RE: Insurance Company

[Guest guest]

Darcy,

I don’t think any of your 5 options as you have them laid out

are good. But, Cleveland Clinic does have a good reputation in many area

(Sometimes going even par with even Mayo) so is it possible that you had an

isolated poor experience or that you can get the care you deserve from them by

having candid/productive/civil discussions with them? If that is not

productive, then maybe a meeting with a department head or higher would give

you some results.

I agree with the others that lying shouldn’t be an option. If you get caught

doing this it might spell a lot of trouble for you getting a claim through for

a transplant in the future and may get you labeled as being an uncooperative

patient.

Rick

From:

[mailto: ] On Behalf

Of dmelzer514

Sent: Saturday, March 14, 2009 10:34 AM

To:

Subject: Insurance Company

I found out yesterday that my insurance company

will not cover the referral to Pittsburgh my dr set up. They called to tell me

if I wanted to go to Pittsburgh it would cost me an $8,000 out of network

deductible plus all the charges above their usual, customary and reasonable

charges. Those lovely charges would not go toward the deductible and I would be

responsible for them throughout treatment.

They then said I have to go to the Cleveland Clinic and if I go to Cleveland

they will consider it in the network and it will be free. My dr's office argued

with them and I argued with them and got nowhere. There is not a transplant

hospital in my insurance network but apparently they have negotiated something

with Cleveland.

So now I have to choose:

1. Give up vacations and sporting events and all the fun things in life so that

I will have the money to go to Pittsburgh - and most likely still end up with

money trouble.

2. Agree to go like a lamb to the slaughter and return to the Cleveland Clinic

where I am certain I would die if I had to have major surgery. That place is a

horrible hell hole of incompetence and arrogance.

3. Make my local dr. mad and just ignore his request to go to a transplant

hospital completely. This is the one I'm leaning toward. I would let there

office set everything up and then just cancel it so they would think I went. I

might be able to pull this off because Cleveland doesn't like to waste their

time with the little community dr's so they won't keep him updated.

4. Quit my job so that I can get on my husband's insurance. I can't be on his

insurance if I work 32 hours a week outside the home for a company that has

health insurance. Obviously quitting is a very bad plan in this economy.

5. Have the owners at work lie for me (which they would do in a heartbeat. The

one lied for me all the time when I wanted to skip tests in grad school to go

to concerts - he wrote letters for my prof's that I was going to be out of town

on business). Have them tell my husband's employer I've had my hours cut and no

longer qualify for insurance. I just can't get caught working full time or I

would have to repay all the claims.

None of these scenarios seem good. I do not feel safe going back to Cleveland.

I completely understand the possible ramifications of not going but I think my

odds are better with no treatment then being treated by the Cleveland Clinic. I

am certain that hospital would kill me, torment me and drive me crazy in the

process.

Has anyone ever won one of these battles with an insurance company? Did you

just give in and go to a bad hospital or end up spending every dime you had on

medical care?

Thanks,

Darcy