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I need to vent a little.

So the insurance thing is hard to explain. It's more what they didn't tell me that was problematic.
They never told me when claims were denied, they never told my providers either (who just kept re-billing and re-billing because they didn't know what was wrong)
They never told me when my policy maximum was reached, and couldn't explain my policy maximums to me when I asked about them.
They never told me, in our 5 hours of conversation, that my policy had changed and I would need more information from my healthcare providers before my next shipment of pods could be approved and sent to me...even though we were talking about my Insulet bill and my durable medical equipment limits and policies. When my Insulet rep called me she apologized that I had to deal with the company and offered me a courtesy box of pods because she had been arguing with them over my lifesaving medical equipment for an hour and didn't know how long the new procedure would take for approval based on how long they have taken with the bills and other approval processes. Maybe they don't understand that the thought of 10 days without my pump will send me into a nervous breakdown, and that it involves them paying for another RX for pens, needles and long acting insulin that I don't normally use.
They never told me why I had to fill out forms for every lab I've had done in the past 2 years even though I know they cover Peace Health labs and hospitals.
They never told me why they straight up deny receiving bills form McAfee's office, even though I have proof that the bills were sent, and that they have paid 2 out of the 10-some odd bills from their office.
They never talked to me honestly about my policy because they didn't know what it was and didn't know who could talk to me about it. I gave them my phone number over a week ago, and they told me they would call last tuesday about it. They didn't seem to want to speak to me, they wanted to talk to my healthcare providers, but every time a provider calls them, they tell me how hard the people at GBG are to work with.

I'm not sure if they quite comprehend that I'm not trying to screw them over. I'm not chasing ambulances. I'm just trying to live my life as fully as possible with the tools that have supposedly been made available to me...except they never pay for anything. If my endocrinologist didn't personally like me so much I would have been turned away from her office last week when I went in for my check up, but she stood up for me and has called the company multiple times herself to try and figure things out, but has never gotten any answers, let alone payment.
When I call and talk to them, they tell me they can only handle a couple of claims at a time and hang up on me and make me call back to talk to a different rep, and every time I talk to someone I get a different story.
Maybe they don't understand that Diabetes isn't something I choose to have. Maybe they don't understand that by using the system I do and seeing the doctors I see, I am probably never going to suffer from any serious complications from this disease. Maybe they don't quite get that I will die without insulin, and that if my parents weren't supporting me I wouldn't be able to afford the medication that saves my life, let alone the labs and the doctors visits. Maybe they think that the HBA1c that I get done twice a year isn't worth paying for, or that I can afford to work the full time job that is Diabetes and the full time job that is dealing with their company and the full time job that is attending class as a university student all at the same time, but that's only raising my blood pressure and my A1c. Maybe they don't understand that 3 full time jobs is 24 hours of work each day, and that doesn't leave a lot of time for sleep, food, or getting a job that pays money instead of costs it.

It makes me want to get married to someone for their insurance plan. It makes me want to move to Europe, it makes me want to quit school and work for Costco because their healthcare is the stuff of legends. If that isn't frustrating and sad then I don't know what is.

When the thought of giving yourself 8-10 shots a day and pricking your fingers 10-12 times to make sure you don't fall into a coma or shut down your organs is less stressful than the thought of dealing with your insurance company, you know something is wrong.

I know this isn't the most clear and professional thing I've ever written, but I think it explains my perspective on what's been going on the past 3 weeks...and how they have been mismanaging my account.
I feel taken advantage of because I'm not the policy holder and don't know the ins and outs of the industry. Neither of those things should be required for me to be treated like a valued customer or even someone who is trying their best.

Views: 21

Comment by Brian (bsc) on February 24, 2011 at 6:22am
I am sorry about your troubles with your insurance. I have concluded that all for-profit insurance companies are "THE ENEMY." Their sole purpose in life is to take your money, give you nothing, make a huge profit and then claim they are there to help people. I just want you to know that I feel for you. Hang in there, you will overcome this.
Comment by Kate on February 24, 2011 at 6:54am
I am so sorry to hear that you are in this awful situation! I hope it turns around soon and you are able to find a solution (other than losing your pump!).

I am currently fighting my insurance for a non-D related issue; it is not as twisted as your situation yet, but the writing is on the wall. I totally feel your pain. Good luck!
Comment by MaiaJane on February 24, 2011 at 8:30am
thanks ladies...means a lot to hear from others who know what I'm feeling...
Comment by Seth on February 24, 2011 at 11:29am
Wow we have similar issues. I have been fighting with HealthNet (who is yours?) for the last four years, but the last 6 months have been horrible. Just got denied for a replacement "Dexcom Insulin Pump"?!?!?!?!?!?! I have spoken with half a dozen people, all of whom are wrong. I finally got a hold of someone who helped me 3 years ago and actually has a brain. I know she will follow up and get to the bottom of everything but next time I need to order something the brainless drones will deny me again.

The only advice is take names, dates and numbers and keep them in your records. Keep asking to speak to supervisors and don't stop. It is key when you find one of those helpful independent thinkers you have the information to contact them again. It is also helpful when you speak with some one two years later who couldn’t help you the first time that you can recite their name, direct extention, and issue from befor (this really takes them off guard) It is hard, it is stressful, how do I keep from cussing at these people? It is complete BS that we have to take so much time out of our day to deal with their BS. And when it comes down to it I have been right every single time! Is there any ramifications for them? NO! Do they compensate in any way? NO! Will any of that stop me from fighting? NO F'n WAY
Comment by Jessica Edelman on February 25, 2011 at 3:54pm
Preach on... I totally understand... I don't even have health insurance... it's amazingly difficult. Obamacare!


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