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[michigander]

I just allowed my health insurance "mangled care" company to beat me down.

I'm having foot surgery in 2 days.  Afterwards, I'll be restricted from putting any weight on my foot for at least 4 weeks.  From previous experience with foot surgery, I know that I don't have the upper body strength to use crutches without falling down a lot.  I'm 62 and not in great physical condition.  So 10 days ago I started making arrangements for a "roll about" cart to use to get around the house and to and from work.  I had one after a different foot surgery a year ago.  This morning, the health insurance company's durable medical equipment sub-contractor denied my request uttering the fateful words "letter of medical necessity."  For 10 days, no one had told me about this.  I didn't need one the last time.  Now that it's too late to get one and have it considered in time for me to have the cart to get me from the car to my house when I come home from the hospital, someone has said that I need one.  And, there's a catch 22.  If I pay up front so that I can have the cart, they won't reimburse me even if it's eventually approved which it will be because my health insurance company says it's fully covered without any copay.

A few years ago when I had a much more expensive surgery, the surgeon warned me that the insurance companies play these games to make people give up on getting benefits that they are entitled to in order to save money.  That time, it was about tens of thousands of dollars, so I persisted and even had the surgery rescheduled once due to the delay until I was finally successful in the end.  This time there are medical reasons not to wait and the out-of-pocket expense for me to rent the cart myself is only $60 per month, so I've decided to save the wear and tear on me and just put it on my credit card.  I'll pick it up tomorrow.

I'm just venting, but similar tales from readers will be welcome.

[hegemony]

They don't reimburse you if you pay out of pocket, even if the expense qualifies?  That's just ridiculous.  How maddening.

[peppergal]

While in grad school, I severed a finger in a dishwashing accident (don't ask).  I went to the closest emergency room, where my finger was successfully reattached.  My health insurance company refused to pay, since I had gone to an out-of-network emergency room.  The cost of reattaching my finger was more than my graduate stipend for the year, and I wasn't about to take out a loan to pay for it (MLA field, and I took to heart the "no debt during a humanities PhD" advice).  After six months of fighting, I finally got the health insurance company to pay, using the argument (with a letter from the surgeon who reattached my finger) that the distance to the closest in-network emergency room was such that by the time I arrived, the finger would not have been able to be reattached.  I think what finally worked was my phone call to the insurance company saying that if they didn't pay, my next phone call would be to ABC News.

[ideagirl]

I think what finally worked was my phone call to the insurance company saying that if they didn't pay, my next phone call would be to ABC News.

You rock.

[punchnpie]

I think what finally worked was my phone call to the insurance company saying that if they didn't pay, my next phone call would be to ABC News.

I find that threats to contact the media and/or the Attorney General's office do wonders. I'm glad they finally paid up.