You Know You’ve Joined a Cheap HMO When…

10. Your annual breast exam is conducted at Hooters. 9. Directions to your doctor’s office include, “Take a left when you enter the trailer park.” 8. The tongue depressors taste faintly of Fudgesicles. 7. The only proctologist in the plan is “Gus” from Roto-Rooter. 6. The only item listed under Preventive Care coverage is “An apple a day.” 5. Your “primary care physician” is wearing the pants you gave to Goodwill last month. 4. “The patient is responsible for 200% of out-of-network charges” is not a typo. 3.The only expense covered 100% is embalming. 2. Your Prozac comes in different colors with little “M”s on them. 1. Your ask for Viagra; you get a Popsicle stick and duct tape.

Originally Posted At: Coalition Against HMO & Insurance Abuse

I am now involved in a lawsuit with yet another Blue Cross. This one has denied payments for prescription drugs, doctor services, diagnostic tests, and for “durable medical equipment” DME, in this case a scooter to allow me to get around in spite of my severe Chronic Fatigue Syndrome (CFS).

When I first became disabled with CFS, I continued my insurance coverage with Guardian, under COBRA. They paid for all drugs prescribed, including one that was not approved by the FDA for marketing and had to be formulated by the pharmacist. (Components used to make it were FDA-approved as required by federal law.)

When the COBRA period ran out, I wound up joining another Blue Cross plan, a PPO. Not my first choice, but I was assured at the time that BC was a great plan in this area. (NOT!)

BC starting refusing to pay for prescription drugs right away. For one, they used a series of excuses, all lies, including that it was not a prescription drug, that it was a food additive, a food supplement, a vitamin, not a vitamin (!), and not in their formulary. For the one that had to be pharmacy formulated, they simply claimed that it was available OTC, which it was not.

As usual, when first contacted about this, they said “oh, you can’t just look at the benefits booklet. You need to look at the contract.” Unfortunately for them, we HAD the contract. After 4 times through their appeal land grievance system, nothing had changed. They still had not stated any reason for their denial of these drugs. Finally, after suit was filed, they declared that they had a “long-standing” medical policy about that drug and its coverage. They eventually showed it to us, under a strict confidentiality order. It was dated 1999 – 4 years AFTER their first denials of this drug. Longstanding indeed.

They also refused to pay for various diagnostic tests ordered by my various doctors. In explaining this when I appealed, they stated that “diagnostic services are not covered under your Plan.” There are 6 pages in the contract about coverage for diagnostic tests.

They also refused to pay for trigger point injections, stating initially that “Your plan does not provide for this SURGICAL service.” My doctor’s office called about this, and was instructed to resubmit it using a different code number. Vast improvement (NOT!): now it was “Your plan does not provide for this ANAESTHESIA service.” On appeal, they stated flatly that “therapeutic injections are not covered under your Plan.” The contract states, in black and white, that therapeutic injections are covered; no exceptions, exclusions, or need for pre-approval. BC repeated this lie a total of 3 times in writing, including once by an outside attorney after I filed a bad faith lawsuit.

When I started getting worse, and less able to walk, my doctor recommended an electric scooter for mobility. BC sent me to a “Independent Medical Examination” (IME). Their IME dr. did the tests prescribed by BC, and declared that “there is no reason why [I] should not receive” a scooter. The scooter company put the paperwork through, only to have it denied on the grounds that “the tests were all normal.” Looking at the tests in hindsight and with the benefit of seeing another of their secret medical policies, I can see what they did: they prescribed tests that if positive would bar me from getting a scooter, and if all were negative they could (and did) say “the tests are all negative” so he doesn’t need one. Heads I win, tails you lose.

When they tried to defend their actions in appeal, and later in the lawsuit, they quoted from this secret medical guideline. At least, they put quote marks around the stuff they were saying – but they left out a couple of important details that would have shifted me into the eligible category. They also, in another area, flat contradicted their own secret medical policy.

