Humana's f'ed up

[The Walk of the Penguin Mich]

I'm officially taking back all the decent things on the thread that Naggie started about Humana. Right now, I'm dealing with a bill that is f'ed up beyond all belief!.

Humana's claiming that they did not receive a request for pre-approval for my hospital admission for my gall bladder surgery and ERCP. The hospital is claiming that they requested it on 3/21, the day after I was admitted (Monday am, admitted Sunday night). Since they claim that they did not receive it, they're only going to pay 50% of the hospital bill, leaving me with a nearly $16K balance.

Then the asses are claiming that the surgery and the ERCP were done at the same time. All the assholes have to do is to look at the freaking dates of service. Surgery done 3/20, ERCP done 3/22. If the procedures were done at the same time, they're paid at a reduced rate (same anesthesia, OR room). So now I'm being billed another $700+ for this.

They're paying some of my radiology bills and not others. Excuse for not paying other is that radiology is not in network.

It's open enrollment right now and jumping to my HMO option (which while cheaper) would wind up being even more f'ed up should I ever need emergency treatment out of state again.

How can a medical center advocate working with such a shitty insurance company? We're self insured, but the plan's administered by Humana.

Asses!

[Bluerobin]

mich, I did have a problem with our administrating insurance company when I got sick. I got in touch with the manager at our company who administers the health plans, and she straightened it out. Try that route.

[The Walk of the Penguin Mich]

Already in the works, Blue....I contacted her Monday when I received the EOB for my hospital stay last week and saw that they only paid 50% of the bill. Speaking of which, I need to touch base with her again today.

I'm working on this from all ends simulataneously. I've also contacted the hospital.

[busymom]

I hate ALL insurance companies!! It's all about them, ya know. Never mind we're the ones paying for their fancy vacations.

Keep fighting & appealing Mich. They want you to give up, so they can win. Don't quit!!

[pig]

leaving me with a nearly $16K balance.



That sucks. I have one of the top rated plans in the country and I've never had any of those issues. However, they also have my Rx plan and you KNOW they are getting kickbacks because they cover jack and shit and will do everything they can to not give you medication that's not from their companies whom they get kickbacks from. Good luck, that really sucks.

[Bluerobin]

mich, let them know that you are going through corporate - sometimes that brings pressure.

[The Walk of the Penguin Mich]

What really sucks is that this should have been covered at 100%. I've met my deductible for the year and any emergency surgery is covered at an in-network rate, regardless of hospital or surgeon.

In fact, I was joking with TD while waiting for surgery that since I met my deductible for my hip replacement, it made sense to bundle this surgery in this fiscal year. However, I was hoping to get home before needing to do so. I didn't plan on being doubled over in pain 2 days before getting on a flight home!

This will get resolved to my satisfaction. I just don't like the stress of having to deal with this on top of what I'm already dealing with at work.

[Bluerobin]

mich, I spent a career in collections. When I faced an up hill battle, I would keep escalating up to a higher level. Look for the Chairman's or President's name. Call at lunch time, and you will get his secretary. She will make sure the matter is resolved, so he won't have to handle. It will have the same effect as having gotten through to #1. If you need the #1 guy, try before normal working hours.

[pig]

Hip replacement?!!? How old are you, exactly??

[The Walk of the Penguin Mich]

51, I had my first one at 47 on the other side. Total of 5 surgeries so far on my hips. One femoral reconstruction, 2 acetabulum reconstructions, 2 hip replacements.

Born with bum hips and I didn't exactly help them too much growing up as I played a lot of sports that I shouldn't have been playing.

[pig]

Oh, sorry to hear that. I hear that what I have in my shoulder is common in patients with joint replacements......keep on eye on it. You're a lot older than I thought. I thought TD was younger than myself.

[Bluerobin]

Doc, I view her as a nice young chick!

[pig]

Yeah, but you are ancient Blue. You make Mrs. Riggs look like a spring chicken.

[The Walk of the Penguin Mich]

I was born with a congenital dislocation (thus the femoral osteotomy) and bilateral hip dysplasia (the acetabular osteotomies to buy me time - one got me 13 years, the other 4).

In the grand scheme of things, I'm relatively lucky in that I was diagnosed with this at 6 weeks. Unfortunately, I was one of the babies that using the mechanical methods of trying to fix the dysplasia did not work - I was in the harnesses, braces, casts for 2 years and the bone would not meld.

TD's older than I am......

[pig]

Were either of you married previously? If you don't mind me asking.

[TD2K]

I've been married, Mich hasn't made that mistake.

[pig]

I had you pictured all wrong. I thought you were young and never married.

[lulubean]

Yep, DH works for a slew of hospitals, specialists and primary cares but Humana I suppose does the paperwork and they suck.

He also worked for seven years for a health ins company and they were excellent.

[The Walk of the Penguin Mich]

I get a phone call this evening from the hospital billing department. Supposedly someone there spoke to someone at Humana about the preapproval form, so the bill's going to be resubmitted. Complete with authorization # for the preapproval (which I have in my grimy paws).

One problem down, one remaining.....

[Sammy]

TD's much older than I am...... (fixed)

[TD2K]

But, MUCH MUCH younger than Sammy


Sam was like our school marm back on MSN.