Guest guest Posted March 28, 2003 Report Share Posted March 28, 2003 Well, I've got a couple of insurance issues going on. First, I have appealed a denial for breast reduction all the way to Independent External Review. The way it works in NJ, after sending in the package, it gets checked for completeness, then goes to a preliminary review to see if it's even accepted for the Independent Review. Well, 5 very long weeks later, I finally got the letter that it's been accepted for review. They now have 30 business days to respond. BTW, there's a government website that lists all the ins. cos. in the state and ratio of decision reversals to upheld decisions, and it's close to 50/50, so we'll see. Second, back in Oct. 2002, I filed a complaint with the State against my ins. co. (who shall remain nameless for now in case of spies ) for a couple of things, including applying a supposedly covered Dexascan to my deductible, but also coming up with a second $1000 deductible...they call it an in-network ded. and an out-of-network ded. (I have a PPO). The customer service reps & supervisors all have different stories about if this even exists, too. IOW, half say no, there's only one $1000 ded., the other half say there's an in & out (2 $1000 ded.). So, I had no choice but to file a complaint & let the State handle it. Anyway, I was reimbursed for the Dexascan, but the deductible issue was never addressed. After going back & forth with the Investigator on my case, and trying to get him to understand, I finally read off my notes of all phone calls to my ins. co. (he has a copy) stating every call, date, person I spoke to, time of call and subject of call, and there it was...once my original ded. was satisfied, all of a sudden a new ded. kicked in. The investigator was floored, and he told me about another complaint with same ins. co. with a similar issue, but the lady didn't have proof. He then told me that this has to go before the Board, and said that I may have single-handedly just started something really huge. My words to him... " Go for it, Babe! " So, I have no idea how long this will take, or even if anything will come of it, but right now, I feel like that guy in the movie who exposed the lying tobacco companies...LOL So, this should be interesting. Bottom line...document every call, every date, every person, every damned time you call your Insurance company, whether you've had problems with them or not...they are NOT looking out for your best interests, and you just never know. in NJ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 28, 2003 Report Share Posted March 28, 2003 Well, I've got a couple of insurance issues going on. First, I have appealed a denial for breast reduction all the way to Independent External Review. The way it works in NJ, after sending in the package, it gets checked for completeness, then goes to a preliminary review to see if it's even accepted for the Independent Review. Well, 5 very long weeks later, I finally got the letter that it's been accepted for review. They now have 30 business days to respond. BTW, there's a government website that lists all the ins. cos. in the state and ratio of decision reversals to upheld decisions, and it's close to 50/50, so we'll see. Second, back in Oct. 2002, I filed a complaint with the State against my ins. co. (who shall remain nameless for now in case of spies ) for a couple of things, including applying a supposedly covered Dexascan to my deductible, but also coming up with a second $1000 deductible...they call it an in-network ded. and an out-of-network ded. (I have a PPO). The customer service reps & supervisors all have different stories about if this even exists, too. IOW, half say no, there's only one $1000 ded., the other half say there's an in & out (2 $1000 ded.). So, I had no choice but to file a complaint & let the State handle it. Anyway, I was reimbursed for the Dexascan, but the deductible issue was never addressed. After going back & forth with the Investigator on my case, and trying to get him to understand, I finally read off my notes of all phone calls to my ins. co. (he has a copy) stating every call, date, person I spoke to, time of call and subject of call, and there it was...once my original ded. was satisfied, all of a sudden a new ded. kicked in. The investigator was floored, and he told me about another complaint with same ins. co. with a similar issue, but the lady didn't have proof. He then told me that this has to go before the Board, and said that I may have single-handedly just started something really huge. My words to him... " Go for it, Babe! " So, I have no idea how long this will take, or even if anything will come of it, but right now, I feel like that guy in the movie who exposed the lying tobacco companies...LOL So, this should be interesting. Bottom line...document every call, every date, every person, every damned time you call your Insurance company, whether you've had problems with them or not...they are NOT looking out for your best interests, and you just never know. in NJ Quote Link to comment Share on other sites More sharing options...
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