One such encounter went like this:
Me: “Hi. I’m calling about my daughter’s ambulance and hospital charges. I haven’t been able to reach my grievance coordinator about the appeal.”
Representative: “I can help you.”
**Me: **(Genuinely excited.) “Great!”
Representative: “Oh, I see your daughter turned 18. I can’t discuss her information with you.”
Me: “I sent a release of information form by mail, fax and email. I also faxed our conservatorship papers.”
Representative: “I’m sorry, it’s not on file. What office did you send it to?”
Me: (I give the information.)
Representative: “That’s the wrong fax number. Let me give you the correct one.”
Me: “I’m not inventing numbers out of the ether. This is the third new fax number I’ve been given. Are the address and email inaccurate too?”
Representative: “I’m sorry, but I can’t discuss your daughter’s claims with you without this information. Can you put her on the phone to give verbal consent?”
**Me: **“I can’t put her on the phone. She’s currently in a treatment center and has no access to a phone, which is why I have a conservatorship to help with her medical care.”
Representative: “I’m sorry, ma’am. There’s nothing I can do without the forms or her verbal consent.”
Me: “Who do you think pays the insurance premium and all her providers? I’m just trying to settle her claims, and I don’t know what we owe without access.”
Representative: “I can only answer general questions.”
Me: “OK. From the bills I’ve received, we’re being charged out-of-network fees for the ambulance, ER, ER doctor and hospital.”
Representative: “Was this out of state?”
**Me: **“Yes.”
Representative: “Hang on, I have to transfer you.”
I was on hold for another 15 minutes, and then got cut off. I called back, was transferred twice and then repeated a version of the above conversation before resuming — with a grievance coordinator!
Grievance coordinator: “The ambulance and ER facility were both out of state and out of network.”
Me: “A treatment center called for an ambulance. I wasn’t given a choice of who responded or where they took her.”
Grievance coordinator: “They used out-of-network providers.”
Me: “They dialed 911. No one stops to ask the closest ambulance what their network status is.”
Grievance coordinator: “They did transfer her to an in-network hospital, but the physicians were not participating providers.”
**Me: **“Under the No Surprises Act, insurance must cover all providers in the case of an emergency, whether they are in network or not — even if out of state.”
(There was a long silence.)
Me: “Are you still there?”
Grievance coordinator: “Yes, ma’am. Once you get the conservatorship papers to us, we can look at those claims. Is there anything else I can help you with?”
Me: “Apparently not.”
How is this legal?
It actually isn’t, but those in charge know our legal system works so slowly. So the companies already know they just have to delay and they’ll only pay a percentage of a fine for swindling patients. And instead of being accused of robbing, their legal team will get charges lowered and the company will just change its name and start over. Until the punishment fits the crime, the rich scams will continue.
Yup. They violate HIPAA all the time, too. Rules for thee, not for me.
Bingo. Which is why they comfortably hide using the infighting of the two party system. One party has to be willing to accept they’ll be doing most of the work to fix the situation. Up until now, they wanted us believing the task is Sisyphean and impossible, the truth is we can easily catch them with their pants down.
Oh you sweet summer child. As if that matters.
It’s not but since the Government refuses to enforce it’s own laws, it’s up to individuals to pursue expensive and extremely long civil cases.
RepubliQan’ts
This has been a problem for decades longer than they have been around.
Wtf?
Or
Or
If #1 or #2 is your meaning, allow me to debate your position.
Conservatives (including conservative neo-liberals) are the direct fucking cause of this situation. If they were removed from the equation, we would at least be on par with one of the 30 other developed nations. We are the ONLY developed nation on earth without healthcare, and the reason for it is conservative cockroaches doing the bidding of the billionaire class. That is the only reason.
The cure to our health woes is the eradication of conservatism. It really, truly is as simple as that. If we were able to cure the plague of conservatism, we would be rewarded with a normal civilization that includes a healthcare system.