2013년 11월 25일 월요일

About 'debt collection forum'|... and business fees, and ending San Diego’s guarantee of free trash collection for owner-occupied single-family homes, would bring in enough money to help...







About 'debt collection forum'|... and business fees, and ending San Diego’s guarantee of free trash collection for owner-occupied single-family homes, would bring in enough money to help...








In               June               of               2004,               my               (now)               husband               was               admitted               to               the               hospital               when               he               went               to               the               emergency               room               with               severe               abdominal               pain.

A               week               later,               he               was               discharged,               minus               his               gall               bladder.

Over               the               summer               months,               my               husband               received               numerous               small               doctor               bills               that               he               had               assumed               were               part               of               the               claim               during               his               hospital               stay.

He               paid               the               required               co-pay               on               each               of               these               bills               and               since               he               had               been               admitted               via               the               emergency               room,               had               no               reason               to               think               that               United               Healthcare               would               not               cover               his               surgery               or               his               hospital               stay.

Under               his               health               insurance               plan,               any               hospital               stay               and               subsequent               surgery               that               came               about               from               an               emergency               room               visit               was               fully               covered,               minus               any               individual               doctor               co-pays.

If               he'd               visited               the               doctor               previously               complaining               of               abdominal               pain,               then               the               claim               could               have               been               denied               due               to               their               pre-existing               condition               clause.

Since               that               was               not               the               case,               he               went               about               his               merry               way               and               didn't               think               about               it               again.
               In               November               of               2004,               a               bill               arrived               from               a               bill               collector.

It               was               for               an               unpaid               hospital               bill               to               the               tune               of               $67,000.

This               was               the               first               indication               that               perhaps               something               had               gone               wrong               with               the               health               insurance               claim.

My               first               thought               was               that               the               hospital               had               probably               sent               out               the               bill               before               the               health               insurance               had               processed               the               claim.

My               husband               called               United               Healthcare               to               confirm               my               suspicion,               where               he               was               told               the               claim               had               been               denied,               and               the               health               insurance               company               cited               the               reason               for               the               denial               was               due               to               a               pre-existing               condition.

After               being               asked               several               questions               surrounding               the               hospital               stay               where               my               husband               iterated               that               he               had               not               ever               seen               a               doctor               for               abdominal               pain,               the               insurance               adjuster               seemed               satisfied               that               the               error               was               on               their               end               and               said               he               would               request               that               the               claim               be               reprocessed.

The               adjuster               also               said               he               would               send               out               a               questionnaire               that               asked               the               same               questions               he'd               just               asked               my               husband.

My               husband               was               given               a               phone               number               and               a               claim               number               should               he               feel               the               need               to               follow               up.

The               promised               letter               never               arrived,               we               forgot               about               it,               and               due               to               the               silence               of               the               health               insurance               agency,               assumed               that               the               matter               had               been               taken               care               of.
               Fast               forward               to               October               of               2006.

A               collection               notice               arrived               from               a               third-party               collection               agency,               offering               to               settle               the               $67,000               bill               for               the               mere               sum               of               $23,000.

Obviously,               something               had               gone               awry               again.

By               now,               my               husband               had               moved               on               to               another               job               and               no               longer               had               health               insurance               with               United               Healthcare.

We               had               also               moved               during               this               time,               too.
               The               first               thing               we               did               was               send               a               registered               letter               to               the               collection               agency               to               dispute               the               validity               of               the               debt               and               demand               that               they               send               us               a               copy               of               the               debt               owed.

I               figured               this               would               buy               us               some               time               to               figure               things               out               before               the               collection               agency               demanded               a               court               date.

It               would               also               officially               put               the               debt               in               question               into               dispute               status               on               my               husband's               credit               report.

They               sent               us               a               copy               of               the               hospital               bill,               which               was               57               pages               long.
               We               found               the               phone               number               and               claim               number               and               called               United               Healthcare,               only               to               discover               that               the               phone               number               given               to               my               husband               by               the               adjuster               was               no               longer               in               use.

I               went               online               and               after               much               digging,               managed               to               find               a               phone               number.

I               did               not               find               this               phone               number               anywhere               on               United               Healthcare's               website;               rather               I               scoured               the               Internet               and               found               a               user               forum               where               a               user               had               posted               it.
               Thus               began               our               sojourn               into               Health               Insurance               Claim               Hell.

