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Old 10-23-2006, 10:23 PM   #1
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IO: Hell-th Insurance WARNING: LONG POST!

OK, some of you know that in the last year, I've participated in something I like to call 'the job parade'. Since June of 2005, I've found myself employed three different places. Circumstances, opportunities - different reasons for all the changes, but that's another thread.

Anyway, when I left my employer last June I had been a participant in the company's healthcare plan since my eligibility with them 2 1/2 years earlier. (Prior to that job, I was a participant through another group, but with the same provider... let's call them Red Crucifix/Red Armour ) I went straight from this position to the new one I accepted, but my first 3 months in the job were through a placement agency who offered no healthcare. I didn't opt for COBRA from my former employee, because I'm a generally healthy person & thought I'd save myself & Mr. Blu a few bucks for those few months. (That proved to be a huge mistake twice over. First for not making sure I had continuous coverage, second because 5 weeks into the new job, I got sinusitis & shelled out over $300 for doctor's visits & meds.)

OK, so at the end of my 3-month placement contract I begin my eligibility countdown for the new employer, 30 days. Soon as the 30th day is over, I get coverage through my employer. You guessed it, with Red Crucifix/Red Armour.... they are a huge insurer here in NC. Anyway, I've gone 4 months without coverage. So I get a letter from RC/RA stating that because I had a lapse in coverage greater than 62 days, I have a pre-existing condition clause & any treatment stemming from that condition is excluded from coverage for a year.

OK - I can't see my endocrinologist for a year - I wasn't really bitching, 'cause I hate bothering with it but rationality got the better of me & I realized that wasn't a great thing since I should have my blood sugars better regulated. So I appeal their decision - I explain that I understand the 62-day lapse thing, but that all my prior medical history for the last 5 years has been covered by one plan or another offered through Red Crucifix/Red Armor. In other words, couldn't I get an exception since they happily paid my medical bills in the past for the very thing they were excluding now? The quick answer came back a flat 'NO' - end of story, don't ask us again. Fine, I can't see my endo for a year.... I just decided to deal with it. I didn't like taking the damn medication anyway.

Alright, this was October of 2005. February of this year, I get an offer for management in the cell phone industry. Out of the blue, the offer literally fell in my lap, thanks to a neighbor. I take the job. Huge fuckin' mistake on so many levels, but mostly because they jerked me around on my health insurance. Once again, I didn't take COBRA coverage when I left the old job & came to this one becuase I'd been told by the woman that hired me that I'd be eligible as management to have health coverage after 30 days. Uh...no. I trust her completely, but unfortunately, she wasn't able to go to bat for me on this - she left for a new job 3 weeks after I started. So the higher ups yank me around for 90 days until June 1st before telling me I'm finally eligible for their health care - yep, with Red Crucifix/Red Armour, only this time out of Virginia instead of NC (their corporate office was in VA). Now stick with me, I'm almost to the end.

Middle of June, I start having some 'female issues'.... a certain visitor being really rough on me, causing me a bunch of pain, hanging around waaaaay after they should have gone, if you get my drift. I call up my GYN to get checked out. Based on my history of funky female stuff & the symptoms I've reported, she sets me up for an ultrasound on July 3rd. The results of that showed polyps which required further tests be performed, & on/about July 20 I have an endometrial biopsy.

By this time, I've had my fill of the cell phone world & have accepted a position back in my old field. Not wanting any lapses in insurance - cause I learned my lesson on that last year! - and because I once again accepted the new job through a temp/placement agency who offered no healthcare, we have me put on Mr. Blu's insurance (guess who! - Red Crucifix/Red Armor)effective August 1st, my prior coverage ending July 31st. So now it's the end of July & my GYN tells me the biopsy shows some sketchy cells & she wants to perform a minor out-patient surgery to have them removed. No big whoop, I had the same procedure in 2000. So that surgery is set for August 4th.