As for the lawsuit, they have defended vigorously. Four times (6 if you count reconsideration and certification for appeal requests) they have tried to have it thrown out because they claim they are exempt from state law. (The mere fact that their interpretation of the particular law they are claiming exemption under leads to logical contradictions is irrelevant; this isn’t logic after all, its a legal action.) They also started out saying “this is just a simple contract action…”, then later claimed that there is no contract action. They have also claimed that the magical incantation “as determined by the Plan” allows them absolute freedom in determining coverage. (The mere fact that many courts including federal Circuit courts, the US Supreme Court and many state Superior and Supreme courts have already ruled that this is not the case, somehow never quite makes it to their legal briefs, in spite of the legal ethics canon require “absolute candor (full disclosure) to the tribunal.”)

They have already succeeded in delaying trial twice. They have violated court orders – nothing new for BC, as I have seen a case where they agreed to settle if the suit was dropped, then refused to pay the settlement! They have also sought court orders to go through my attorney’s personal medical records, starting 4 years before I ever met him. (They later claimed that was a “mistake” – but somehow it never got corrected in court.)

Their most recent legal maneuver is to try to exclude all of our evidence. They are trying to get our expert witnesses excluded; get the court to order that we cannot reveal the secret medical policy to the jury (the original court confidentiality order explicitly says that it can be), seeks to exclude public documents available from the CDC and NIH, and even tries to throw out some of the letters between me and BC. They are also claiming that “cost containment” is not a policy they use – even though their own annual reports state that cost containment is the number one priority.

BTW, this BC had, in 1998, a record $220 million profit (oops, they are NON-profit, so they can’t have a profit – call it a “surplus” instead.) Immediately following that, they 1) requested a 30% rate increase, and 2) demanded 15%reimbursement reductions from all providers. Not surprisingly in this state, they got a rate increase – 10% – and some reductions, about 5%. Also not surprisingly, in 1999 they had another record profit (excuse me, _surplus_) of $250 million. They now have in excess of half a billion dollars sitting in various investments, not earmarked for any expenses. Gee, I wonder why medical costs are going up?

Originally Posted At: Coalition Against HMO & Insurance Abuse

When I was working for a small company, they purchased individual BC policies for us. These policies all had a $2000 pre-existing condition limitation for the first year. There were 3 of us who exceeded the $2000. One broke her foot 6 months after starting work. This was denied as a “pre-existing condition.” 

No amount of additional information or appeals or grievances would change that. Eventually, what did change it (15 months later) was that she had a secondary insurer through her husband’s employer, and they paid it. The secondary insurer then sent to Blue Cross a letter saying essentially “we have as many lawyers as you do, and will not only win this case but get punitive damages from it.”

The second instance was me – I tore a cartilage in my knee. The bill for surgery for this was split into 2 parts: one from the surgeon, another from the clinic where the surgery took place. The clinic (with attorney on retainer) was paid immediately. The surgeon was not because BC labeled the problem as “pre-existing condition: rheumatoid arthritis.” My doctor offered to send them the film of the surgery, showing quite clearly a large piece of cartilage floating around in the joint. BC didn’t want to see it, and would not change their denial. They continued to refuse to change the denial, until a letter from my surgeon’s attorney went out, threatening to not only sue, and for punitive damages, but to introduce a resolution into his chapter of the AMA calling on members to stop participating in Blue Cross plans. That got their attention – and they finally paid the bill – over a year after it was first submitted.

The third is the most ridiculous. A coworker’s newborn child was having breathing problems, and was taken by ambulance to the ER, and subsequently admitted to the neonatal ICU. The bills topped $30,000. BC refused to pay, on the grounds that “your contract does not provide for WELL-CHILD CARE.” As usual, appeals and grievances were futile. The hospital, being afraid of what BC could do to them in the way of delaying or denying payments, did not press BC for payment. Instead they went after my coworker. Unfortunately he didn’t have a strong player on his side, or an attorney familiar with health care and BC’s charades. He did, however, have a job offer elsewhere, and to my knowledge the bill remains unpaid to this time. (IMO serves the hospital right.)

