Coventry Healthcare warning

They both suck.
Coventry covered all my claims for 1 and a qtr years and now decided to stop.
A while back Medtronic put in an order for sensors that was twice the normal size of my order. Coventry raised the flag. They said we are not going to cover this. First they said the AMA decided to change the status. Then they said we need medical records. I do not have the medical records for the dates they asked for.

So I called the PEO(people who do our payroll) and asked them for help. The company is called SOI. So far I have had 3 different reasons why Coventry does not want to pay for my medtronic supplies.
IT IS CLEAR THAT our group IS A BAD DEAL FOR COVENTRY. They sure are trying to not pay. Medtronic was nice enough to credit me for their mistake and hopefully have corrected bad sales practices.
-My problem is now Coventry. My open enrollment is too far away and I do not have a qualifying event to get me out of this crappy insurance.
I was so mad about this I told our CEO. He told the PEO(payroll) that if I was not covered they lose our biz. In addition I called the insurance commissioner and related the whole story.

As a side note:if a health insurance company needs the person to meet certain criteria for an insulin pump that includes many hypoglycemic reactions. No problem. Just take an extra 10 units everyday for a few weeks. That way you can prove you need it. How stupid are these companies?

Coventry’s revenues increased 18.8% from the prior year quarter. This is dated July 28, 2009.

Why are they denying coverage when they continue to make enormous profits? Health Care should not be a consumer product. We are not picking out a pair of jeans here; we are just trying to stay alive.

Good point, but if a particular group is a loser cause of one member, why would they lose money on it. It is their job to make money. I think I got them good though. I keep having various doctors from my past send letters. I keep thinking that if my A1C has gone from 7.9 to 6.4 since I got the pump, I need it.

I have to agree with the Coventry warning. I was covered by them, and I ordered my pump supplies (which I’d been getting through them for years). Then they decided that, because I had not gotten permission to buy pump supplies that time around, they weren’t going to cover it. So, next time around, I went and got permission from them, they told me, “Okay, go ahead and order pump supplies, we’ll cover it.” So I did. But they didn’t cover it. (I went off the pump a week later (for other reasons), but I still owe a thousand dollars for pump supplies I didn’t use.)

It’s their job to provide health care and not make arbitrary and administrative judgments on what is deemed necessary. The doctors can do that. It may be their job to make money but not to have billion dollar profits, while the rest of us drowned in the rising cost of health care.

It turns out Coventry Healthcare is only the 3rd party admin for the payroll company we go through. Thwe waters just became muddier since no one ever told us about this. Never mentioned when we called the payroll company SOI. SOI self funds the insurance. So it appears SOI is the main decision maker behind this. I hate when a business lies to me.