Health care horror stories

December 8, 2009Jon Brooks Comments Off

A few months ago we did a series called Health Care Horror Stories. Back then, the House had yet to pass its health care bill and the Senate bill wasn’t even out of committee. The process is much further along now, but considering that the Senate still has to pass its bill (which it’s currently debating), and that the two chambers will then have to reconcile the differences between the two pieces of legislation and send that meshed bill back to their respective bodies for one more vote each, there is still a long way to go.

So it might be a good time to take another look healthcareimage8 at some of the more egregious experiences of those who have been ensnared in our less-than-perfect system of health insurance. In researching these, it’s not necessarily the anger, frustration, and total incredulity of the people effected that make the biggest impression, but the sheer number stories in which dire circumstances have prompted a need to vent in public.

These extracts have been edited for spelling, grammar, and length. Since obviously none of these stories can be verified, the names of the insurance companies have been omitted. But a list of sites from which they were taken can be found at the end of the text.

I was 7 months pregnant and my doctor felt the need to take me off of work due to pressure and pelvic that showed signs of pre-term labor. Well I called my insurance company, which I pay monthly through my benefits for a supplemental disability, and then the company harasses my doctor, wanting to speak to him personally because they wanted more information than what he submitted on the form. Then they tell me that my claim was denied because the company felt there was no need for me to be out of work that early. So a pregnant woman showing signs of preterm labor isn’t a good enough reason to be off of work. But my state disability didn’t have any problem with it.
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I’m a former employee of a health insurance company. Regarding customer service, the employees that take your calls receive only one week of training. They are forced to answer the calls as quickly as possible. They are told to say whatever they have to to get you off the phone and take the next call. When they inform you that they will “get back toyou ” it;s crap. You will never receive a call back. They are not even given the time to research the problem to get an answer for you. Our billing department has about a 30-day backup–meaning you send in your payment and it doesn’t post for another 25 days. When you’re in danger of being termed for non-pay, chances are it’s our fault. When you are told that we have a “5 business day turn-around” thats also a crock. When you fax, or send in something, it will be lost. If there is a piece of information missing from the form you send in, someone will shred it so they don’t have to follow up with you.
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I applied for disability on January 10. I have small cell lung cancer and can’t work. My insurance company has not responded to my claim yet and I haven’t received a single payment. I had to cancel two doctor appointments because I don’t have the money to pay. It is now February 18 and I have an appointment with my oncologist on March 6. If I don’t receive a payment by then I’ll have to cancel that appointment also. I am supposed to get another CT scan on the 6th to see if my tumor has shrunk . I also have brain radiation appointments that I can’t keep. Without my disability, I can not go to the doctors. What is going on here? I can’t even get the company to return my calls.
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Tried to use my disability claim after a horrible life-altering accident. After a mere 3 months of disability, I receive notice that I am dropped from my medical, disability and life insurance policies. They did not receive paper work on time from my MD, so adios to me! They will not even take calls from me or the doctor. Their words: “The case is closed” I hope they try saying this to the state insurance comissioner.
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My sister nearly had a nervous breakdown and her doctor has sent in medical notes numerous times, but the insurance company as no record. She has not received a disability check since the beginning of January and it is now May. Her case manager has been changed numerous times without notice. She can’t get her meds on a regular basis and suffers from severe depression. She needs her disability pay in order to get proper treatment.
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I have been waiting for almost 6 weeks for approval. My case worker never returns my calls. When I call her and ask when they will have a decision she says in a few days or by Friday and she still never calls back.
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I have paid for long term disability for 7 years. I had a back operation and
the normal recovery time for the procedure is 3 to 6 months. The insurance company thought I should have been back to work in 2 weeks. This is totally insane. I have as yet not been paid and am at the end of my rope as I have lost the job I had. I have filed an appeal, but have gotten a royal run around. I don’t know what to do next .Please help! My doctor would not OK me to return to work for 3 months.
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I have student health insurance through the University of Kentucky. In theory, it is a wonderful plan . . . 100% of patient expenses are covered (no deductible) for services at UK Hospital and UK Clinic. In practice, it is quite different. Things were going all right until I had a baby. Faced with a relatively large bill (though I had a natural, uncomplicated childbirth and the baby was born within 1 1/2 hours of my arriving at the hospital), the insurer looked for any possible way to get me to pay it for them.

They started by cancelling my health insurance, claiming I wasn’t a student. I was. I was perfectly eligible. You’d think that if there was some question as to my eligibility, they would contact me to clear that up. Nope. No letter notifying me that my insurance had been cancelled. No refund check in the mail. Nothing. Just a bunch of medical bills suddenly flooding my mailbox. Suddenly and quite inexplicably, I was uninsured. They cancelled my policy in January of 2009. I realized that it had been cancelled a month later (because of the medical bills and because I had to pay out of pocket at the pharmacy). It took me several MONTHS worth of phone calls (and if they ever tell you they will call you back about something, don’t believe it . . . they never do) to figure out why my insurance was cancelled. During that period they extended the cancellation all the way back to August, retroactively, leaving me with even more medical bills. “Our records indicate that you were not a student during the fall semester.”

It wasn’t enough for the company that I provide a transcript proving that I had been a student the previous semester. Instead, I had to contact each and every one of my professors and have them submit letters stating that, not only had I been in their classes, but I had attended for at least the first 30 days. You would think that my 4.0 GPA would have been enough for them. Apparently not.

From the time all the letters and other documents were finally in, it took them over a month to finally reinstate my insurance. No apology or explanation for the 4-5 month long headache they had caused me. And now, eight months after this debacle began, they still haven’t notified the pharmacy that I am insured, so I’m still paying out of pocket for my prescriptions (and still haven’t been refunded for past prescription purchases). They told me the other day that there are a few more forms I need to fill out to get that taken care of.

Since they have reinstated my insurance, the company has had to come up with new, more creative ways of robbing me and my family. They ended my husband’s insurance three months early, claiming that he had only paid for nine months (rather than a year). We have the bank statements to prove otherwise. They have refused payment on every one of my son’s appointments. Initially they claimed that it was because he has other insurance . . . he does not. We filled out forms and got that taken care of. Now they keep adding in additional charges for the deductible, though their brochure clearly states that the deductible is waived for all services performed at UK hospital and clinic. Two customer service reps lied to me about that. Finally, I located it in the brochure and they owned up.

I could go on and on. I wasted so many hours of my life on the phone with these people. I am a very positive, trusting person. I look for the good in people. This has been a disillusioning experience. It would appear that the company coaches their employees to deny coverage and cause problems for customers. Their behavior is dishonest, unethical, and altogether abhorrent. Dealing with them has been far more stressful than pregnancy, childbirth, motherhood, or any of the illnesses (including a kidney infection that had me hospitalized) for which we are seeking payment.

At this point, we are still trying to get them to pay us back for bills that we paid but were not in fact liable for. We are seriously considering filing a bad faith claim against them. This company should be shut down.

Cited sites:

More health care horror stories in this section.

Posted on December 8, 2009 at 1:22 am
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