Originally Posted At: Coalition Against HMO & Insurance Abuse

This is probably minor compared to other people’s problems, but this so annoyed me that I wanted to tell someone. I have health insurance through one of the companies I call “The New Terrorists” who are terrorizing the American people; this company’s name is Blue Cross.

Aside from the basic problems of them not covering dental and medical treatments I thought should be covered, they are now trying to double-charge me for my already expensive coverage. I pay about $640 per 3 months (it was just raised a month ago) and I sent payment on time. I got a leter a month later that they hadn’t received payment and that I would be discontinued.

I located my cancelled check that they had cashed and called them to inform them that I would not pay twice for their coverage. Unfortunately every time I call, their computerized “billing system” is down and they can’t access it. When I’ve asked to talk to a supervisor, they inform me that one is “not available” at present but they wil gladly take my number and have one call me in 24-48 hours. I am so disgusted with Blue Cross and the whole medical and pharmaceutical industry that I believe it is time for Americans to rise up and treat these companies as the terrorists that they really are.

I am planning on setting up a web site called “The New Terrorists”, identifying various medical, health insurance, and pharmaceutical companies as terrorist groups and encouraging our politicians and the American public to start treating these companies as terrorists. I was wondering if you knew of any way of finding out the names and addresses of the corporate leaders of companies like Blue Cross and any of the other major healthcare companies.

I am convinced that only by creating a threatening environment for the heads of these companies will there ever be any end to the rampaging greed of these sickening terrorist groups. Any help would be appreciated. Thanks,

Mark
clearlit@execpc.com

Originally Posted At: Coalition Against HMO & Insurance Abuse

I think it time to raise hell with the insurance industry and the politicians they have bought. Here’s why. In May of 2001, my wife suffered kidney failure while hospitalized with a severe case of pneumonia. Since then she has had to have dialysis three times a week and has been waiting for a transplant. It has been nearly two years.

My wife gets her insurance thru her employer and the company was bought by another company. On the first of January, they changed insurance companies and the new company (Aetna) doesn’t seem to want to answer their phones. On January 20, the local hospital called to say that they had a kidney ready for my wife’s transplant, but we couldn’t have it done because the insurance hadn’t approved it. We couldn’t contact the insurance company because it was a legal holiday.

Now, Aetna old us today that they will not approve of a transplant in Tulsa; it has to be done at Baylor University in Texas. Baylor told my wife that she has to fill out a bunch of forms for them and then wait again for a kidney. It’s going to be expensive for us to spend time in Texas.

Meantime, my wife’s company is again up for sale. If they cut back on employment, move to a different region, cancel employee insurance or change insurance companies, she will again be unable to get the transplant. Please complain to your congressmen and other politicians. This kind of thing must stop.

Sincerely, from Oklahoma

Originally Posted At: Coalition Against HMO & Insurance Abuse

My horror story, or 10 year nightmare, began in the fall of ‘92. President Clinton was about to win the candidacy and I had suddenly fell ill to sickness within my sinus bones that would wind up haunting me for the rest of my life.

