Each of the past 4 years my employer has changed insurance providers due to bad employee experiences. We have 350 employees and I was part of and supported the decision to move each time. Presently we are back on Anthem, which we were on pre-Obama care which from my observation is the point shortly before everything went downhill. Our experience on Anthem pre-Obama care was very positive.

I had 1 shoulder (injury) surgery and my wife had 1 child pre-Obama care. No issues, everything related to insurance was smooth sailing.

Post Obama care my wife has had 2 children and 1 surgery. Each time the amount of paperwork, billing screw-ups, and seemingly pointless hurdles has increased.

Yesterday I had a bone-spur removed from under my scapula, and the bursa that the bone spur destroyed also removed. It was an arthroscopic out-patient procedure. Prior to the surgery Anthem sent me a nice form saying the surgery was approved. I thought oh good, this should be easy this time.

That approval form was then followed up by a total of 7 forms to fill out prior to the surgery. All asked similar questions like if this was a work place injury, or if I had any additional insurance that could be billed for this. Each of these letters required I fill out and return the physical form (no electronic option), and warned if not returned they would not approve the surgery (even though it was already approved). I also had to buy stamps for the first time in like 3 years to mail back these stupid things.

Then in the span of 5 days I got 3 phone calls from Anthem to verify the surgical information (including the date of surgery) and what caused the injury. I did get to at least have a little fun with that question, as I just answered- I dunno, calcium?

The last final hassle from them came yesterday evening. It was a 2 hour ride home from the out-patient center, my wife dropped me off and then went to drop off the script of 5 day supply of pain meds. CVS said it would be a few hours, but no big deal as I had a nerve block and this was not a major surgery. 3 hours later and the nerve block is starting to wear off, so my wife runs out to pick up the script. CVS tells her that when they ran the script through insurance, the Anthem rejected the script because “they need to have the orthopedic surgeon contact them to tell them the purpose of the prescription is for”. WTF is wrong with these idiots?

It was a $17 script without insurance so we just went that route, but then it took CVS another hour to fill it because they didn’t even start filling it after the idiots at Anthem rejected it.

My question for all is- are others experiencing this same sort of stupidity in their states? Every year regardless of the insurance company it seems like this type of nonsense gets worse.

Your experience is becoming more common than ever before. As a physician I experience the issues on both sides. I’ve been been called about a prescription as you explained. The nurse practitioner wrote the prescription using our electronic system. Despite the indication being on the prescription the pharmacy still called me. I returned the page and held for less than a minute. Spoke to the pharmacist for a about 15 seconds and everything was good to go. Amazingly frustrating for the patient and the physician.

My hospital is currently trialing a model in which the coding personnel will come with me on rounds 2 days a week. Both are seasoned nurses who have transitioned into the coding aspect for a 9-5 schedule. They don’t treat patients. They simply interpret my findings into acceptable billing wording that I then apply to my notes. For example, if a patient has low sodium and I include low sodium in my note it is not recognized. However if I say hyponatremia that counts and is applied to the severity of illness and is recognized for billing in the sense that I identified the issue and if I order a treatment then that will add to the bill. Also to clarify I’m a flat rate salaried physician so it doesn’t matter if I accumulate $10 or $10 million in charges not to mention the fact that charges and collections are two entirely different

I chose my profession for many reasons and am truly blessed but it scares me when I see the direction things are going. In our region we’ve had two hospitals announce closure and one announcing cutbacks in service in the past 6 weeks. Not to mention a national physician shortage that will only get worse according to most projections.

My son was hospitalized last year for a couple days for a severe virus and dehydration, dehydrated so much that he hadn’t peed for 16 hours which is not good for a 2 year old. The insurance company was less than helpful at first. Thankfully I finally spoke to an intelligent young lady in Minnesota who identified the coding issue and adjusted the claim which saved me about $10000!

Sorry for the rant. I do feel better!

I've had anthem for years. Even before I was retired. I have had nothing but good experiences with them. I just had a routine colonoscopy and everything was covered 100%

I've started paying for two prescriptions out of pocket because I don't want to fight the assholes.

I long for the pre Obamacare days when insurance was cheap and covered everything. Back then people bought high deductible plans to save money, now it's the only way to afford coverage that doesn't really cover anything.

CVS.....don’t get me started. I’m not to happy with them either.

quote:

Originally posted by phil in indy:
I've had anthem for years. Even before I was retired. I have had nothing but good experiences with them. I just had a routine colonoscopy and everything was covered 100%

Colonoscopy over age 50 is usually covered 100% by all Medical Insurance companies. Comes under preventative maintenance.

quote:

Originally posted by mindustrial:
CVS.....don’t get me started. I’m not to happy with them either.

One CVS pharmacy I go to is efficient and quick with filling a prescription. Another has staff that's lazy and won't even answer the phone.

quote:

Originally posted by Skins2881:
I've started paying for two prescriptions out of pocket because I don't want to fight the assholes.

