LINDON, UTAH -- As most, I have one option for insurance through my work. Mine is Premera BCBS. What a joke. My wife is having severe knee problems. She went to see an Orthopedic Surgeon who knew immediately after examining her that she needed at least a scope. The day before that was scheduled, they called and said they wanted her to go to physical therapy for 6 weeks before they would authorize it. Reschedule number one. The doctor, thank God, took it upon himself to call them and explain that he knew that would not help. He did the surgery and explained to us that he was worried as she was now bone on bone in that joint and was worried she needed a replacement.
Sure enough, she has been down since then. She went back to see him and they immediately scheduled a surgery to replace her knee. 3 weeks later, again, the day before surgery, they are 'behind' and have not approved her surgery. This means another 2 week delay of her being in bed because she cannot walk as well as rescheduling everything like time off, baby sitters, etc, that we had arranged.
I someday dream of being in a job where I can see a bid from them and being able to tell them to jump in a lake. The amount my employer and I pay them, I am dumbfounded that they have done this to us twice now. I so wish this was their decision maker lying in bed because they cannot walk.
SEATTLE, WASHINGTON -- I just recently had my braces removed. It was tough having them as an adult, but when I was a kid, even though I needed them, we couldn't afford them. As an adult, working a good job, making decent money, I was able to afford them. My dental insurance was through Premera Blue Cross. The insurance plan for the company I worked for had an orthodontics benefit with a maximum of $1500 paid out. The way it worked for insurance was there was an initial fee of $250 from the orthodontist for when the braces were put on my teeth, followed by a $50 charge each month for an adjustment.
The $250 initial charge was covered by insurance no problem. The first $50 monthly charge was also covered, no problem. Then the second month, I received a statement saying the $50 charge had been denied due to me reaching the maximum benefit amount. In what world does 250 + 50 = 1500? I called them and they apologized, and corrected the error.
Two months later, the charge was again denied for the same reason. Once again I called them and they apologized and fixed it. The next month, again denied, same reason. This happened every couple of months over the course of two years. About every other month on average, they'd deny the claim saying I'd reached my maximum benefit and each time I'd have to call them to correct the issue. Each time the person I talked to would say the same thing "I don't know why it denied your claim. We'll fix it." But obviously they weren't fixing the root problem.
Now to me, this doesn't seem like a mistake. Once or twice would be a mistake. This seems more like a policy. Why would they do such a thing? I don't know. My guess would be that a certain percentage of people simply pay the bill rather than call the insurance company and argue with them about it. If that's the case, then this would clearly be a case of fraud.
Or maybe their system is just so screwy that they can't add simple numbers like 250 and 50. Admittedly this could have been much worse with them completely refusing to pay the claim even after I called. But still, I know most insurance companies are reluctant to pay out. After all, they're not a charitable organization; profit is their primary goal. The repeated denials just make me very suspicious of the way this company does business.
MOUNTLAKE TERRACE, WASHINGTON -- I have been taking several medications for years. One of which is an injection that must be refrigerated, no big deal. I have been getting it for over 30 years at a retail pharmacy (I get some through the mail order - but it's a pain in the butt and customer service is non-existent). I was recently put on another injectable med (enbrel) and was told I have to get it through a 'specialty pharmacy' because it is an injection and must be refrigerated. (Funny, that sounds just like my other medication!) Shelf life of enbrel is over 3 years, no other strange dealings with it.
Then to top it off, I have to be at the specified address (all day) to receive it and I only get a 30 day supply and I have to deal with these pain in the ass telephone calls from the specialty pharmacy in order to re-order the med! What moron thought this process up? All of my meds are 3 month supply because I travel quite a bit (internationally too), but not this one. Someone at Premera is getting a big kickback for this! Customer service? Gone! Care about the patient's well-being? Poof - gone!
I am not at all in support of Obamacare, but it's stupid things like this that piss people off enough that the idiots in dc think they know better and should butt in. Wise up Premera, you really stink at giving your customers warm fuzzy feelings, you are part of a problem that should not be this bad (yes, our health system is broken - but do you have to be the poster child for what's broken in the insurance industry?) And, your new non-grandfathered (because of the 'health care affordability act') plans really really really sucks. It's slightly less expensive on premiums, but will drive you into bankruptcy if you have to use them!
If you are looking for individual, small business, or larger business plans; look elsewhere! Premera of Washington and Alaska isn't worth the time it takes to bring up their broken website.
SEATTLE, WASHINGTON -- Who do you complain to when you have a problem with your insurance company? I have been on the same anti-depressant for several years. PBC has covered my prescription. But it was so expensive through them that a drug representative friend helped me out for over a year so that I wouldn't end up in debt. After my stash ran out, I tried to refill my prescription but the insurance company told me that I needed Pre-Authorization from my doctor before they would fill it. So, no prescription. My doctor filled out the form last week.
PBC keeps saying they never got it and that my doctor hasn't sent it in. My doctor said that they are strong-arming us so that she will go with a cheaper drug. But this one is working. Now I find myself in withdrawal - sweaty, shaky, dizzy, nauseous, and PBC doesn't care. Would they prefer that I end up in the emergency room? Especially when I find myself zoning out while driving?
Or, should I find some other drugs to make myself feel better? And then they would have to pay for the long-term health problems associated with that? But, no, they won't help pay for my prescription but prefer to pay thousands more for other things. They are so stupid.