Well, score one for the little man. After months of fighting with the insurance company over coverage of Reeves' surgery, the insurance company has finally conceded. They are paying all the hospital charges!! What a wonderful early Christmas present! And what timing, after a few of us had, just Saturday night, been bemoaning the insurance companies.
It is just ridiculous that we had to go through all of this to have this resolved. As it turned out, MUSC did notify them within the required time period. Apparently, an email from them, coupled with a strongly worded letter from an attorney friend, was enough for the insurance company to concede. Oh, wait a minute, did I say "concede", what I meant to say, was accept their responsibility!! Which begs the question, "Is this truly standard practice for the insurance companies?" What happens to the people who don't have the ability or persistance to follow up like this? And those who don't have a friend who is a lawyer who can put some pressure on them? There must be hundreds of thousands of dollars paid by insureds unnecessarily. This almost borders on criminal. We were just about to set up a payment plan with MUSC because in a couple of weeks this would be going to collections, which would affect our credit. But what were we to do?
There must be a better way. It's not like this surgery was an option. We weren't having a mole removed! We were saving our son's life. I'm not begging for compassion from them. It would just be nice not to have them add insult to injury. I know for our family, I will be looking into a medical savings account or something similar. I'm tired of feeling like Oliver Twist. "Please, sir, can you pay my claim?"
3 comments:
Way to go!! As you know, I am right there with you wondering how insurance companies can treat their 'clients' the way that they do!
Your persistence paid off! It is frustrating and a relief. I am really happy for y'all.
K:
This is a comment from Mario...
It is a common misconception that health insurance companies think of the "insureds" as the client. The reality is that for more than 50% of insurance business, the insurance company is only a third-party administrator or intermediary between the employer and the medical provider. The insurance company earns fees to administer an account, but it is the employer that absorbs the risk of loss and ultimately pays any and all claims. As a result, the more the insurance company can save for its client, the employer, the better the insurance company can retain the employer as a client and gain more employers as clients. Thus, the employer pays less and the insurance company earns more. Those that lose out are patients and doctors.
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