Our health care system is far from perfect

I was told that I had to schedule blood tests and cat scans pursuant to my doctors review on February 20th.  We scheduled it for this morning at 9:15.  On monday I got a robo call from Nortwestern reminding me to make my appointment.  This morning I got up a half hour early and took 2.5 hours driving in traffic jams because of the snow and ice.   I arrive about 9:20 five minutes late.  They have me sign consents and take me to a dressing room.  I put on robes and lock my locker.  I go to have a port put in the arm to get the contrast during the cat scan and then go to the table.....get the cat scan......dress......go to the 21st floor and get my blood drawn.....get in the car.....drive to a Wed poker tournament......get knocked out....drive to the office....check my voice mail.......Mr. Seaoat.....your insurance company has not approved the cat scan yet, and they are reviewing it, and you should reschedule the cat scan....time of call 9:30....my phone is in the locker, and Northwestern is calling my cell phone instead of the ct/diagnostic front desk to speak to me.  I now am facing a cat scan without insurance coverage because a Northwestern employee did not bother to call Cigna until Tuesday.........yet they robo call me Monday and tell me to be there.   If I told you this was not the first time, I would be lying.  Hospitals, doctors, staff, and insurance companies have created an environment of multiple mistakes and chaos.  I will give you an update, but this is going to be expensive, and I am totally dependent on the guidance of Northwestern and the doctors.

Sounds a bit like the runaround we've received in the care of a family member.
I feel for the workers who have to coordinate every dot of the I and cross of the T. So much in their work day and then to have the insurance companies having the final say. The medical teams are powerless in your medical care, it seems. Your insurance company decides your fate.

I don't blame Obama care as I know many will do on this forum. This particular problem has been going on for years. And it only worsens as the insurance companies worry over cost vs patient care/outcome.

The stress is not needed by the patient dealing with their personal healthcare.

They need to eat the charges of that cat scan. Simple as that.

They need to eat the charges of that cat scan. Simple as that.


Eventually this will be accomplished, but only after six months of layer after layer of resistance. We had this exact thing happen when my lung was removed in 08, and it involved about 16k. The problem is every time you go to schedule during the dispute period another doctor ordered procedure, they will be telling you that they need payment of some amount before they can schedule the next procedure.....it is a nightmare caused almost exclusively by lazy hospital personnel who wait to the last minute to get insurance clearances. I let my wife deal with it, and when she hits the inevitable roadblock, I get involved and go up the chain.......it is all avoidable.

SheWrites wrote:Sounds a bit like the runaround we've received in the care of a family member.
I feel for the workers who have to coordinate every dot of the I and cross of the T.  So much in their work day and then to have the insurance companies having the final say.  The medical teams are powerless in your medical care, it seems.  Your insurance company decides your fate.  

I don't blame Obama care as I know many will do on this forum.  This particular problem has been going on for years. And it only worsens as the insurance companies worry over cost vs patient care/outcome.

The stress is not needed by the patient dealing with their personal healthcare.

Since you are relatively new to the forum......I will repeat.Ihave been bitching about insurance companies for many years. You are right, insurance companies dictate healthcare. Insurance reform was needed years ago. It started when HMO's became popular....phyicians prostituted themselves for the monthly fee per patient without knowing they lost control of medical decisions.



Seaoat....tell the insurance company and Nortwestern you are sorry about their delimma and you hope it works out well for them. They will try to blame you for having the scan without being notified.....but in actuality the insurance company notifies Northwestern regards to the approval or not.

The good news is that insurance and hospital profits are way up... yea team..!!

Well when you have the government mandating that people have to buy something from a private industry so the CEO's and administration can line their pockets that tends to happen.

It's a good thing the 1% have the Democrats and current president in their pocket to help them out.

*****CHUCKLE*****

https://www.youtube.com/watch?v=lAD6Obi7Cag

Another profound statement. Oy vey.

*****CHUCKLE*****

https://www.youtube.com/watch?v=vzK6jefqoZk

2seaoat, so what?

Please keep in mind what Jonathan Gruber called everyone who supported ObamaCare. Allow me to remind you, on numerous times Jonathan Gruber called you Stupid.

Not me, no one but the architect of ObamaCare.

2seaoat, so what?

Please keep in mind what Jonathan Gruber called everyone who supported ObamaCare. Allow me to remind you, on numerous times Jonathan Gruber called you Stupid.

Not me, no one but the architect of ObamaCare.


Still thick as a brick......this has nothing to do with politics or the ACA. This problem existed in 2008 before the ACA, and it existed after the ACA. It has nothing to do with the huge success of the ACA which does not magically turn incompetent employees into competent employees. However, Gruber was correct that some people are stupid.....as evidenced by your response to this thread.

Joanimaroni wrote:

SheWrites wrote:Sounds a bit like the runaround we've received in the care of a family member.
I feel for the workers who have to coordinate every dot of the I and cross of the T.  So much in their work day and then to have the insurance companies having the final say.  The medical teams are powerless in your medical care, it seems.  Your insurance company decides your fate.  

