Yay! Excellent. Ever so much better. But you may wish to go after the 20%. Maybe they were planning this all along? As in, if it's worth 80%, why isn't it worth 100%? And if it wasn't a deliberate plan on their part, to induce you to settle after stringing you along, doesn't it seem like ineptitude? Maybe ask them what paperwork/documentation is still missing? Might it be emotionally satisfying to demand their documentation as to why they won't pay the balance?
Anne, the 80% is what they state they'll pay for prosthetics. That was all I actually ever wanted, as a prosthetic (as far as I'm concerned) is a prosthetic is a prosthetic.
The folks at the insurance company tried to say this was exclusively dental, rather than medical, as a way of getting out of paying for it.
I'm happy to hold them to their contractual obligations.
And BTW, it is an excellent example of the gross inefficiency of a private health insurance system like we have as opposed to single payer. How much money/productivity got pissed away paying for the fucken stupid deny/appeal/approve process shitte you went through and the people who administer it that could have been spent on just providing the goddamn care??
I like the cut of Anne's jib. I am sad that the terms of the contract make her suggestions moot, but I very much approve of the Hun Horde attitude that created them. Just for today, in honor of this victory, I will be Hun Horde in everything I do.
"Take nothing but the best; leave nothing but smoking ruins."
Good, *G.O.O.D.* for you, Jo; and thank you (and also your Beloved Sister, too!!) for hangin' in there............ (and for doing all of that genuinely arduous/tedious/frustrating/exasperating and gut-busting work!!)............ throughout your long Blue Cross/Blue Shield Health Insurance Saga!!
I just have to ask: with BC/BS of Texas, is their now - finally!! - agreeing to pay 80% of the cost of your oral prosthetic............ "precedent-setting" (for BC/BS) in the State of Texas?? I have many Immediate/Extended Family members across Texas; plus one of my (numerous!!) R.N.-cousins is a Patient Safety/Risk Management Coordinator in a Medical Center in the TX Panhandle; so if your winning your (wonderfully kick-a**!!) Appeal then "sets it in stone" for OTHER prosthetic-needing oral cancer patients across Texas, who have BC/BS Health Insurance............ (and with BC/BS Nationwide, too??)............ I am really, REALLY going to share this news............ and there'll be a LOT of nurses (me included!!) and physicians who'll be *c.e.l.e.b.r.a.t.i.n.g.* "with" you ~ big-time ~ for their PATIENTS!!
Fantastic!!!! Although the hoops you had to jump through were ridiculous!!
ReplyDeleteWOO HOO!!!
ReplyDeleteYay! Excellent. Ever so much better.
ReplyDeleteBut you may wish to go after the 20%. Maybe they were planning this all along? As in, if it's worth 80%, why isn't it worth 100%?
And if it wasn't a deliberate plan on their part, to induce you to settle after stringing you along, doesn't it seem like ineptitude?
Maybe ask them what paperwork/documentation is still missing?
Might it be emotionally satisfying to demand their documentation as to why they won't pay the balance?
Anne, the 80% is what they state they'll pay for prosthetics. That was all I actually ever wanted, as a prosthetic (as far as I'm concerned) is a prosthetic is a prosthetic.
ReplyDeleteThe folks at the insurance company tried to say this was exclusively dental, rather than medical, as a way of getting out of paying for it.
I'm happy to hold them to their contractual obligations.
Wonderful!
ReplyDeleteCongrats! Brilliant! So happy for you!
ReplyDeleteFantastic! Go you. ;)
ReplyDeleteYippee!!!!!!!
ReplyDeleteGlad to hear this worked out for you!
ReplyDeleteAnd BTW, it is an excellent example of the gross inefficiency of a private health insurance system like we have as opposed to single payer. How much money/productivity got pissed away paying for the fucken stupid deny/appeal/approve process shitte you went through and the people who administer it that could have been spent on just providing the goddamn care??
I like the cut of Anne's jib. I am sad that the terms of the contract make her suggestions moot, but I very much approve of the Hun Horde attitude that created them. Just for today, in honor of this victory, I will be Hun Horde in everything I do.
ReplyDelete"Take nothing but the best; leave nothing but smoking ruins."
Oh, and WOOOOOOOOOOOOOOT.
YAY!!!!!!!!!!!!!!!
ReplyDeleteHurray! That's really good news!
ReplyDeleteCongratulations, did it come with an apology?
ReplyDeleteYES. I can't believe it took five months and all of that followup, but you got it! Hooray!
ReplyDeleteI'm so glad everything worked out!
ReplyDeleteHappy Snoopy Dance!!!
ReplyDeleteCongratulations!
ReplyDeleteGood, *G.O.O.D.* for you, Jo; and thank you (and also your Beloved Sister, too!!) for hangin' in there............ (and for doing all of that genuinely arduous/tedious/frustrating/exasperating and gut-busting work!!)............ throughout your long Blue Cross/Blue Shield Health Insurance Saga!!
ReplyDeleteI just have to ask: with BC/BS of Texas, is their now - finally!! - agreeing to pay 80% of the cost of your oral prosthetic............ "precedent-setting" (for BC/BS) in the State of Texas?? I have many Immediate/Extended Family members across Texas; plus one of my (numerous!!) R.N.-cousins is a Patient Safety/Risk Management Coordinator in a Medical Center in the TX Panhandle; so if your winning your (wonderfully kick-a**!!) Appeal then "sets it in stone" for OTHER prosthetic-needing oral cancer patients across Texas, who have BC/BS Health Insurance............ (and with BC/BS Nationwide, too??)............ I am really, REALLY going to share this news............ and there'll be a LOT of nurses (me included!!) and physicians who'll be *c.e.l.e.b.r.a.t.i.n.g.* "with" you ~ big-time ~ for their PATIENTS!!
Pulling for you worked--jolly well done,Jo,you have been thru the wringe rwith these folks and it was hell. Now it's Yay Time.
ReplyDeleteYEAH!!!!!
ReplyDelete