Tuesday, June 15, 2010

Don't Get Sick! (In America)

In the beginning of May I was told by the company that threw me away that my COBRA coverage expired.  It was just another chapter in the ongoing pursuit of more money on their part.
But they were blatantly wrong.  They were either lying or showing their stupidity since by New York State law I had another 17 months left.
Given those two choices and knowing they will never admit that they are stupid and I don’t like to use that word anyway they therefore must be lying bastards.
On May 10th my wife had a procedure done at an in network medical lab, the Endo Ctr.
Procedures at the Endo Ctr. are covered under the morass that is my current policy.
On June 1st a bill was sent out to us explaining that we must pay for the services since we are not covered.
The bill we received was the first of 3 bills totaling $6,350.
I immediately contacted the old lb's and was told to call their agent to straighten it out.
The agent, a lovely lady in a tough job looked into things and said that Endo Ctr. must have sent the claim to the wrong place.
The Endo Ctr. said they are in network and therefore sent it to the correct location as per the instructions on the insurance card.  They have done exactly the same thing in the past without problems.
But you see the insurance company did a very smart thing a while back and created another division between the little guy and claim payments. My carrier is Guardian and they created Magnacare and decided that some of the claims must go there but not all of them.
Don’t bother to ask which because it will change with the need to obfuscate.
If it was a fair system then a claim submitted to either of these two crooked entities would be taken care of by forwarding it to the correct party WITHIN THEIR OWN CORPORATION!
It is clear that the provided service occurred during the days which the lb's had us as not covered.
I discovered that in order to get paid the Endo Ctr. would have to resubmit or call the insurance carrier to straighten it out.
I let the Endo Ctr. people know this and they said I had to do it.
I told them that if they wish to get paid they should do it.
They said it was my responsibility.
I said it was theirs since I paid my insurance to the lb's and I was covered.
They said the insurance company will just consider it a duplicate submission of the same bill and ignore it.
I agreed but stated if you merely send it in without calling or explaining the situation as I am doing now that will happen.
They said then call the insurance carrier and explain it to them.
My reply as any human would give was, “And I should do this SO THAT YOU CAN GET PAID???”
Not only did the lb's throw me away now I must do the work of the medical industry without being paid by them so that all parties involved can get their money???
The insurance industry and the doctor’s offices and medical centers around this country play this game day in and day out.  It is called pass the buck. And they are aided and abetted by the lying bastards of the business world.  And it is the little guy, the individual who constantly gets pushed around and shat upon.
The bottom line in this is simply that I paid all the bills and followed all the rules and checked beforehand to make sure that everyone involved was ready to go and all were covered and no problems would arise and still I GET F**KED.
I have to correct all of their ON PURPOSE MISTAKES!!!
I have to make all the calls to GET THEM THEIR MONEY!!!
And if I cannot succeed I will be held liable for the full amount of their inflated medical bills!
And all the time I am going crazy raising my blood pressure they are sitting in their ivory towers with their golden reins watching us run around like the idiots we are!
Healthcare reform?

Bottom line – After five phone conversations and twelve e-mails I received this:
As previously stated Guardian has not received this claims and issued any denials.  I reached out to MagnaCare to inquire if an error occurred on their end.  MagnaCare did confirm they received the claims and had been denied by them in error.  MagnaCare stated they will resubmit the claims to Guardian for processing.

So in other words they are finally admitting that they lied and will NOW start the process of trying to deny a legitimate claim.  The fun continues and we the people are the pawns in this high stakes cluster f**k designed to kill off the poor and take as much money from the middle class as possible.
I will no doubt receive a notice that some if not all of the claim will be denied because there was a full moon at the time of the procedure and page 496 – paragraph 14 – lines 7 and 8 of the insurance bible clearly states that...

Think I am alone?  OF course you don't! According to this linked article I am in the majority!!!

One more thought - In no way do I feel Rwanda is a better country than the U.S. but did you know that they make it a point of covering every citizen with health insurance for the exorbitant price of $2 per year?

Anyone believe that our representatives in Congress are unaware of the goings on?

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