Private Insurance SUCKS

This is the US. Welcome to hell.

File an appeal and include the fax sent documentation

My father has to see A LOT of doctors and my mother and I always have to make sure all of the i's are dotted and t's crossed dealing with insurance. It's enough to make you even sicker than you were after going to the doctor. We need universal healthcare. That fucking Iraq war could've paid for (at least) twenty years of healthcare for every one of us.

R2, I just did that today (and interestingly the AETNA call center rep and her supervisor couldn't tell me where to find the documents. I had to google them!

I also sent emails to top Aetna people and to the social media people.

I got no answer at all from the social media people until I sent a follow-up email threatening to go to my attorney general and congressman. Then they start bending over backwards to help.

This is such shit

Can you imagine trying to do this if you were really sick or had a job that keeps you occupied constantly?

Why do Americans allow this nonsense?

[quote]I just did that today (and interestingly the AETNA call center rep and her supervisor couldn't tell me where to find the documents. I had to google them!

That's the most insane part about calling some of these call centers. They're looking at the same thing you are or they have no clue about the most basic things! You'd think they'd have a better, detailed system in place, but they're pretty much getting paid for googling what you're googling and even that, they won't do for you.

Anyone in NYC knows this if they've dealt with 311. I actually laughed at one person I spoke with who was reading verbatim what I was looking at on the NYC.gov site and the reason I even called was because what she was reading wasn't a detailed explanation.

[quote]Why do Americans allow this nonsense?

Because the wealthy investors via their whores in Congress convince the poor/working class fools that whatever pittance they get is going to "illegals."

the whole point of private health insurance is to make their investors rich. This carousel isn't a bug; it's a feature

Op here-- I filed an appeal.

I just got an email saying my appeal was filed too late and that I must file and appeal to the appeal.

Hilarious but true. I'll fill out whatever stupid paperwork they want.

I’ve had private insurance for decades - no need for referrals. Went to specialist without ever seeing my primary. This year I had to buy Obamacare insurance because I lost my job. They ONLY offer plans that require a referral. The referral process is a nightmare! I would pay anything for a non-referral plan - but no one offers one in NY.

I pay close to $1,000/month - and I’m grateful to be able to get insurance at all thanks to Obamacare. I just wish there was a non-referral insurance provider. I’d be willing to pay more than the insane amount I already pay,

Requiring referrals has been shown to reduce health care costs because people can’t get access.

It’s really great that we have health insurance designed to stop people from seeing their doctor

OP, your PCP is receiving a Fax Transaction Confirmation. All that means is the number he faxed the referral to rec'd the transmission. The Stupid Fucking Asshole didn't even bother to ask you for the number, in case the one they programmed into his fax machine on the eve of WWII has changed. Call Aetna, get the correct fax number, call your PCP's office, give them the number AND TELL THEM YOU'LL WAIT WHILE THEY FAX THE REFERRAL. AND NO, YOU WILL NO WAIT FOR THEM TO FAX IT AFTER HOURS because they are holding up the insurance. Do not take no for an answer. Rip them a new asshole, vent your anger on them. There are times when it's necessary. That is, if they try to fob you off and say they'll get to it blah blah blah. Or, depending upon how close you live to your PCP, drive over there and get the fucking thing yourself. And who the fuck uses fax machines? And your fucking doctor doesn't have the online capability to do this? Is he still treating HIV symptoms by telling his patients to limit their partners. BE SOLUTION ORIENTED, NOT EXCUSE PRONE! If a medical clinic doesn't have something remotely close to the latest technology, I'd find a new PCP TOOT SWEET! Yes, I feel strongly when professionals who are paid shit tons of $ can't do their fucking jobs. And I'm never quiet about it. Good luck.

If I acted like that R12, my doctors assistant would ensure it would NEVER be sent. And would make future referrals equally problematic. When it comes to dealing with someone who you will need to rely on for many years in very difficult situations, maybe not a great idea to be a bitch to them. Especially since it is likely the insurance company’s fault.

