:Insurance & Employer - Chelle

[Guest guest]

Oh I definitely agree with you Chelle – as with

anything, you don’t know if you don’t try. It is just so

frustrating that there are so many variables, and we as the consumer have to fight

for what is rightfully ours. It has always been the squeaky wheel and I don’t

think that will ever change. Sometimes it works and sometimes it doesn’t.

But when it comes to insurance, at the cost of medical treatment, it is

certainly worth it to fight for everything. And by fight, I just mean stand up

for what is rightfully yours in a polite, non-confrontational way. And

naturally it always happens when you are the most vulnerable.

I don’t mean to get into a discussion of insurance

companies, but when I was finally approved for the surgery they approved the

hospital stay for only one night. I was in there five nights. My doctor’s

office said it would be OK, as they could prove it was medically necessary.

Until I know the bill is paid, I still won’t rest easy.

Another example – my husband’s boss (same

insurance company) went in for open heart surgery. I don’t know the whole

story, but the insurance company has a prescribed amount of days that they

would allow for this procedure. So he had to leave after the documented amount

of days even though his incision was still bleeding - but not bleeding enough

that the doctor could prove it was medically necessary. He ended up hemorrhaging,

and going back to the hospital for another fifteen days. If they had let him

stay originally, it might not have happened.

After my surgery, there was a danger of infection and hemorrhaging.

That is why my doctor insisted (as he does for all his patients) that I stay in

a hotel within 3 miles of the hospital for seven days following surgery. We

lived ninety minutes away, but that was not close enough if I needed to go to

the ER. In this case it was an inconvenience for me, but I agree it was not

medically necessary for me to stay in the hospital. And who would want to - LOL!!!

Until this happened to me, I thought my insurance company

was the best – I would always brag about them. There is nothing that they

deny me for. They pay all my PT appointments (with no limit), my TENS unit

($750) - plus the monthly supplies which ran about $35, and all my compounding prescriptions.

So, please excuse my ramble, but I did learn a lot from this

experience and I am better prepared on how to deal with it if it comes up in

the future. (I sure hope not!)

nne

nne, you bring up some good points...all I know is that in my

situations we got the Human Resources with the Employer involved and as you

read in my last post, we got things taken care of. I'm sure that there

'are' a lot of variables, and it may not work everytime...but I say TRY!

It's like everything else, we won't know if we don't try. Maybe some

companies like it better when they choose a plan and allow the Insurance to

make decisions....but my husband's previous employer was pretty good at working

with us...as a matter of fact, the previous employer's head of HR was so well

suited for her job. I think it was good though that the woman from your

doc's office would not give up...I'm telling you, that was answered prayers for

sure! *grin* ~Chelle