I don't blame Obama care as I know many will do on this forum.  This particular problem has been going on for years. And it only worsens as the insurance companies worry over cost vs patient care/outcome.

The stress is not needed by the patient dealing with their personal healthcare.

Since you are relatively new to the forum......I will repeat.Ihave been bitching about insurance companies for many years. You are right, insurance companies dictate healthcare. Insurance reform was needed years ago. It started when HMO's became popular....phyicians prostituted themselves for the monthly fee per patient without knowing they lost control of medical decisions.



Seaoat....tell the insurance company and Nortwestern you are sorry about their delimma and you hope it works out well for them. They will try to blame you for having the scan without being notified.....but in actuality the insurance company notifies Northwestern regards to the approval or not.

It bears repeating, Joani! Two times in the last (boy she's old) years I have worked medical insurance. First time, no issues. Procedures scheduled, no stress for the doc or patient, insurance paid. If not, we provided office notes and procedure reports. Even dealt with workers' comp and that is a total pain in the ass. Second time around the nightmare about stroked me out! I could not explain anything to the insurance companies I dealt with because they knew NOTHING about diagnosis, medical care or procedures. Neither did they have knowledge of their own insurance rules. They spoke from a script. It got to be where I'd call them and immediately ask for a supervisor...which was usually a joke.

So, from my experience, it's not the workers in the system at the clinics and hospitals...it is...INDEED...insurance companies who don't know jack squat about your health needs.

I can't tell you how many times I said, "Excuse me, you work for an insurance company that is to surrender payment on this patients policy for a procedure their MEDICAL DOCTOR ordered. Where did you receive medical degree?"

And let me reiterate for the Obama bashers .... This is not about Obamacare. It's been going on for years.

SheWrites wrote:

Joanimaroni wrote:

SheWrites wrote:Sounds a bit like the runaround we've received in the care of a family member.
I feel for the workers who have to coordinate every dot of the I and cross of the T.  So much in their work day and then to have the insurance companies having the final say.  The medical teams are powerless in your medical care, it seems.  Your insurance company decides your fate.  

I don't blame Obama care as I know many will do on this forum.  This particular problem has been going on for years. And it only worsens as the insurance companies worry over cost vs patient care/outcome.

The stress is not needed by the patient dealing with their personal healthcare.

Since you are relatively new to the forum......I will repeat.Ihave been bitching about insurance companies for many years. You are right, insurance companies dictate healthcare. Insurance reform was needed years ago. It started when HMO's became popular....phyicians prostituted themselves for the monthly fee per patient without knowing they lost control of medical decisions.



Seaoat....tell the insurance company and Nortwestern you are sorry about their delimma and you hope it works out well for them. They will try to blame you for having the scan without being notified.....but in actuality the insurance company notifies Northwestern regards to the approval or not.

It bears repeating, Joani!    Two times in the last (boy she's old) years I have worked medical insurance.  First time, no issues.  Procedures scheduled, no stress for the doc or patient, insurance paid.  If not, we provided office notes and procedure reports.  Even dealt with workers' comp and that is a total pain in the ass.  Second time around the nightmare about stroked me out!   I could not explain anything to the insurance companies I dealt with because they knew NOTHING about diagnosis, medical care or procedures. Neither did they have knowledge of  their own insurance rules.  They spoke from a script.  It got to be where I'd call them and immediately ask for a supervisor...which was usually a joke.

So, from my experience, it's not the workers in the system at the clinics and hospitals...it is...INDEED...insurance companies who don't know jack squat about your health needs.  

I can't tell you how many times I said, "Excuse me, you work for an insurance company that is to surrender payment on this patients policy for a procedure their MEDICAL DOCTOR ordered. Where did you receive medical degree?"

And let me reiterate for the Obama bashers ....  This is not about Obamacare.  It's been going on for years.

Well said, thank you.  The couple of years before I retired, I spent several hours a day arguing with insurance supervisiors and lousy phyicians (that couldn't make it private practice) working for insurance companies just to get approval for scans, physical therapy, surgery and admissions. It was unbelievable.

Joanimaroni wrote:

Well said, thank you.  The couple of years before I retired, I spent several hours a day arguing with insurance supervisiors and lousy phyicians (that couldn't make it private practice) working for insurance companies just to get approval for scans, physical therapy, surgery and admissions. It was unbelievable.

Yes, and then there was the middle layer money manger ogre who was on my back saying, "Your numbers of cleared items are down this week.  We need 100 completed items per day or we'll have to let you go."

100 cleared items meant money in their pocket.  Too bad it took sometimes well over an hour for ONE payment item to be cleared when you had to talk to someone on the other side of the world about a denied claim.  Sure thing, Bucko, let me fit that into my 40 hour week.  



Trust me, writing fiction is a breeze. And my blood pressure is waaaaaay down!