California Fines Pacific Care

[saidinstouch]

As the title says, the state of California is investigating and planning to fine PacifiCare 1.33 billion dollars due to problems with their payments. I thought this seemed appropriate with the other thread on hospital bills and that people might like to know that if your insurance gives you trouble, it is worth writing to your insurance commissioner. An LA Times story can be found here http://www.latimes.com/business/la-fi-insure29jan29,0,3638983.story

PacifiCare is my primary insurance and has given me any number of problems requiring 10-20 hours or more to get resolved so I can continue my treatments for my crohns. My mom got fed up with them and filed a number of reports last year and was contacted yesterday to notify her that she might be asked to testify about our problems. So for all of us with problematic insurances, this goes to show that while the system might move slowly, it is worth your hour or two extra to notify the appropriate authorities when you believe your insurance has done something wrong.

From what my mom was told, PacifiCare is not the only insurance company being investigated for these practices. Apparently most or all insurance companies are being checked into by California right now and more similar announcements might be on the way. This is a big step toward better accessibility to treatments for us crohns patients and others like us who might rely on expensive treatments for our well being. Especially given that it is often very stressful to get the approval taken care of and maintaining that approval, which is a known factor to worsening our health.

Hopefully you all enjoy .

 

[Kev]

Hip, hip, hooray for our side. Now, all they need to do is take those fat beuracrats at those insurance companies, give them a colonoscopy prep, and take away their keys to the executive washrooms... Maybe lock them in their offices, or Caddys!!

 

[Sojourn]

I agree. They're getting so fat on their "bonuses" they probably could use a good colonoscopy prep cleansing. The former CEO of Blue Cross of Massachusetts is currently under investigation about a 16.4 million dollar severance he got when he left. Obscene.

Thanks saidsintouch. It's easy to brush off doing anything when you think nothing will come of it. My mother is the same way and is always sending letters and writing emails whenever she feels she is wronged. I've never much been one to do that. But I am going to go through all these bills, from my recent surgery, and am not in the mood to put up with much crap from the hospital or the insurance company so they better get it straight.

 

[D Bergy]

Being we deal with medical billing as a business, we have seen how inaccurate hospital bills can be. I advise anyone paying for a hospital bill, to go over it carefully.

There is probably a better than a 1 out of 3 chance it is incorrect for one reason or another.

Check to make sure you actually received the procedures listed and whatever else they are charging for. Also, make sure the insurance pays for what they are supposed to. Insurers rely on consumer ignorance to pass off charges they should pay on to the patients.

My wife has successfully argued every denial we have ever had. They have even paid for things they are not supposed to, such as outside lab charges. There was no hospital lab in this case, so there was no choice but an outside lab. Persistence can pay off in many of these cases.

Our prescription coverage is even paying for my LDN, even though Naltrexone is mentioned by name as a drug not covered. They actually have three reasons not to pay for it.

One: It is excluded by name.
Two: My coverage is not supposed to pay for compounded drugs.
Three: It could be argued it is experimental for Crohn's.

Yet they are paying for it. It is so cheap, I do not think they care. If it was thousands of dollars they would look at it much closer.


Dan Bergman

 

[saidinstouch]

Just wanted to update this thread. Apparently Nevada has decided to delay a takeover of Sierra Health services because of how poorly the takeover of PacifiCare in California. Apparently my Aunt watched the city council meeting where it was discussed and my particular case was brought up and played an important factor in the decision to hold off the merger.

Here is an article about the merger and the delay, the part about my case isn't included, but that isn't really news. I just feel glad that my case and the difficulties my mom and I have dealt with are actually being used for some good. Even if it is only a minor victory in the long run, it is definitely nice to know that people are doing something about it and it isn't just a small action, but a large possibly multi-billion dollar action.
http://www.boston.com/business/healthcare/articles/2008/02/08/nevada_critics_slam_unitedhealth/

I'll update you guys with more information if it gets made available to me. There is a decent chance the LA Times will be releasing a story that is based around what I went through and if it does happen I'll post it here. It is nice to know that the extra few hours to report our troubles might be the best few hours we have spent dealing with the insurance companies and once again I implore anyone who feels their company is doing something wrong/illegal to not hesitate and file a report with your state insurance commissioner. Even if you weren't wronged, it is one more person who forces them to look at a company and I can guarantee you enough other people have been wronged to get some action taken. It just takes enough people and enough reports.

We all know how horrible this disease can be, even for me who has had it fairly easy my first few years as far as daily symptoms go. The cost is immense to keep it that way and even then flairs are only one step away. It is nice to have a bit of hope that being treated like trash by a company will actually carry consequences.

 

[Kev]

Hey, score one for the 'little' guy.. with the big disease. Shows that you can fight 'city' hall (or in this case, should that be 'shitty haul'??). Keep us posted on this..