Insurance

Posts from Jan. 1, 2018 to the present. Plus important announcements. (ICD warning sounds)

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ROBO Pop
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Joined: September 14th, 2009, 2:36 pm
Location: the Oval Office

Insurance

Post by ROBO Pop » May 29th, 2018, 11:55 am

Here I am a month since my Cardiologist informed me I have severe sleep apnea and wrote a prescription for a CPAP torture chamber yet no word from the medical supply co.

Last I heard out on the street was the insurance was stalling...my guess they're hoping lack of oxygen to the brain causes more brain damage and loss of what was that again?

US insurance has become a travesty. I just got a scrip for unstable angina and had to fork over $500 out of pocket for one month. This on top of my already high monthly premiums for Medicare, Supplemental Insurance, and Part D prescription coverage.

So I could go out and buy a CPAP or rent one paying out of pocket, like yourkidsmom suggested, until insurance decides one way or another whether I'm worth it, but really? Why do seniors in the United States have to fight for proper care. I fought in a war and sacrificed for this country because I loved it and was proud to be an American, guess the feelings aren't mutual...
Broken Heart
Nobody has ever survived life, but I'm trying...
My story and sticking to it
http://www.icdsupportgroup.org/board/vi ... 97&p=91375

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mykidsmom
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Joined: February 9th, 2012, 5:09 pm

Re: Insurance

Post by mykidsmom » May 29th, 2018, 1:00 pm

I dont even know what to say to you...everyone i know and their grannys here have cpap machines someone i know got one the other day for restless leg syndrome....its despicable that some little pen pusher somewhere has the ability to decided if your care requirements prescribed by a dr should be approved or not..health issues are big business in your country and they shouldnt be...

I personally would try to pick up a machine...every day you get some relief is a good day...and heaven knows when this shower of robbers will if ever approve yours....and how come your drugs cost so much....i always need to have epi=pens and theyre 4 times as expensive down south of our border....none of it makes sense....

get your machine....you shouldnt need to battle this battle when your sick and in need of it..and i can very easily imagine how upset disappointed and down right fed up you are.....love x0x0x
I think.....Therefore I am.!!!!!

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TruckerRon
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Joined: February 22nd, 2010, 8:52 pm
Location: Provo, UT

Re: Insurance

Post by TruckerRon » May 29th, 2018, 5:54 pm

I can't imagine being treated so badly by an insurance company unless it's collapsing into Chapter 13 (corporate bankruptcy with no hope of recovering). I suggest you contact these people:

Consumer Assistance Section
2910 North 44th Street, Suite 210
Phoenix, AZ 85018-7269

Telephone Representative Hours: Mondays - Fridays, 9 AM to 4 PM

Walk-in Hours (Mondays - Fridays)
- w/o appointment: 9 AM to 4 PM
- w/ appointment: 8 AM to 5 PM (meetings must end by 5 PM)
consumers@azinsurance.gov
602-364-2499
TruckerRon -- Received Minion I on 17 Sep 2009, Minion II on 26 Jan 2015

Non-ischemic cardiomyopathy
Medtronic Viva XT CRT-D
No shocks yet...
My intro is at: http://www.icdsupportgroup.org/board/vi ... 099#p57099

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Ozchrissy
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Joined: September 27th, 2008, 9:28 am
Location: Australian

Re: Insurance

Post by Ozchrissy » May 29th, 2018, 7:36 pm

I am with Ron, make as much noise as possible. As you say, you deserve the best and to be treated with respect. We have a scheme over here where the GOVERNMENT supplies the CPAP machine, free of charge. My sister got one at Christmas and only had to wait 2 weeks.

I know this doesn't help with comparisons, but surely you have recourse, I know I would be jumping up and down and really making a noise. Even the local paper would hear about it. Over here we do have a culture of making things we disagree with PUBLIC. We just had a drug approved under our PBS system for Emphysema, which was costing $100,000 a months approved for patients. That came about because of Public lobbying and probably because there is an election coming up. BUT. Also all my drugs are on the PBS as well, I only pay $6 for each prescription and when I reach a cut off for out of pocked expenses they will be free. I am almost at that stage now.

AS you say you have worked all your life, paid your taxes and I believe you also contributed each pay to a Social Security network, so you do deserve to receive all the care you should. This is not socialism as some people like to call it, but JUSTICE and a society looking after its own.
“I am not what happened to me, I am what I choose to become.” Carl Jung

Diagnosed with cardiomyopathy in 10/99
LBBB & VT diagnosed Feb 06
Guidant Biventricular Pacer ICD inserted Feb 06: Boston Scientific Incepta CRT-D inserted May, 2012
Oesophageal Cancer, 2012, Gall Bladder & Septicemia 2014 resulting in VFib and severe heart damage
Bare Metal Stent May, 2012 Mitral Valve replaced 2015
Meds: Entresto, Bicard, Coralan, Eurtorxsiq, Frusehexl, Spiractin, Sigmaxin, Creon, Warfarin,
Appropriate Shocks for Ventricular VFib.

