lexie3131
01-29-2004, 01:32 AM
Hey everbody!!! It all started at 3:30pm. I have been in tears for the last 9 hours. My head, neck, and spinal cord are really hurting right now. Crying always makes me hurt worse. Well, let me tell you what happened. I got a call from my surgeon's nurse at 3:30pm saying the Hospital I normal use does not take my insurance anymore...even though I pre-admitted yesterday. She said they were showing me as having an insurance that is "open access plus" (meaning a limited group of Doctors and hospitals) versus the PPO I had which was almost any doctor or hospital. I told her that was impossible because I had it in writing on my personalized benefit fact sheet. I was in a panic trying to reach my insurance company and when I finally did their computers were down!!!! So then I called my supervisor at work. I was hysterical because I had to get back to the nurse before 4:30pm. He told me I had to contact our Employee Benefits Dept in KS. Well, I finally got ahold of them...to my surprise they said that I did change from a PPO to Open Access type insurance. They told me if I wanted to have the surgery I would have to pay 40% of the surgery. I told them they were crazy. I brought their attention to what I had in writing and read to them verbatim what was enclosed in my materials. She then pointed out in their little book they sent me one small sentence that read of a change to open access for all employees except for the KS area. (where they are located, isn't that convienient). I told them they were being deceptive and dishonest. I even told them I was going to have my attorney look over my information and would be contacting them (which I really am doing). So I had to cancel the surgery until I could get this straightened out. I'm sorry to ramble on...but I am so upset about all of this. I found out from the hospital that several other people came in not knowing of the change. My own supervisor did not know it either. When looking through the materials it's almost like they were trying to hide it. Even two people I talked to before the supervisor admitted they made an error on my fact sheet...which is what we use to verify our benefits. Then the supervisor gave me 3 different excuses. I was not a very happy person. I told her "the company I work for" would be responsible for any damage to my body. Whew.....thanks for listening!!! I have a lot of phone calls to make tomorrow. I will let you know something. THANKS FOR YOUR THOUGHTS. >>Irish, I was glad to see your post. I was getting worried about you. Hope all is well.
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sadieho
01-29-2004, 09:18 AM
I am so sorry for you! Am I the only one who KNOWS who runs this world???Insurance companies do!! Get your lawyer & I pray you have good results.
Sadie
Sadie
lexie3131
01-29-2004, 09:38 AM
Thanks Sadie. I agree with you on Insurance companies. Surprisingly in this case it is big business. The company I work for is who did the switch-a-roo. I spoke to my insurance company this AM. They said there have been a lot of complaints from my co-workers. And the hospital I was suppose to go to said the same thing. Our home office is based out of KS and they changed everbody but their insurance to a less desirable coverage. And they did it in such a way to cover themselves but so we wouldn't notice. I am going to consult a family friend who is a lawyer for insurance and employee benefit rights to see if there is anything I can do for me and my co-workers. It's just not right!!
I am so sorry for you! Am I the only one who KNOWS who runs this world???Insurance companies do!! Get your lawyer & I pray you have good results.
Sadie
I am so sorry for you! Am I the only one who KNOWS who runs this world???Insurance companies do!! Get your lawyer & I pray you have good results.
Sadie
irish34
01-29-2004, 10:15 AM
Lexie--
That is horrible! You just wanted me to go first, didn't you?!? Just kidding. I really hope that everything works out for you. I know with our insurance, the company is able to switch our insurance at ANY time...they have a little blurp on our sheets that you get at the VERY beginning of signing up that reads, 'we reserve the rights to make any insurance changes at any time' basically. AND they don't have to tell you since it's their right. Kinda shady huh? That is one thing I am grateful for with mine, I don't have to worry about insurance since it's covered by Work Comp...but they stopped paying me my wages. So, one aspect is good; the other BAD. It's always a no win situation for us little people in the world, competing against the large companies.
Are you able to still have the surgery covered if you use a different surgeon, or a different hospital? I know many doctors around here (WI) have operating privileges at a number of local hospitals.
Well, I wish you Luck of the Irish....please stay around for the next couple days if possible. I need my surgery buddy to talk to. I am getting nervous today...it's just around the corner.
Take Care!
That is horrible! You just wanted me to go first, didn't you?!? Just kidding. I really hope that everything works out for you. I know with our insurance, the company is able to switch our insurance at ANY time...they have a little blurp on our sheets that you get at the VERY beginning of signing up that reads, 'we reserve the rights to make any insurance changes at any time' basically. AND they don't have to tell you since it's their right. Kinda shady huh? That is one thing I am grateful for with mine, I don't have to worry about insurance since it's covered by Work Comp...but they stopped paying me my wages. So, one aspect is good; the other BAD. It's always a no win situation for us little people in the world, competing against the large companies.
Are you able to still have the surgery covered if you use a different surgeon, or a different hospital? I know many doctors around here (WI) have operating privileges at a number of local hospitals.
Well, I wish you Luck of the Irish....please stay around for the next couple days if possible. I need my surgery buddy to talk to. I am getting nervous today...it's just around the corner.
Take Care!
Deb F
01-29-2004, 08:19 PM
Lexie -
Really frustrating! Insurance - cant live with it (afford or understand it) and surely can't be without it. Get good solid answers before proceeding, preferably in writing. What about a pre-determination of benefits that is good for a certain length of time? (every policy is different) Good luck to you.
Thanks for your sentiments about my situation too!!
Deb
Really frustrating! Insurance - cant live with it (afford or understand it) and surely can't be without it. Get good solid answers before proceeding, preferably in writing. What about a pre-determination of benefits that is good for a certain length of time? (every policy is different) Good luck to you.
Thanks for your sentiments about my situation too!!
Deb

