Today, I was assigned a Patient Advocate from Allstate/Hewitt to work on the now year-long battle with Rush University Medical Center & United Healthcare. After such a long time of fighting to have the claims for Raj's stay processed properly, I gave up and found other insurance - Medicare with various supplements for Raj, and a separate plan I found on the open market for the kids and myself. Once our new coverage was in force, I called Hewitt to cancel the oxymoron medical coverage I was paying 3x more for. My request was DENIED, and they explained that the only way to end the medical coverage is for non-payment of premium (even though they still haven't processed November 2010's benefit election to charge the correct amount for said premium)! The benefits representative had a hard time communicating their "decision" and I stayed on the phone an extra hour to provide enough information for him to appeal on our behalf.
After similar experiences with Raj's Humana plan for June - December of 2011, I was assigned a Patient Advocate from Humana, and I'm keeping him very busy.
The issues are pretty much the same, regardless of Medicare vs non-Medicare coverage, PPO vs POS, prescriptions included or not: They promise the world when you elect/buy the coverage, provide documentation to support this to "comply" with Healthcare Reform and other laws; and I suppose everything would be going well, if it were not for claims. When I submit claims for covered expenses - prescription drugs, doctor visits, hospital services, durable medical equipment - both sides panic. The billers don't even want to try, and the insurance company won't process anything to be paid, even if it DOES get submitted. The folks answering the phones either hang up on me, or tell me the providers have no intention of honoring their contracts. I've never seen anything like this BEFORE Healthcare Reform.
Example:
A line item for one of Raj's hospital stays (the first line, unfortunately) got submitted as "out of network" instead of "in network" so all subsequent line items and claims were processed incorrectly. Endless calls, emails, and faxes resulted in backing out an invalid deductible (good) but they resubmitted it with ME as the patient (bad).
We've already lost several of Raj's doctors, due to issues they've experienced under Healthcare Reform, and we lost another one - his psychiatrist - last week. Anyone know of a psychiatrist in the area that is accepting new patients? How about one that is still in business?
