Archive for October, 2009

PostHeaderIcon Healthcare reform update – part two

The Senate Finance Committee approved their version of the healthcare bill. This proposal eliminated the public option and left states to fend for the uninsured and formerly untaxed medical coverages and insurances are now ridden with taxes — insurance policies that cost over $8,000 annually will herein be taxed.  Individuals without insurance will be penalized.
The new proposal contains long needed reforms, such as elimination of any pre-existing conditions penalties as well as the removal of lifetime caps.  Other measures, such as elimination of co-pays and deductibles, could be beneficial but we all need to remember that added benefits carry added cost.  

Both houses are working to combine five healthcare proposals to come up with two competing bills. Somewhere along the line, Congress lost track of the need to devise a bill that is best suited for this nation as a whole. The goal now is to formulate a bill that will pass with enough votes.

Healthcare reform is too important just to pass any bill. The erroneous bill will do more harm than good.

PostHeaderIcon Pre-existing condition…

The pre-existing condition is a health condition or illness that you have had before your first day of coverage on a new plan. The actual health coverage for those with pre-existing conditions depends on a number of factors such as the type of health insurance plan, the level of care that required for your pre-existing condition, and your health insurance history. A person with a pre-existing condition can cost an insurance company big bucks and naturally, it is in their best interest to exclude those who have them.

On the ligth side, here’s The Wizzard of ID cartoon that does describe the meaning of pre-existing condition on a morbid way:
Wizzard of Oz

PostHeaderIcon If you don’t like the answer…

A significant part of a claim assistance professionals work consists of follow up with insurance companies.  We send claims, appeals, and other items, and wait, usually 30 days, to have it processed.

Today I called an insurance company to follow up on a claim submissions as well as two appeals.  I was told by the customer service representative that they cannot do anything until the Human Resources department update specific files.  I was advised to request this information to be sent to the insurance company directly from the member’s HR Department.  Having been doing this for several years, I’ve learned not to argue and didn’t get carried away.  After all, this is business as usual….

So, naturally I waited about 10 minutes to simmer over and called again the same insurance company, the same phone number, and naturally about the same claims and appeal letters.  The second call yielded a completely different result.  The customer service representative checked the claims, verified that all information is correct, and on the file, and promised to reprocess these same claims by the end of this week.

The lesson of my story: if you decide to call your insurance, and push all the necessary buttons on your phone, while lucky enough to get a life human being, the answers aren’t always the same.  Therefore, if you don’t like to response, call again and repeat as necessary.