It all first began in the winter of 1982, after the birth of my first child, that I suddenly began to suffer from endless sinus and ear infections and it seemed that no amount of antibiotics would make any of it go away. Out of desperation one night, I called this doctor, whose name had been mentioned to me in passing somewhere, that he was good with this type of thing and might be able to help me. Late one Sunday night, finally at the end of the rope, I called and he met me at the ER and soon we discovered that I had developed multiple allergies to many environmental things and it was assumed that this was the current problem. So I started on an anti-allergen regimen and cleaned house of dust and mold, got rid of my cat and my plants, and a serum, much like a vaccine was created for me, and I took this by injection about every week to every other week, and after about 8 months or so, I tapered off. Infections had finally cleared up some and I was doing much better but I was told I was left with some damage to my left maxillary sinus and would need a surgery, that back in those days was called a Caldwell-Luc procedure, to aid in the drainage of this affected sinus that had not been working properly while I was so sick. I went through the surgery and recovered rather quickly and was back to work in no time since I was only 21 then, very healthy and active, otherwise, and I never even needed the pain medication. This was what I percieved to be the end of this illness I had been suffering from for over a year and I did not think that anything else would ever again plague me in that area, since I was convinced that I had been cured. Well I was so wrong
I was in for a serious and un-welcomed surprise in the fall of 1992. I had just moved into a very old, drafty house in the country and even though prior to moving in, much cleaning and dusting was done, to prevent allergy attacks from recurring, since I still got them occasionally. About a month after moving in, I awoke one morning with the most excruciating pain in the left side of my face, and swelling and unable to blow anything from that side of my nose and I was suddenly just devastatingly sick. I immediately contacted the ENT surgeon who had done the surgery back in 1982, and was seen immediately. Even he seemed shocked at the severity of this new infection. My entire left maxillary sinus was completely full of infection and swollen and painful and I literally could not open my jaw. This infection had infected not only the sinus, but the jawbone, and out into the tissues beneath my face and was beneath my cheeks in the form of cellulitis. I could not blow anything from that nostril and the pain was very intense. The doctor, unsure of just what had happened here, performed in his office, a minor, but very painful, surgical procedure called a sinus lavage and attempted to rinse this infected substance from my nose. He even had to perforate the buccal area of my mouth, just under the upper lip, along the gum line, with a very long needle and inserted it directly into the sinus to aspirate this strange substance to be sent to pathology to determine what kind of bacteria or cancer or whatever this might be. This perforation and aspiration was done almost every other day, while I continued to take every kind of antibiotic available from broad spectrum to fungal kinds to anaerobic bacterial types. Nothing seemed to be working at all and the infection was so deep into the bones of my sinus floor that my condition did not have a very good prognosis at this point. We finally hit on an antibiotic combination that seemed to begin clearing it up, but by now I was on so much stuff from decongestants to antibiotics and so by now it is March of 1994 and the nightmare isn’t over still. I am now facing more surgery, pain, and tremendous amounts of money being dumped into this, which by now, if I had only known better at the time, I would never have gone through with the root canals. I would have had those teeth extracted as well, and speaking futuristically, it would have been in my best interest, I just did not know it at the time. So I had the surgery first, where the oral surgeon went in while I was under anesthesia, and cut out the jaw tooth, the bones surrounding it, and basically did a cleanup job from the prior surgery, where he could see more scar tissue trying to develop and this “hole” that he called a “surgical defect” was like a constant open wound that oozed pus quite often, so he did the best he could to clean that disaster up and try to promote some healthy bone to begin healing. Afterwards, I had to see the dentist and prepare for the other 2 teeth to be root canaled. By summer of that year, ‘94, I was finally starting to see some kind of light at the end this infinite tunnel, but things still were not quite right. While the dentist was working on the 2 root canals, I appeared to be having problems still, within the alveolar bones that support the teeth, and I was still in constant pain. Now, as I mentioned earlier, the first operation had gone so well that I never took any narcotics. In fact, up until that fateful day just before that sinus surgery in the fall of ‘92, at age 31, I realized I had never taken a pain pill stronger than an aspirin, in my entire life. I had, in fact, been a pretty sheltered girl most of my life and did not drink or do drugs, had gone to nursing school back in the early ’80’s, but never finished to become a registered nurse, since life has a way of making you put aside your dreams temporarily while you deal with other things like having children and going through divorce and being forced to drop out of school for a while and work in doctor’s offices instead, until the time could be right.