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mrag
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Joined: February 10th, 2009, 4:56 pm
Location: The Former Mushroom Capital of World when America was great

Re: Insurance

Post by mrag » May 29th, 2018, 11:15 pm

With all due respect, ROBO is apparently having an issue with Medicare. Medicare is a SINGLE PAYER federal program offering medical insurance in the USA to those 65 and over regardless of health. Previous or otherwise. Virtually EVERY sane person over 65 enrolls in Medicare as soon as they can.

Medicare is a program challenged by Republicans who wish to end it. Hence this is a POLITICAL matter and totally unsuited for this forum.

Please lock and or dispose of this thread in its entirety. In the interim, you can offer some thoughts and prayers to ROBO if so inclined.
"The greatest enemy of knowledge is not ignorance, it is the illusion of knowledge" S Hawking

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TruckerRon
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Re: Insurance

Post by TruckerRon » May 30th, 2018, 9:53 am

mrag wrote:
May 29th, 2018, 11:15 pm
With all due respect, ROBO is apparently having an issue with Medicare. Medicare is a SINGLE PAYER federal program offering medical insurance in the USA to those 65 and over regardless of health. Previous or otherwise. Virtually EVERY sane person over 65 enrolls in Medicare as soon as they can.

Medicare is a program challenged by Republicans who wish to end it. Hence this is a POLITICAL matter and totally unsuited for this forum.

Please lock and or dispose of this thread in its entirety. In the interim, you can offer some thoughts and prayers to ROBO if so inclined.
The topic here is about INSURANCE. Not political parties or political goals that those parties may or may not have. Those would definitely be OT. So don't go there, OK?

nononono
TruckerRon -- Received Minion I on 17 Sep 2009, Minion II on 26 Jan 2015

Non-ischemic cardiomyopathy
Medtronic Viva XT CRT-D
No shocks yet...
My intro is at: http://www.icdsupportgroup.org/board/vi ... 099#p57099

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Michael L
Posts: 528
Joined: June 17th, 2014, 8:39 am
Location: Central Florida

Re: Insurance

Post by Michael L » May 30th, 2018, 12:35 pm

I agree with the others, make noise! Write your representatives at both the Federal and State level. Write your medicare advantage insurance company - it has been my experience that a letter directed to the CEO versus the local patient advocate will get a quicker and more appropriate response! Depending on how much they charge to rent a CPAP you may be better off purchasing one. After 13 monthly 'rental" payments based on your supplemental insurance you own the machine.

Good luck and I hope you get some relief.
Biotronik Ilesto 7 implanted May 5, 2014
CABG 3X February 1998

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ROBO Pop
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Joined: September 14th, 2009, 2:36 pm
Location: the Oval Office

Re: Insurance

Post by ROBO Pop » May 30th, 2018, 1:57 pm

Thank you guys. :::) I cannot tell you all how I appreciate being able to come back after starting a discussion to read and find out what I was thinking...I really seldom know lmao4dx
Broken Heart
Nobody has ever survived life, but I'm trying...
My story and sticking to it
http://www.icdsupportgroup.org/board/vi ... 97&p=91375

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ROBO Pop
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Joined: September 14th, 2009, 2:36 pm
Location: the Oval Office

Re: Insurance

Post by ROBO Pop » May 30th, 2018, 5:03 pm

It just don't get any better than this...The long awaited call from CPAP equipment provider in Georgia came this afternoon. The lovely lady on the phone graciously announced that they have an overlap in business with another company in this area and cannot service me as it would be a conflict of interest, but they would be happy to provide me the name of another company who may be able to help me out.

Why yes, yes I did ream her rear. It's been 5 weeks since they got the prescription and called me to confirm my address and insurance. It took 5 weeks to figure out they don't service this area? and get ready for this...they have a facility here in town just blocks from my Cardiologist's office. I called just to confirm it is the same company. They weren't sure a CPAP would fit where I told them to put it. Now we know why it's a 2.2 out of 5 star business rating. Well honestly I wonder who rated them so high.

And so it goes. Does the steam coming out of my ears make my face look fat?
Broken Heart
Nobody has ever survived life, but I'm trying...
My story and sticking to it
http://www.icdsupportgroup.org/board/vi ... 97&p=91375

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TruckerRon
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Joined: February 22nd, 2010, 8:52 pm
Location: Provo, UT

Re: Insurance

Post by TruckerRon » May 30th, 2018, 5:38 pm

ROBO Pop wrote:
May 30th, 2018, 5:03 pm
...And so it goes. Does the steam coming out of my ears make my face look fat?
I have only one response to this situation:

TruckerRon -- Received Minion I on 17 Sep 2009, Minion II on 26 Jan 2015

Non-ischemic cardiomyopathy
Medtronic Viva XT CRT-D
No shocks yet...
My intro is at: http://www.icdsupportgroup.org/board/vi ... 099#p57099

DebW
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Joined: July 23rd, 2016, 6:23 pm

Re: Insurance

Post by DebW » May 30th, 2018, 6:34 pm

That is just stinking crazy ROBO!!!