I long for the pre Obamacare days when insurance was cheap and covered everything. Back then people bought high deductible plans to save money, now it's the only way to afford coverage that doesn't really cover anything.

I agree, and I hope and think once Trump is re-elected, he'll get rid of this crap of Obamacare in his second term. I'm paying double what it cost pre-Obamacare for less insurance and higher deductables.

About 4 years ago I had united health care and didn't realize or pay attention that the primary care physician they put me with was a 4 hour drive from me. I was 37 and didn't really see doctors. So anyways I had a cyst pop up in me butt crack that was painful as hell. My sister is a pharm rep and recommended a few DR's and one of them was on my plan, so I made an appointment and went in. They said I needed a referral from my doctor first. I couldn't wait so I said how much is it if I just pay cash, $250. Ok so I paid for it. I went home and called United and straightened out the primary care and they switched it to the DR I went to, retroactively to the beginning of the year. So I walk into the DR 4 days later and tell them, and they can bill my insurance......WELL..... a month later I get a full page bill with a bunch of items and owe an additional $249 , on top of the $250 I paid. When I mentioned it, they say when it goes through insurance it's a set amount etc. I was SOOOOO pissed, I thought I was doing them a favor and they could bill more and it cost me double...…….this is precisely what is wrong with the insurance industry.

This message has been edited. Last edited by: jimmy123x,

I'm clerking in a pharmacy. Jan 1 many, many insurance companies changed numbers and codes on policies. My training started learning the forty bazillion combinations of computer entries to apply the insurance and learning how to read the denials. I took it as an opportunity to hustler for my employer's pharmacy discount plan. 26 bucks a year, and a whole bunch of common scripts are discounted up to 80 percent, and can be applied regardless of insurance. Obamacare is driving innovation in that part of medical services.

To avoid confusion, I'm also selling guns part time in a LGS.

quote:

Obamacare is driving innovation in that part of medical services.

^^^^
How??

This is one reason to be glad I’m getting older.
I am self employed and was paying outrageous premiums for crappy insurance and high deductibles.
I’ve now been on Medicare for a year and a half with a part G supplement plan.
One of the few nice things about aging.

quote:

Originally posted by 220-9er:
This is one reason to be glad I’m getting older.
I am self employed and was paying outrageous premiums for crappy insurance and high deductibles.
I’ve now been on Medicare for a year and a half with a part G supplement plan.
One of the few nice things about aging.

Next January for me. Same thing. I've made deductible and out of pocket (around $4K total) four years in a row now. Hope medicare helps the cash flow.

I have been retired since 2012. Prior to that, I worked for 39 years. I was a self-employed physician. My family was covered by an individual BC/BS plan. I never had a co-pay and never had a deductible. Never paid a dime out of pocket. Now people are saddled with huge premiums and huge amounts they have to pay before the insurance company pays a dime. We will never have "affordable health care" in this country as long as the insurance companies and the drug companies are given free rein.

Based on my experiences with health care recently,
I firmly believe that our entire system of health care needs to be trashed and rebuilt. With emphasis on quality care and not profit or greed.
How we could accomplish this is beyond me. Too many entities would block the process.
Here is one of my recent health care funsies:
I was scheduled to have an ultrasound exam. When I was called up to the registration desk, the bored clerk entered (yet again) my info into their system and then made a phone call. She then handed me the phone and told me that someone wanted to talk to me. It was their billing dept, who told me they had "estimated" how much my procedure was going to cost and they wanted to know how I wanted to pay for it.
No treatment rendered yet. No diagnosis made. But pay up! I said three words: Bill my insurance. And hung up.
Thank God I wasnt actually sick.

The local clinics have started forcing everyone to use ipad type device to enter info before each visit. One required step is to pay any remaining balance whether insurance is involved or not. There's no way to proceed if you don't pay right then.

One receptionist said they can enter the info manually if you can't pay everything that day.

The best thing I did for our normal "day to day" type healthcare was to sign us up with a concierge practice. I can see my doctor as much as I'd like, for an unrushed hour, and not worry about insurance. I get my low cost meds from them also at wholesale cost so I don't have to worry about the insurance company blocking a prescription for whatever reason.

^^^^^^^^^^^
Yep. You do have to carry catastrophic insurance for possible hospital stays, but it is great for both the patient and the physician.

quote:

I’ve now been on Medicare for a year and a half with a part G supplement plan.
One of the few nice things about aging.

amen. I'm so happy with medicare and the supplement. saves a lot of time energy and aggravation that was typical with previous insurance plans.

BCBS is the absolute WORST for us. My pain management doc has been fighting with them for a month trying to get a procedure covered. We pay thousands for their coverage and they piss and moan about every claim. Insurance is a scam

I got so irritated with BC&BS, they would not pay for normal monthly prescriptions. Stall and delay and deny, over and over.

I talked to the Costco Pharmacist and found out I can pay cash and get it with no hassle. The price was within a couple 2 or 3 dollars of my BC&BS copay. Yea Costco!