Here is how this drama began to unfold. I was very sick and I was getting very weak. I was 31 years old and had never taken pain pills before and did not want to. I was actually kind of scared of them, based on what I had learned in the pharmacology I studied in nursing school. But one day, that pain was bad, so bad that I felt like dying, that I just did not think there was any more strength left in me to fight it off and I had been given a few of these little speckled pills for pain to take if it ever got to the point where I needed it. Well I think I had long gone past that point months earlier and was finally at the breaking point. So I took out this pill, in a little blister pak, an obvious sample from the doctor, that I had been holding on to for quite a while. The day I decided to take it was not whimsical or anything like that. I planned to take it, but first I had to research it, since research is my thing and what I seem to do best, I had to know everything there was to know about this drug called “Lortab”, and before I swallowed this pill, I had to know exactly what to expect. I was that pill-phobic. So after my research, I took the pill and waited. About 15-20 minutes later, the course of my entire life had just changed. A complete 180 had taken place, and I did not even know it yet. All I knew at that particular moment, was that for the first time in years, I suddenly felt absolutely no pain at all. Apparently I had been in low grade pain for several years prior, and I just assumed it was a stress headache or sinus pressure and I figured I could live with it and go on, that this was just the way it was, and I really did not know anything different, until that day. That day, a whole different world that I had not seen, opened up to me and at the time, things looked and felt good, and I oblivious to what the future held at that time.
When the root canals were “supposedly” done, I still had pain in them, and the doctors did not believe me. They felt sure that everything had been corrected and by now I should be over the pain, but I wasn’t. They began to cut me of from pain medication and I still needed it, since they did not know it yet, but they still had not fixed the problem yet. I begged for the pills and sometimes I got them, and sometimes I did not, so I got tired of the whining and begging and being accused of being an addict. One day while standing in line at Kinkos copiers, a devious idea popped into my head. I did not need these doctors to call in the medicines for me or write more prescriptions. I had been to nursing school and I knew how to do it myself, so I did. And I did, and I did, and many months went by and I had stopped bugging the doctors, and I was still not quite right, my sinus had some kind of permanent defect now that needed alveoplastic surgery to correct, but no one knew at the time. I had given up on everyone and decided I would do things my way now. After a few months of playing doctor, and not even really realizing I was committing a felony, I started getting sloppy, and one day, that sloppiness caught the eye of a very sharp pharmacist who busted me right then and there. So now I was not only still sick, but facing jail? How much worse could things get? A lot worse. I was sentenced to probation, since it was my first time ever to break the law and I was never ordered to be in rehab, nor was I seeing any more doctors to try to solve the still existing sinus bone problem, that still hurt and made me do what I did in the first place. I tried for a few months to give the medicine up. I tried alternatives but there just wasn’t anything strong enough to fight it off. With time, I sort of learned to deal with it the best way I could, and occasionally I would get a script from a doctor to help with the pain, but it was mostly random, and started dealing with the pain at night by taking anything and everything available

Originally Posted At: Coalition Against HMO & Insurance Abuse

After all the following occured, I contacted the Rockledge Police Department, I found out there were 22 theft complaints against Wuesthoff so far this year. A few were things like car theft, but many had similar complaints to this one. When will someone investigate them? Karen Davila, Vice President of Wuesthoff Health Systems, has threatened me with libel if I tell my story. Well, this story is true, so here it is. Truth is not libel!

My mother, Mary Lucas, 72, was gravely ill and also suffered from dementia and was in Wuesthoff hospital in Rockledge, FL, Brevard County, for about a month through December (2002). During her stay, she had a battery of tests and was moved from one room and section to another many times. They made a fortune off of her from Medicare and Medicaid.

They never did tell us why she was so ill. Anyway, during the moves, various things disappeared. Items lost and not located in lost and found included all her clothing, her jewelry, gifts bought for her while she was ill in the hospital, and both her upper and lower dentures. I was in to visit her to sign a permission sheet for a heart procedure, and she had both dentures in at that time.

How do I know? They brought her supper to her while I was there, and she could not eat. I thought she needed to put her teeth in and was going to assist her, and she showed them to me but she was too ill to eat. It was at that time I noticed all her belongings were GONE! She was in a bare room with nothing but her gown. No clothing in the closet, nothing of hers in her room except her and her teeth.

