My Insurer is Dysfunctional

[bmichaelh]

I get my health insurance from my employer.

My health insurance provider is dysfunctional.

I just finished my sixth chemotherapy cycle using the R-CHOP protocol.
The insurer refused payment of a $46K drug rituximab as medically unnecessary.

On the other five chemotherapies, they initially refused payment for the same drug for the same reason, as medically unnecessary.
When I provided them documentation proving it was medically necessary, they paid for the drug.

I should not have to go through the process again to provide them documentation which they possess.

[Sherman A1]

1. Their function is to deny claims

and make you just have to fight for every last dollar to which you are entitled. So unfortunately you are going to have to repeat the process over and over and over again.

[modrepub]

3. My Friend's Mother Used to Work For A Lab

He job was to remind insurance companies to pay their invoices. When I asked her why she told me insurance companies like to delay payments hoping to push back their payments in order to make their quarterly statements look better; cash on hand from non payments adds to the bottom line. Sadly this was back in the 90s so this has been going on a long time.

[babylonsister]

2. That sucks. You don't need that

aggravation on top of treatments. You have my sympathies and I hope you don't have too many more treatments to go.

[HeiressofBickworth]

4. I finished my sixth and final round of R-Chop in Sept

Fortunately, I'm on Medicare and a supplement. I never had a problem with coverage for the expensive treatments. There is something woefully wrong with an insurance scheme that seems to exist just to collect premiums and deny coverage. Good argument in favor of Medicare for All.

My cancer was in remission after the first two treatments and still in remission after the sixth. Hope you have the same results!

[Voltaire2]

5. When I was desperately ill 15 years ago, I realized what an absolute crap system

employer based insurance is. I happened to have had no problems with refusing treatments, but I should have been at home trying to get better instead of dragging my sorry chemo-brained ass to work every day. The choice was: work or die. WTF kind of system is that?

My son almost died from a drug-resistant staph infection. While in the ER, one of the doctors who treated him was 'out of network', and had he not been admitted to the ICU, he would have been stuck with that bill. The infection spread to one of his eyes, and they tried to send him to the eye specialist in the hospital he had been admitted to, but they were 'out of network' so the insurance wouldn't cover it. So instead he had to see an in network specialist 30 miles away. WTF.

I think the people who keep claiming they love them their employer based insurance have never actually been seriously ill. It is a shit show. You spend days on the phone arguing with some poor person who is paid to deny you coverage about everything you need to do. Bills show up and you have no clue why. Back on the phone, again.

[mahina]

7. Holy crap. I hope your son is recovered, and you as well. Any filing process/setup reccomendations

To be as ready as possible?

Thanks very much.

[BigmanPigman]

6. Same thing happened with me and my Botox injections for daily migraines.

When you are going through pain and are ill the last thing you need is another headache from insur providers. I hate them all!

[bmichaelh]

8. Insurer Update

Update.

Well my insurer paid for the drugs.

[femmocrat]

9. Glad to hear that.

They must be craven heartless bastards to put desperately ill people through such stress.