ENDO Messages for September, 2007: Re: endo specialist/insurance

Re: endo specialist/insurance

From: D (anonymous@obgyn.net)
Wed Sep 12 22:58:41 2007

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What kind of insurance do you have? Is it a PPO? Insurance is a HUGE problem for anyone who has the misfortune to get sick. Every state has some kind of insurance board, they should be able to help you figure out the best way to appeal, and how to make a complaint if you don't get satisfaction. Here's the one for Illinois: http://www.idfpr.com/DOI/default2.asp

When they say they'll pay 60%, what they mean is they'll pay 60% of what they consider to be "reasonable and customary" charges (after you've met the deductible) - you pay 100% of everything above that, as well as 40% of everything within their R&C limits. Another way they squeeze customers is if you have multiple procedures done, sometimes they'll try to say only the main procedure was "medically necessary" and refuse to cover the others.

The way our healthcare system is now, if you can't afford it you can't have it. It's pretty scary! Insurance companies are in business to make money, and they do that by limiting care.

At Wed, 12 Sep 2007, endo wrote: >
>I had surgery w/ the CEC in atlanta Ga this past July and now I am
>getting these hellish stmts from my ins co telling me I owe over $17,000
>just for the Dr bill even though I pd $3500 already before surgery. This
>doesn't include the hospital bill. It's not fair that insurance
>companies won't pay for drs who give us the best care. Is this what
>would happen if I had a rare form of cancer and had to travel out of
>state to a specialist to save my life? I realize endo is not fatal but
>it does limit your life. I just needed to vent...if any one has any
>advice about how to dispute these charges, let me know. I have an email
>into the CEC to ask if they could help me out by resubmitting the claim
>or to word it so they would cover more of the bill. I was told that
>they would pay 60% up to 10,000 then 100% after that. Yeah right!! :( I
>am feeling much better but it's sad that insurance companies don't cover
>for endo specialists very well at all.

-- Find an endo specialist in the ERC's EndoDocs group: http://groups.yahoo.com/group/EndoDocs/

Try an excellent endo support group: http://groups.yahoo.com/group/erc/

Info on pain management: http://www.painfoundation.org/

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