My brother, Lloyd, assisted her at discharge and is a witness. At the time, the staff had to get clothes and shoes out of lost and found for her to wear home. At that time the staff that was present insisted the hospital was not responsible for missing items. They intimidated my family so much they just left without a struggle. When I heard about this, I got furious.
A friend of mine had the same thing happen to her husband (they lost his denture) and she suggested I take in an estimate since she was reimbursed for her dead husband’s denture. He died before he could get his impressions and she still received a check from Wuesthoff. When Kathy called Karen to complain about the treatment we got there, Karen told her that she should not have cashed the check if her husband had died! The nerve!

I went to the hospital in December of 2002 and was sent to four different offices before I found a person responsible for reimbursement. I did not want payment for anything except for the lost dentures at the time since my mother was in a nursing home and on social security (and medicaid will not pay for dentures anymore, thank you Jeb), and so there was no way she could afford to replace them. I did tell Karen Davila at that time that all her stuff was missing at discharge, but at the time I was not worried about the rest of it. She claims to be deaf about that part.
So, I hand delivered a written estimate for $1000 from Atlantic Denture Clinic to replace her teeth to Karen L. Davila, at 321-636-2211 ext 1509. She later wrote that the fact that the estimate was hand written by a business started by a deceased dentist made us suspect–hinting to people we were trying to pull something over the hospital…well, a lot of businesses have lost the original owner and are still operating…Wal-mart, for example. Much to her credit, Karen made sure that a check was written to that clinic to replace the teeth, acknowledging their responsibility for the loss (she later writes that she had the check written out of pity and not because of responsibility).
So, with a way to pay for her lost teeth, We scheduled and canceled many appointments to take my mother into the denture clinic because she was too ill to keep them. My brother and I finally got her to Atlantic Denture Clinic a week or so before she died, but my mom was being difficult that day. We could not get impressions, but left the check with them since we were going to try it again the next week. Unfortunately, my mother died (Wednesday) before that appointment.

The Monday following her death, I collected the check from Atlantic Denture Clinic (I had gone Friday but they were closed) and I went to Karen Davilla’s office and quietly told the receptionist that my mom passed away last Wednesday, and was it possible for a new check to be reissued to my father. The receptionist went back to Karen who I overheard explaining the situation, and suddenly, instead of inviting me into her office and sitting with her at her desk, instead of quietly explaining policy is such and such, instead she yelled at me from maybe 15 feet away that she was sorry for my loss but that she would not reimburse my father because my mother had died and no longer needed teeth. Then I heard her tell her secretary to take back the check, and at that point I left the office, since that check was proof that they acknowledged the loss and their responsibility to pay for it.

Well, this was just too much. I had just lost my mom, who I was with when she passed and even had to close her eyes afterwards; the Thursday before, I lost my mother-in-law who I had been taking care of since her stroke in January of 2002, and was with her when she passed; a week before that, a person I cared alot about passed away, and a week before that, my brother-in-law, only 38 years old, was tragically unrecognizably mangled in a tractor trailer accident, not his fault. After all this, I get treated this way. I told her I will tell people about this and she did not care.

I filed complaints with every consumer group and person I could think of, and then I decided to create this web site so no one else ever has to go through this–the reason is that no newspaper or reporter or television action teams would touch the story. My guess is Wuesthoff is a big advertising client and no one would break this story. No satisfaction has ever been received. But as word gets out, maybe someone will be spared the living hell we went through thanks to the vice president of Wusthoff Hospital.

Karen still refuses to reissue a check reimbursing my mother’s estate for the teeth they lost. She is hinting that we are trying to rip off the hospital to those who call or otherwise contact her in protest to this action of hers. I discovered that she was considering implementing a policy that all patients have to sign a document stating that anything that is lost is not their responsibility. Who reads all the stuff you have to sign at admission!!! And, an attorney told me that she can do this.