I               explained               the               scenario               to               the               first               representative,               and               she               seemed               very               sympathetic               and               apologized               for               our               troubles.

When               I               gave               her               the               claim               number,               she               discovered               the               claim               number               we'd               been               given               so               long               ago               actually               was               for               a               different               claim,               and               that               one               had               been               paid.

Meanwhile,               there               appeared               to               be               no               record               on               file               for               his               hospital               stay.

The               representative               told               me               there               were               no               outstanding               claims,               but               due               to               the               age               of               this               claim,               it               most               likely               had               been               purged               from               their               electronic               system               and               stored               on               film.

She               put               in               a               request               to               pull               the               claim               from               storage;               I               was               told               it               would               take               two               weeks.
               Two               weeks               later,               I               called               again               to               make               sure               they               had               been               able               to               retrieve               the               claim.

Once               again,               I               had               to               explain               all               over               again               what               had               happened.

This               representative               also               seemed               nice,               and               she               managed               to               see               the               claim               that               had               been               pulled               from               storage.

She               informed               me               that               the               claim               had               been               denied.

The               reason?

It               had               been               a               pre-existing               condition.

I               politely               asked               her               if               we               could               request               the               claim               to               be               reprocessed               and               explained               once               again               that               the               hospital               stay               and               surgery               was               not               in               any               way               related               to               a               pre-existing               condition.

Since               he               had               been               admitted               through               the               emergency               room,               she               agreed               and               told               me               it               would               take               two               weeks               to               reprocess               the               claim.
               I               marked               the               calendar               and               called               again               two               weeks               later.

I               went               through               the               whole               story               again               to               yet               a               different               representative,               who               merely               chuckled               and               said               it               would               take               at               least               thirty               days               to               reprocess               a               claim,               and               that               it               was               too               soon               to               know               the               results.
               I               marked               the               calendar               and               when               a               month               had               passed               since               requesting               the               reprocess,               I               called               and               spoke               to               another               different               representative,               who               told               me               that               the               claim               could               not               be               processed               because               they               were               waiting               for               us               to               return               some               paperwork               to               them.

I               asked               what               paperwork               that               might               be,               and               the               representative               said               it               was               a               questionnaire               we               needed               to               complete               and               return.

I               informed               the               representative               that               this               was               the               first               we               had               been               told               of               such               a               letter,               so               he               put               in               a               request               to               have               the               questionnaire               sent               to               us.

He               advised               to               allow               two               weeks'               time               for               the               questionnaire               to               arrive.
               After               two               more               weeks               passed,               I               called               to               inform               United               Healthcare               that               the               promised               questionnaire               did               not               show               up.

Once               again,               I               spoke               to               yet               a               different               representative,               and               had               to               retell               my               story               to               this               person.

This               representative               told               me               their               records               showed               it               had               been               sent.

I               asked               to               verify               the               address               they               sent               the               questionnaire               to,               and               the               representative               rattled               off               an               address               I               had               never               heard               of.

It               wasn't               our               current               address               or               our               previous               address.

In               fact,               it               had               been               sent               to               an               apartment.

Neither               I               nor               my               husband               had               lived               in               an               apartment               while               he               had               health               coverage               with               United               Healthcare.

When               I               asked               what               I               had               to               do               in               order               to               update               the               address,               the               representative               informed               me               that               my               husband               would               have               to               call               his               employer               and               request               the               address               be               updated               through               them.

I               asked               what               does               he               do               if               he               no               longer               works               for               that               employer               and               he               no               longer               has               health               insurance               with               United               Healthcare,               this               being               the               case               for               over               a               year               and               a               half.

The               representative               insisted               this               was               the               only               way               to               update               the               address               they               had               on               file.

Realizing               that               the               odds               of               us               actually               ever               receiving               the               questionnaire               were               slim,               I               asked               if               she               could               fax               me               a               copy               of               it.

The               representative               complied.
               When               I               pulled               the               fax               from               the               fax               machine,               I               could               hardly               believe               my               eyes.

Here,               finally,               was               our               golden               ticket,               our               only               means               of               ever               getting               to               the               bottom               of               this               unpaid               claim.

What               I               found               instead               was               a               single               page               with               a               checkbox               asking               if               my               husband               had               any               pre-existing               conditions,               and               instructions               to               fill               out               the               information               indicated               on               the               lines               below               that               had               an               "x"               next               to               it.