Surgery comes & goes, one polyp is much larger than expected & gets sent to a lab for pathology. After much waiting, the thing comes back as pre/early cancer. Doctor & I agree, uterine cancer ain't no joke, the old baby basket's gotta' come out. No hard feelings from me, it's never been any use to me anyway. However, there are complications. RC/RA, who was called by my GYN's office for authorization prior to the Aug. 4th surgery & granted the same, now says they won't pay for the surgery because it's a pre-existing condition, having been diagnosed while I was on prior coverage.

We fight - we appeal - we send document upon document - for what? For them to finally decide that they won't make me wait until Aug 1, 2007 for pre-existing conditions - I only have to wait until May 1, 2007, AND anything diagnosed or reccommended in the SIX MONTHS prior to my current coverage would be excluded.

Now Mr. Blu and I have $10,000 in medical bills we're responsible for. Plus, because we can't do the hysterectomy and we can't just let the few cancer cells grow into lots of cancer, I've been prescribed a medication by my GYN to help in blocking hormones in my uterine area, since those are what the cancer feeds from (as it's been explained to me). The beauty of that? I have to pay all the costs for the meds, PLUS!!! one of it's main side effects is increased appetite/decreased ability to lose weight. Which I already have enough issues with, thanks to my insulin resistance. The higher my weight goes, the less control I'll have over my blood sugars. Perfect, right?

Anyway, the reason I've done all this rambling is A) it's sort of my therapy for the time being. Mr. Blu, my mom & my in-law's know what I'm dealing with, but most people who know me have no clue what I've been fighting; and B)I'm appealing to strangers with intimate details about myself in the hopes that maybe someone else who was foolhardy or bored enough to read all this might have been through something similar & could offer me some guidance. I'm actually calling an attorney tomorrow to set up a consultation and see if they think I might have a strong enough case to fight the insurance company.

I'm just so furious about it all - the headaches, the run-arounds, the utter anihilation of any travel plans or anything else for that matter, that we want to do over the next several years. I mean, even if we end up paying the doctors ourselves & they all cut a few hundred dollars off their bills because I'm a self-pay, it's still over $8000 & we simply don't have a bunch of extra money laying around just waiting to get spent. Worse, I'm having to play with a serious health issue because the fucking insurance company gets to make up their rules as they go along. And the reason I say that? Like I stated before, my doctor did the right thing & called in the surgery authorization the day before my procedure - during which they assured coverage was available. However, now they now say that doesn't guarrantee they'll make any payment, it just means that the potential for them to pay was there. I hate the bastards right now.... but at least my bitterness has spawned me to try and sue the sons of bitches. May be a waste of time, but at least I can say I tried.

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Old 10-23-2006, 10:37 PM   #2
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Jesus.. what an ordeal. I'm so sorry you are going through this. I wish you all the best.

Health insurance almost never works to your 'benefit'.

If you dont mind.. I think this thread is best for Confesh!

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Old 10-23-2006, 10:47 PM   #3
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^ That's cool... I debated on ZC or IO before posting. Shoulda' gone with my original choice. Thanks for moving it & thanks for the support.
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Old 10-23-2006, 11:29 PM   #4
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Man oh man what a run around. Huge conglomerate companies such as Red Crucifix/Red Armour (great name by the way, I have them and hate them too) have right arms that don't know what the left arms are doing. And we as people and customers get caught up and raped by them.

As I was reading I was thinking see an attorney. Glad you are a step ahead. I only hope the attorney will be able to do something to help. Best of luck to you, stay strong, keep the faith no matter what, and I'll keep you in my thoughts and prayers, kiddo!

Also check back and keep us posted
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Old 10-23-2006, 11:31 PM   #5
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I also have a health condition I've been trying to ignore for almost a year because of crappy insurance, but it pales in comparison to this. It's wrong on so many levels. Like you said, you have a serious health concern and can't even concentrate on it b/c you can only think of the money. You could have cancer, but yeah even if they DID decide to help you out, it would take years for the paperwork to go through. It reminds me of when my little brother broke his arm and my parents had to cash in everyone's life insurance policy and cancel dental and doctor visits for five years in order to pay it off. I can't believe shit like this still happens in this country, but then I think of this guy who is currently running for governor in my state and how when his dad needed a new heart, he literally PAID his way to the top of the transplant list in Europe. No one's going to bat for us.