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Ozchrissy
Posts: 7249
Joined: September 27th, 2008, 9:28 am
Location: Australian

Re: Insurance

Post by Ozchrissy » May 31st, 2018, 6:23 am

Ditto to what Deb said, I have been thinking of a response all day, I was speechless, but Deb summed it up.
“I am not what happened to me, I am what I choose to become.” Carl Jung

Diagnosed with cardiomyopathy in 10/99
LBBB & VT diagnosed Feb 06
Guidant Biventricular Pacer ICD inserted Feb 06: Boston Scientific Incepta CRT-D inserted May, 2012
Oesophageal Cancer, 2012, Gall Bladder & Septicemia 2014 resulting in VFib and severe heart damage
Bare Metal Stent May, 2012 Mitral Valve replaced 2015
Meds: Entresto, Bicard, Coralan, Eurtorxsiq, Frusehexl, Spiractin, Sigmaxin, Creon, Warfarin,
Appropriate Shocks for Ventricular VFib.

InSync
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Posts: 976
Joined: July 21st, 2012, 10:26 pm
Location: The Edge of America, SC

Re: Insurance

Post by InSync » May 31st, 2018, 7:43 am

There seems to be a disconnect within insurance companies and medical providers. Processes that used to be quite simple are now very complex. I recently had a couple of lumbar steroid injections for sciatic pain. Both times, insurance pre approval was quick, almost immediate. Then when billed, both times the charges were denied and I got forms to fill out to declare if the service was to treat an accident. Easy to resolve, but left me shaking my head and wondering if departments don't talk to each other, don't have electronic records, etc. It seems that often the process is the biggest hurdle and finding the right person to help is the biggest challenge.

I hope you get it resolved soon!
Dilated Cardiomyopathy, LBBB, CHF
St. Jude CRT-D 5/12
The beat goes on.....

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mykidsmom
Posts: 3656
Joined: February 9th, 2012, 5:09 pm

Re: Insurance

Post by mykidsmom » June 1st, 2018, 9:04 am

I agree with Deb and chrissie....but regarding the insurance Insync i cant even pretend to understand your insurance system...my g/f in SC has 2 insurances Plus some veterans plan from her hubby...and she still manages to have to pay almost $400 a month....now my friend in Ill recently went by ambulance to the local hospital had some xrays given some meds and sent home...shes saying now her premiums are going to be more than $1000 a month she got an huge whopper of a bill for her trouble but looks like her insurance is only paying a portion???? and the increase in her monthly premiums seems to me to be penalizing her for using the coverage....

I think to navigate thro the red tape and all the rules and regulations youd need to be as sharp as a whistle and many of us sickies are in brain fog constantly...
I think.....Therefore I am.!!!!!

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ROBO Pop
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Joined: September 14th, 2009, 2:36 pm
Location: the Oval Office

Re: Insurance

Post by ROBO Pop » June 1st, 2018, 11:50 am

Ron catch 22 - so true
mykidsmom wrote:
June 1st, 2018, 9:04 am
i cant even pretend to understand your insurance system...

I think to navigate thro the red tape and all the rules and regulations you'd need to be as sharp as a whistle and many of us sickies are in brain fog constantly...
Unless you have nothing better to do with your life, don't read further... consolsmile

I used to negotiate with insurer's for my employee's healthcare coverage and even with my experience can't understand the nuances. When I retired and went onto Medicare I had to get a licensed insurance agent to explain much of it. Didn't help. I finally called all of my doctors Accounting departments, the local hospitals accounting, and two transplant facilities to get their opinions on what combination of insurance would best suit my specific needs with my condition, and for the record, I am certain they gave me the best advice you can get.

Point of interest, rules for Medicare and coverage they provide can vary state to state even though administered by the Federal Government.

Medicare is very complex and basically is a step back into the 1970's where you pay monthly premiums plus co-pays for every medical visit, plus 20% of what services they will approve. Some things they do cover there is still an annual deductible such as my prescription which cost me $500 oop. Anything they deem outside coverage I pay out of pocket full cost.

Medicare is a federal health insurance program for people 65 or older and/or younger people with disabilities. It's not free, I pay a monthly premium. Additionally I have what is known as supplemental insurance which covers some of the "gap" that Medicare doesn't pay with a private insurance company, and again I pay a stiff monthly premium for that insurance. And let's not forget that neither of those cover medication so I have a third insurance for that, yep another monthly premium plus co-pays. Dizzy yet? My poor bride chose to work two more years beyond when she could have retired purely because of the insurance costs, and her employer (state government) will actually pay a part of her insurance when she finally does retire this November.

Now a lot of people might point to some laws that made changes in the recent past for those ridiculous conditions, but in fact, this is a long time pain in the derriere for Americans. I can remember fighting this and paying through the nose when I first started my career and that sure wasn't yesterday. Sadly, Insurance company profits are up significantly and they are paying their CEO's enough to support several third world countries yet they scream they have to raise rates. Like much of what's going on now days, at some point it will all come to a head and people will rebel.

and no, I still haven't heard anything about the CPAP kick butt
Broken Heart
Nobody has ever survived life, but I'm trying...
My story and sticking to it
http://www.icdsupportgroup.org/board/vi ... 97&p=91375

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