None               of               the               lines               below               had               an               "x"               next               to               them.
               I               called               back,               parroted               the               whole               story               from               memory               by               now,               and               asked               which               line               I               needed               to               complete.

The               representative               told               me               she               didn't               know.

She               had               no               way               of               knowing               which               line               I               needed               to               complete,               because               she               didn't               have               any               way               of               viewing               the               questionnaire               that               had               been               sent               to               us.

Apparently               the               previous               representative               had               faxed               over               a               blank               questionnaire.

Sensing               that               this               was               going               to               end               badly,               I               requested               to               speak               to               a               supervisor.

I               was               told               a               supervisor               would               call               me               back               within               48               hours.
               When               the               48               hour               timeframe               had               come               and               gone,               I               decided               I               was               done               dealing               with               United               Healthcare.

Certainly               there               had               to               be               an               advocate               group               out               there               to               help               people               in               cases               such               as               this.

I               discovered               that               the               State               Commissioner's               Office               of               Virginia               did               indeed               help               people               with               scenarios               similar               to               ours.

This               whole               time,               I               had               kept               notes               on               who               I               spoke               to,               when               I               spoke               to               them,               what               I               was               promised,               and               what               actually               happened.

I               took               my               notes               and               typed               them               all               up               in               a               letter               which               I               sent               to               the               State               Commissioner's               Office,               who               then               forwarded               my               letter               to               United               Healthcare.

Any               correspondence               from               this               point               would               be               mediated               by               the               State               Commissioner's               Office.
               Within               a               week,               we               had               received               a               reply               back               from               United               Healthcare,               which               had               been               forwarded               to               us               via               the               State               Commissioner's               Office.

In               their               reply,               United               Healthcare               essentially               begged               that               this               not               go               down               as               a               formal               complaint               against               the               company,               and               that               they               would               look               into               the               situation               and               come               to               a               resolution               within               45               days.

They               promised               to               send               a               letter               stating               their               final               decision               about               the               claim               to               the               State               Commissioner,               who               would               then               forward               it               to               us.
               I               finally               began               feeling               a               sense               of               hope.

Maybe,               just               maybe,               this               would               be               the               answer               and               soon               this               nightmare               would               end.

I               finally               felt               like               somebody               had               my               back               and               was               listening               to               me.

While               we               were               waiting,               we               received               a               doctor               bill               for               a               co-payment,               which               we               took               as               a               good               sign.

Maybe               United               Healthcare               was               finally               processing               the               claim               and               now               the               doctors               were               sending               out               our               portion               of               the               bill.

We               immediately               paid               the               amount               owed               and               waited               for               the               final               letter               from               United               Healthcare.

But               then               the               45               days               passed               without               receiving               anything.

In               fact,               it's               been               about               6               months               and               we               still               have               not               heard               back               from               United               Healthcare.

I               know               we               should               elevate               this               issue               to               the               next               level,               but               I               fear               we               are               succumbing               to               the               wear-down               tactics               of               the               health               insurance               company.

If               they               make               things               difficult               enough,               people               will               give               up               fighting               against               improperly               denied               claims.
               In               the               meantime,               I               know               that               we               are               not               alone.

United               Healthcare,               I               discovered,               denies               more               claims               than               any               other               health               insurance               company               out               there.

They               deny               a               whopping               14.4%               of               their               claims,               whereas               the               national               average               stands               at               4%.

This               experience               has               completely               soured               me               on               health               insurance               altogether.

We               faithfully               paid               our               premiums               every               month,               and               the               one               time               we               needed               health               insurance,               they               did               not               come               through.

Not               only               did               they               not               come               through,               they               have               fought               us               the               entire               way               while               taking               our               money,               and               have               ruined               my               husband's               credit.
               Neither               of               us               currently               have               health               insurance.

Rather,               I               view               health               insurance               the               same               way               I               do               social               security:               it's               a               good               idea,               but               I               am               not               counting               on               it               to               be               there               when               I               need               it.

It               is               every               man               for               himself               out               there               these               days.

I               would               rather               put               the               money               I               would               have               spent               on               monthly               health               insurance               premiums               into               an               investment               account               and               put               that               money               to               good               use               so               if               we               need               it               for               health               reasons               later,               we               can               count               on               it               being               there.
               Sources:               "Think               You're               Insured?

Maybe               Not."               -               March               2007               issue               of               Money               Magazine               by               Walter               Updegrave               and               Kate               Ashford






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