for 4 years. This year they say I make too much money on SS to get extra help. In a month or so I’m going to tumble in the donut hole. I’m making sure life insurance premiums are paid up so my family can drop me in the ground. It is f’ed up.

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