What the bleep is this shit?

[TZ]

looking through my mail and I got a notice from fucking CIGNA, that they want information on why I went to Mayo and that if I had a pre-existing condition its not covered. Fuck of course its a god damned pre-existing condition. But its a group plan, there isn't supposed to be any of this nonsense. What the hell am I going to do if they won't cover anything. I'm looking at probably a 10-20,000 dollar medical bill.
Oh god....

[Parche]

1. Hold The Mayo

Insurance companies suck

:hug:

:hi:

[TZ]

3. ...

I can't deal with this Parche...I'm at wits end with this scam...

[hippywife]

2. Were you without insurance coverage

in the 18 months prior to enrolling in their plan? If I recall correctly, and I'm nost usre that I do, that would be terms for disallowing any coverage for pre-existing conditions for a period of time after enrollment. Check into HIPAA legislation.

If not, check the terms of your enrollment. If they are off-base, blast the shit out of them!

Good luck! :hi:

[TZ]

4. I was on COBRA

And when I read about their corporate sponsered plan, I don't remember any pre-existing condition clause. If there was, shouldn't they have asked about them before enrolling me? You know like they do if you want life insurance? I have NEVER EVER heard of this with group insurance before.

[hippywife]

12. It's been my experience

that when issuing group coverage, they only ask when it comes to disability and life. Never had a group insurer for medical ask. As far as I know, COBRA should count. But I'm not completely familiar with that portion of the HIPAA legislation.

I would research as much as I could of their policy documents and the HIPAA legislation and then don't let them push you around. If you have a leg to stand on, stand firm and keep pushing them back on this.

I really hope it all works out for you. :hug:

[lost-in-nj]

5. Hon

it's time for an appointment with HR
you have to have a liaison
bring your folder and all correspondence


really


get to the bottom of it

and figure out your plan of action....
what they will and will not cover


TZ I am so sorry


:hug:



lost

[TZ]

6. Oh god

my HR is so bad..You know they didn't even want to hire me until I got medical clearance and they didn't want to give me medical clearance until I had proof I was being treated for my blood issues....I'm so fucked...Now I have to go cry myself out...

[LeftyFingerPop]

7. If you were on COBRA prior to this plan...

you were covered.

If you were covered, tell them to take their "pre-existing" conditions and shove them up their ass.

I don't believe they can do this to you...but don't know 100% without seeing the contract.

They will do whatever they can to get out of paying...and I fucking hate these bastard insurance companies with all my being.

Sorry you have to deal with this :hug:

[LaurenG]

8. If I remember correctly as long as you have had continuous coverage

and no gaps over 30 days they have to cover you. (pre-existing or not) Did you go out of network without an auth?

Try not to worry too much until you know more. :hug:

[TZ]

9. I called the mf's before I went to Mayo

to see if I needed any pre-authorization and the bastards told me no. Everything the doctor the clinic ect is IN network. Its not even a goddamn HMO. Its a open access PPO! In fact its the best coverage offered by my company! (large international corporation btw)

[LaurenG]

11. I think you'll be fine

Insurance companies are just about the most rotten entity ever.

They try not to pay as many claims as possible but it looks like, from what you're saying that you're covered.

Call them tomorrow and ask for a supervisor if the clerk answering the phone can't answer you. Document names and times of everyone you speak with and don't give them an inch to mess with you. Hang in there I know how scary this can be, I've been there. :hug:

[LeftyFingerPop]

10. Do you have a copy of your plan at home with you? n/t

[TZ]

16. I might but I'm not up for reading through it at the moment

However if you can...Here is the link to my coverage plan..I still don't see how they can deny me coverage based on a pre-existing condition...I have a terrible headache (I am pretty upset) so if you can see what you can find, I would appreciate it.
http://www.cigna.com/our_plans/medical/open_access_plus/for_you.html

[LeftyFingerPop]

18. On first blush, this internet summary does not discuss....

pre-existing conditions.

This information would be found in the guts of your hard-copy contract.

Your best bet is to review your plan first in detail (tomorrow) and THEN make a phone call to CIGNA.

I tried to google pre-existing condition laws for Maryland, but it gets complicated because I'm not sure where CIGNA is based, etc.

My gut feel is that they are just trying for the denial, hoping you won't fight it.

But take heart that while there are usually some instances (even in a group plan) where they can deny coverage for pre-existing conditions (has a lot to do with the dates, etc)...it is not that easy for them to deny because of federal and state laws.

Don't worry please...but read your contract and be armed with that information before you call them.

Oh, and by the way, fuck CIGNA.

[khashka]

13. They'll do everything they can

to not pay. I hate insurance companies. Sorry you have to go through this. Hugs.

Khash.

[hunter]

14. Speaking from experience, you reach a point where you don't give a shit...

... 'cause if you take it personally you go crazy.

There's no real person at the insurance company or the hospital who really gives a damn, so why should you?

Clean up the medical bills like you are raking up leaves in the autumn, like you haven't a care in the world, especially if you are not feeling well. You were in the hospital, so of course you are not feeling well!

I just paid a four year old medical bill with our George W. Bush mad money, fat lot of boost I gave to this economy... they probably invested it in some brand new way to screw the average person over.

Good Luck!

[mainegreen]

15. Call their bluff. More than likely software flagged you as a -possible- denial.

The next step is they try to not pay. You should be covered (you would be in most states). Gather your information and call back to lodge a dispute. Odds are their attempt at denial was automated and they'll fold.