Experience has proven that people with bad health insurance are often worse off than those with NO health insurance. We don't get any of the breaks they do; we end up having to pay for EVERYTHING, or just get denied b/c the shitty coverage we do have isn't accepted. My parents have often joked that if I wasn't covered, I could walk in to the county hospital and straighten out my problem once and for all. Too bad it's true.

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Old 10-24-2006, 09:27 AM   #6
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That's horrible!
"Knight in shining Zubaz."

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Old 10-24-2006, 11:11 PM   #7
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Oh Dear! I'm sorry that you're going through this. And I hope your attorney can help sort things out in your favor -- although it's a shame that you'll end up with legal bills on top of everything else. Does your state/city have some sort of consumer ombudsman (sp?) who might be able to help?
The bizarre thing is that since RC/RA will be covering you eventually -- I would have thought that they'd want you to take care of things now -- rather than later, when things might well be even more expensive! As a last resort, maybe your doctor and/or the hospital could help with some sort of payment plan or financial aid. Sometimes there are fund available for people who need medical care but are stuck in an insurance #@$#$.
I hope things go well for you!
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Old 10-26-2006, 10:04 PM   #8
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OK, an update:

Of the five significant bills we have in hand, we've decided to just pay in full the two that total around $400 - we've arranged w/our bank to skip our next 2 cars payments, so I told Mr. Blu I can't see breaking those balances into installments. Two of the remaining three that we have so far were very gracious & helpful when I called to notify them that I was disputing the denial & would be making monthly installments myself. They couldn't offer me a discount as a 'self-pay', but they did agree to my terms of a minimum of $25/month & even pushed my first payment back 'til the 15th of November. When I called the third of those - LabCorp - and explained what was going on, I asked about a discount. I was told they offer a 10% discount if the balance is paid in full (mine is $490). I bluntly told the woman on the phone, 'Ma'am, if I could afford to pay the balance in full, we wouldn't be having this conversation.' She proceeded to inform me as well that they only bill twice; if a balance remains after the 2nd billing, they turn it over to a collections agency. I asked, 'Even if I'm making monthly payments to you?' & she answered yes. I told her that they'd just have to turn me over to collections, then. I've also decided they are the LAST people I'll pay - if they're going to turn me in no matter what I owe after two billings, then I'll just let them sweat for the entire amount.

As for an attorney, I'm am pursuing that angle. It took me four separate phone calls, but I was finally referred to an attorney in Raleigh who handles insurance cases like mine. I talked to his paralegal Monday, gave her the run down & answered some questions. I've not heard back from them yet, though, so I'm going to have to get on the phone again tomorrow & chase him down, I guess.

If the attorney doesn't think I have anything to take before a judge, then the last resort I know of is to appeal to the state's Insurance Commissioner & see if I can get them to lean on the insurance company hard enough that they'll pick up maybe 50% of the bills. I get the nasty suspicion that this is all going to fall on my shoulders & stay there.

The worst of it is, even though we know that the cancer was caught very early (and may have been completely removed with the polyp) if my insurance provider weren't being dicks, my GYN would have done the hysterectomy on me already, no question. And I know that if I were in a life-threatening situation, she'd have already done the surgery, insurance or not - we'd have dealt with it later. But it's really disgusting to me that I have to spend the next 6 months worrying if the 'band-aid' pill that's been prescribed to me is really doing the trick & preventing or delaying the growth of anymore cancerous cells or if we're going to have a nasty surprise when my doctor finally does get approval to do surgery. And I'm reeeeaalllllly not a drama queen - but the big "C" is no joke & you don't fucking play around with it.... unless of course, you're an insurance company & it's not your life.

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