This is legal, but not ethical or moral by any means. My mother had dementia, and someone took advantage of this. This incident also raises a question of patient safety. Anyone can walk in and hurt a patient if all her belongings can vanish.
Sure, there is no value to teeth, except to the one who lost them. Without teeth, gums get extremely sore from trying to eat. All meals must be mashed up. We had to do a Heimlich on her several times because she almost choked to death. Great way to live. She lived that way for 3 months.

Non- the-less, my point is this. A hospital is full of sick people, many of them drugged and sleeping. Some are unconscious. For many tests, things such as teeth must be removed.
Thieves will have an open opportunity to steal and the hospital won’t be responsible for that if Karen makes everyone sign this new form she is considering. The form includes anything– teeth, walkers, glass eyes, prosthetics, anything missing will not be the responsibility of the hospital. Is this right?

My mom lost everything… the four silk flower arrangements I took to her over the month valued at $15-22 each; her clothing she came in with; a ceramic bear with a dress I paid $20 for; a $60 ceramic doll I bought her since she collected them; her shoes; a guardian angel pin I brought for her; at least 4 live flower and vase arrangements I bought from the gift shop at the hospital, and her watch and rings. None of these items were in lost and found, and thus assumed thrown away or stolen by someone, whether employees or visitors to the other patient in her room.
Also, there are moral and ethical issues here. She promised me that if the hospital lost her stuff, they would certainly be responsible for it. That is why after she investigated my moms records, she issued a check. Now she won’t take responsibility. This is a consumer issue. If this comes out publicly, maybe we will hear from dozens or more people who this also happened to at this facility and how often hey are getting away with it. I gave up on getting a check for my father, her husband. Karen made it clear she will not give in and reimburse us. But I won’t give up on warning people about this problem.

I just want word out that people may wish to use another facility in Brevard County if they don’t want the possibility of this happening to them, too. This new document Karen wants all admissions to sign gives thieves a free reign, and the hospital a way to not take responsibility for their facilities actions. And please, do not make the mistake we made… call the police to the hospital or nursing home if your items are missing. We just did not think of doing that. It would have made our case a lot easier.

We are not stupid. We did not bring in valuables like gold bars, diamonds, stacks of money, etc. But you would expect your teeth and the clothes you came with to be there at discharge, am I right?
By the way, I sent a letter to the board of directors and the President of Wuesthoff regarding this whole situation, and neither had the decency of a response. What great people to be working in the health related industry and with people.

I am so disgusted with Wuesthoff and their administration. Are you?

Arthur C. Lucas, Jr.

Originally Posted At: Coalition Against HMO & Insurance Abuse

My husband and I just dropped our insurance coverage with Blue Cross Blue Shield of Illinois. We were paying high premiums as we are self-insured and never really getting any benefit. The only thing I ever got was letter after letter saying they were trying to dig up more information on my medical history and couldn’t process claims until they got all the information they needed.

What this really seemed to be was a witch hunt trying to find any reason to disqualify a claim. Recently, they sent one saying they were waiting on information from a physician (an OB/GYN) who I saw AFTER the treatment date — treatment for asthma by the way — and AFTER I had already canceled my policy.

When I called to notify of them, they said “we are doing a complete medical history”. I told them it seemed the information from this doctor was none of their business as it wasn’t HISTORY it was something that happened in the FUTURE … after the treatment in question. They didn’t care. They do this every time I submit a claim and to date, I don’t think they’ve had to pay for anything because my deductibles are so darn high. So why bother?

Gail

Originally Posted At: Coalition Against HMO & Insurance Abuse

After (14) years of continuous payments I was late and Blue Cross cancelled my insurance. They had actually processed a payment but said it was a clerical error.

I had a business that closed after 12 years because our product became obsolete. When this happened my partner files bankruptcy and I had tens of thousands to pay. The financial pressure was horrible with bill collectors calling day and night. I was juggling what I could and got sick.

