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Sorry. That’s Not Good Enough
One of the most visible changes in the new health insurance reality are the medical bill surprises people are receiving that they never received before, for services covered previously as a matter of course. You know – whereas their insurance automatically approved a CT scan for purpose X in the past, now patients need pre-approval. Without that pre-approval, payment for that CT scan comes out of their own pockets – totally unexpected and usually very expensive. Most of us learn the hard way that we need to get permission for many of the services that used to be automatically approved. I know I did. About two years ago I received the full billing ($350) for my annual trip to the dermatologist. I had been referred by my primary, the check-up was a covered benefit, but because I hadn’t gotten it approved ahead of time, I received the bill, and was told I was responsible, for the full ride. I was stunned! And angry, too…. When I called my insurer, the customer service rep told me that was their new policy, and I was out of luck; there was nothing she could do to help me. When I asked when the rule had changed, she told me she wasn’t really sure. When I asked why I had never been notified, she said she didn’t know… Bottom line, I got NO information from her. I finally asked to speak to a supervisor who was even less helpful – until I told her I would be in touch with the state insurance department. Only then did she say she might be able to help me sort out the billing. Eventually they did cover the cost of my appointment – because they couldn’t prove to me that I had ever been notified of the change in policy. I’m not going to lament here the fact that it seems like nothing can be done by customer service these days without threatening them first. Instead let’s look at some lessons for advocates; that is, that when we know we need something, or when we are stonewalled,…