R12, I'm not an idiot. I didn't everything you said. In fact, after making sure it was faxed to the number Aetna gave me, I called Aetna.

It was Aetna that repeatedly said it could not find it.

Why didn't you ask if your insurances was in order BEFORE you had the work done. It takes three seconds to ask and a minute to verify.

I highly doubt the OP did what he said. And stop blaming Iraq when you could say the same thing about "the use of a 25 cent condom instead of the BILLIONS invested in antiretrovirals would've paid for insurance..."

Too bad your sick, but you had a lot of opportunity to learn before you were sick.

R10

I live in upstate NY and have a platinum MVP plan and I don't need referrals to see specialists. I have seen a GI and rheumatologist without referalls; I have never seen a PCP.

It costs about $1000/month. Copays are $45. I hope and pray for Medicare for all, as my healthcare costs are quite high.

Sadly, such plans may not be available in all counties of NY.

[quote]Why didn't you ask if your insurances was in order BEFORE you had the work done. It takes three seconds to ask and a minute to verify.

Yes. it's important to make sure you have insurance authorization before service is performed. Obviously some people would rather not bother.

OP, my apologies; I never thought you were in any way idiotic. I have had that experience, and I thought from the sound of it that your PCP was giving you the run around. This will eventually all be settled. But I know what frustration it causes.

[quote] And stop blaming Iraq when you could say the same thing about "the use of a 25 cent condom instead of the BILLIONS invested in antiretrovirals would've paid for insurance..."

Hey, asshole, the money spent on a fucking war based completely on purposeful LIES and costing trillions (with a "T") is not analogous to irresponsible individuals, and the price tag is no where near the same.

R16 - good to know. Maybe it’s different in NYC. I’m waiting for the NY insurance exchange to open up Nov. 1 to look at plans for next year. It’s such a major part of my monthly expenses now, I would consider moving because of it.

Op here—

After 4 months of this nonsense and all the Aetna runaround, I emailed the CEO of Aetna and contacted the social media team via Facebook.

All of a sudden, the find the referrals my primary care doc has been sending! I’m getting a flurry of emails saying this issue has been escalated and blah blah blah.

Yesterday I got a call saying that the referral has been accepted and the charged amount will go to the specialist (minus the co-pay)!

Although I’ve been relating all the information to my specialist’s billing company, yesterday I also get a notice that the bill has been sent to a collection agency.

It amazing that we Americans have to go through all this bullshit. I can’t imagine that very sick people often have to deal with these crazy billing issues on their own

[Quote] Why didn't you ask if your insurances was in order BEFORE you had the work done. It takes three seconds to ask and a minute to verify.

The funny thing is I did. The specialist’s office said everything was in order. It was only after the visit that the office called to say the date of the referral was wrong and I needed to get another sent.

That’s when the circus started

Europeans would read this story and scratch their heads in amazement

OP I’m a social worker at a skilled/long-term care facility, work a lot on trying to get people their benefits. None of the private insurance companies are particularly great, but Aetna is possibly the WORST company out there. If you’re not 65 yet, I’d suggest you think about getting on Medicare A and B with a good supplement like AARP. The premium for the supplement may be higher than a premium for a Medicare managed care plan, but You will actually receive care and it will actually be covered. The peace of mind could be worth it.

R24, what about medicare advantage? My mother is 64 and is the beginning stages of dementia. Which insurance is best for long-term care?

in*

R25, actually Medicare Advantage combines all the different types (including private supplemental) into one plan.

It all depends on which company Medicare Advantage Plans are located in your area. I know there's an online comparison tool from Medicare itself. Google it and compare the plans to see what works best for you.

Here's the Medicare Advantage comparison tool

Medicare doesn't cover longterm care. Medicaid does but only if you're destitute.

R25, You may be able to cobble together some help from various insurances if your mom stays with you. Speak to an elderly care adviser in your area. Such advice is usually given free by local CBOs