[realisticphish]

17. Good luck

My uncle lucked out when he had a heart attack while on the starting 6-month probation at his job (thus no insurance). He got a federal grant that paid for all but 2 grand. Check with your HR people (even though they suck); you may find someone who has a heart.

and, if you have to sell your house, you can crash at my place :D

[latebloomer]

19. I think it varies by state

but in my state, as long as you didn't let your coverage lapse (and COBRA would count), they can't deny you coverage for a pre-existing condition.

I'm pretty sure it'll be OK.

I know you don't need this shit, as you try to deal with your physical problems. Insurance cos are evil.

:hug:

[flvegan]

20. How do you have "bleep" and "shit" in the same sentence?

Seriously, this is the kind of thing I'll lose sleep over.

:P

[TZ]

21. Thank you

That was a very funny observation....

[flvegan]

22. What do you think the fundraiser is for?

To pay fools like me to make funny observations. Running the site is a red herring.

[Random_Australian]

23. Hey there! Virtual hugs for you!

:hug::hug::hi:

Damn insurance companies. They love to freak people into not getting the damn coverage that they paid for. When I set fire to the atmosphere they will be sorry. I believe that it is an honours project that you can do if your university is a partner with Massive Crime (That Still Isn't As Fucking Stupid as Corporate Bastards) Incorporated.

It's things like this that make me a little less well-inclined toward random humans.

[TZ]

28. Thank you

Maybe you could aim one of those patented Cruise missiles of yours at the damn company..Good thing for them you are on the other side of the world.....:hug:

[Callalily]

24. No advice here . . .

but wishing you a positive outcome. :hug:

[stuntcat]

25. I got no advice either (^)

It's not fucking right for us to go broke to care for ourselves, wtf is up with my country :cry:

I just hope this straightens out :hug:

[TZ]

26. More shit

I was backtracking statements from CIGNA. I've got statements saying they are gonna pay this much and I owe this much..then I got statements saying that they aren't covering anything until they get more info from me!:wtf:
Also I noticed they started this need more info shit with even my routine visit with the hematologist in March
now they don't want to cover ANY FUCKING CLAIM?:banghead:

[siligut]

30. This is really wrong.

It sounds like someone at CIGNA flagged your blood disorder as costly back in March. Can you speak with who does the billing at your hematologist's office there? Usually they will have gotten clearance for treatment.

You probably do have a right to have this covered. If you had coverage when you were diagnosed and then COBRAed, with no breaks, everything I have seen says this should not be treated as a pre-existing condition.

However, CIGNA is one of the worst ins cos I have dealt with. Document everything. If this continues, you might need to get an attorney to play hardball with these asshats.

I agree with treating this as a task, make a list of what you need to do. It is horrible and frustrating, I agree, but take steps to correct it.

[Burma Jones]

27. I am not sure of your precise situation, but the State of Maryland says:

"A carrier may not reject the employee or dependents for this reason or impose a pre-existing condition limitation. Moreover, the carrier may not charge a higher premium because of an employee’s or dependent’s health status."

This is for small (2-50 eligible employees) companies


http://mhcc.maryland.gov/smallgroup/cshbp_brochure.htm

[BarenakedLady]

29. We recently went to CIGNA

When the man got his new job. They have been nothing but pains since the switch. They keep denying all our bills. They eventually get sorted out, but it has been EVERY time so far. It seems like we've all been to various doctor/ER/specialists lately, so it's been almost every week. They've sucked so far, imo.

[ThomCat]

31. I hope it gets straightened out soon.

:(

:hug:

It seems like you've fallen into that big trap. You need special help, so you have triggered special reviews of your case to deny you anything and everything in order to keep costs down. :(

Start doing some searches to find out how other people have fought insurance companies and won.

:hug:

[TZ]

32. I have a friend who is a lawyer as well as her husband

Now she's a patent lawyer and he's a defense attorney, but at least they might know who I can consult on this.

[suninvited]

33. I tried to research it

but it seems all this stuff is written in another language !!

This is from www.dol.gov/elaws

A breakdown from the department of labor on definitions of pre existing conditions:

A limitation or exclusion of benefits for a condition based on the fact that you had the condition before your enrollment date in the group health plan. A pre-existing condition exclusion may be applied to your condition only if the condition is one for which medical advice, diagnosis, care or treatment was recommended or received within the 6 months before your enrollment date in the plan. A pre-existing condition exclusion cannot be applied to pregnancy (regardless of whether the woman had previous coverage), or to genetic information in the absence of a diagnosis. A pre-existing condition exclusion also cannot be applied to a newborn or a child who is adopted or placed for adoption if the child has health coverage within 30 days of birth, adoption or placement for adoption and does not later have a significant break in coverage. If a plan provides coverage to you through an HMO that has an affiliation period, the plan cannot apply a pre-existing condition exclusion. A pre-existing condition exclusion can not be longer than 12 months from your enrollment date (18 months for a late enrollee). A pre-existing condition exclusion that is applied to you must be reduced by the prior creditable coverage you have that was not interrupted by a significant break in coverage. You may show creditable coverage through a certificate of creditable coverage given to you by your prior plan or insurer (including an HMO) or by other proof. The plan can apply a pre-existing condition exclusion to you only if it has first given you written notice. If your plan has both a waiting period and a pre-existing condition exclusion, the exclusion begins when the waiting period begins. In some states, if plan coverage is provided through an insurance policy or HMO, you may have more protections with respect to pre-existing condition exclusions.

[TZ]

34. I just heard from my HR guy

and this statement here.."You may show creditable coverage through a certificate of creditable coverage given to you by your prior plan or insurer (including an HMO) or by other proof." Is basically what he told me I need to do. And I was looking through records this morning and saw what I think is that notice. Thank you. I think I have a game plan now, at least.

[suninvited]

35. Good luck !!

I think you will be fine.