 I went to a shrink because I was suffering who diagnosed from panic syndrome from the stress. B of A threatened to take my house and I paid them 32,500. some borrowed. I was becoming so ill I went to a doctor who found I had Hepatitis C, which they think was contracted from a 1990, mastectomy for Breast Cancer. Then my Mom was diagnosed with Nesothelioma and I went to NY to help her. I thought she would pay my Blue Cross premium on-time but she was so sick and angry and had loaned me 10K to pay BofA. I had to stay and help her and not pressure her as she was so sick.

When I got back to CA I sold a $2500. tread mill for $650. and sent the money to Blue Cross which they cashed. I was sooo relieved and thought everything was OK. Then they send me a refund check. Yes, I had already received a cancellation letter waiting for me in LA.

Over the years I had asked Blue Cross if I could change to an agent who was a personal friend. They said only if I dropped my policy and reapplied… what if I had done that, then I would have been without insurance at an earlier date, and at their own phone customer service persons suggestion. Had I been able to change to this agent he would have suggested a less expensive plan and this would have been avoided. He is someone I know and may have even covered me until I paid.

I filed a complaint with the CA insurance board who spent several months deciding in Blue Cross’ favor. I wrote to Gov. Arnold who not surprisingly referred it to the insurance grievance board and re-iterated their decision. I contacted several lawyers and said, I did business with this company for (14) years, “HOW CAN I BE HIGH AND DRY”, what other industry would treat a good customer with such disdain, ever lawyer said sorry, nothing you can do.

I reapplied to Blue Cross who would not accept me stating a history of:

breast cancer; hepatitis C, and Panic syndrome.

They sent me info to apply for CA high-risk insurance which costs a fortune, takes many months to get coverage and only lasts 36 months with a low ceiling on coverage.

I have been in such a panic since this happened I have not been able to look for work but own a home with equity. I have no money and don’t know how I can afford the $665. a month premiums for the high risk insurance. Had I not been sick with Hep C which causes confusion and depression I may have been able to cope better and not missed the payment. I just had thousands in bills and left in a panic to help Mom.

So, the very illnesses they state for being uninsurable, the panic syndrome kept me from being able to cope with my bills. I asked a lawyer What happens when someone is too sick to make the payment on-time — as I was? and he said, “you better get someone else to or you are out-of-luck. ” This makes no sense. If you are too sick to pay they get to drop you??? I’m thinking of bailing out of the United States and moving to another country. I just can’t take it and worry about my lack of health insurance day and night. It keeps me awake and in a panic constantly. I can’t believe that Blue Cross gets special treatment from the government and they are the ones that manage the high-risk plan, where they get the payments and gov’t subsidies plus I’m sure fees for general management of the program.

BLUE CROSS SUCKS!!!!

What can I do to help fight them?

Any ideas of open group plans I can join to get affordable coverage.

Thank you and best wishes,

Susan

Originally Posted At: Coalition Against HMO & Insurance Abuse

I worked for a “blue brand” for over 3 years, and I can tell ya folks, they are out to get your money, BUT, they are not out to get it in big chunks, they are going to nickle-and-dime you to the poorhouse.

They use and anachronistic computer system from the late 60’s (sics) and just the crappiest system of management that would make Enron execs seem like angels. They can send their daily “feel good” mailers, but can they lower your costs? Answer: NO. They pay their employees crap, they cover crap, they overcharge employers and cheat providers.

You have to call customer service for every little thing, and it will still be screwed up. If you have this shitty insurance it’s better to quit your job and find someplace that does not use this insurance company. If you have the misfortune of having a contract with a “blue-brand” as a provider, it’s better to get out-of-network rates than have to deal with the constant f-ups.

If it’s not screwed up now, it will be. I spent 3 years of my life telling them how to improve their systems so it won’t mess up peoples benefits well over half the time, I got put on warning for not being a “team player.” Just remember it’s not the person answering the phone’s fault, it’s the billionaires who are “stake holders” in this gigantic stinking turd.