Not just annoyed, but angry at my insurance company

So I learned today that Eric’s endo DID send the documentation to Medtronic when we applied for a pump–it’s SOP when they submit a pump application. Something fishy is going on here and I’m thinking it must be at Anthem’s end. See, I find it hard to believe that Medtronic didn’t pass this documentation along, because they wouldn’t have sent me the pump OR given me a payment plan if they hadn’t had assurance from Anthem that the pump would be covered—Anthem, after all, had to tell them just HOW MUCH coverage was involved in order for Medtronic to compute my portion of the payment (which, BTW, I already paid in full, and boy are we going to have a brouhaha if they try to change THAT on me!).

I can’t imagine that Anthem would have given them that assurance without the documentation of the patient’s situation, unless someone at Anthem is unbelievably incompetent, which is certainly possible. But I’m not sure that’s the case. My conclusion is that someone at Anthem has decided to futz with claim approvals at the end of the month because they need to make sure their bottom line was at a specific number. The letter is dated 9/30/09–the day before the new quarter started. If they deny a claim on 9/30, that claim won’t count toward third quarter payouts and thus doesn’t impact their bottom line for that quarter, and can be rolled into the subsequent quarter’s forecast.

So I’m sort of thinking that I’m not the only person who got one of these letters with this date on it. All of which makes me that much angrier at Anthem. I mean, it would be bad enough if their people were so freaking clueless and incompetent that they could tell a service provider “yeah, go ahead, it’s cool” only to decide TWO MONTHS LATER that they were going to stick the patient with the full cost of a medical device that patient could not afford. But I think that’s not what they’re doing; I think they’re deliberately messing with the dates of approval so they can give a specific number to their shareholders for third quarter earnings. Never mind that it stresses me out and makes me rant about how much we need the public option and how I’m going to refuse to vote for either of my senators if they don’t get out from under the thumb of the clueless GOP leadership and vote for a public option.

I need to calm down, because after all, I don’t know that there’s anything other than incompetence going on. But I sure as shootin’ suspect it! GOD I hate the US healthcare system. The people who sit there saying smugly that we have the best system in the world clearly haven’t ever tried to navigate it in the context of a serious chronic illness.

I was so interested to read your post because I just received a letter dated 9/29/2009 from Anthem, denying coverage for my new Dexcom CGM. Mind you, they told Dexcom I was approved, that I had met all deductibles this year (and oh boy, have I…) and I’ve had it for about three weeks now. How in the world this could happen is beyond me, but I really think you’re on to something about Q3 reporting. And I heartily agree- if I hear one more pompous #$$ spout off about the “best health-care system in the world”, I’m going to- oh, I don’t know- try to rage quietly I guess.

It feels like this horrible disease is consuming my life and the insurance companies are doing their best to make it harder to cope. Very frustrating, and sad.

The more I think about it the more I’m convinced that this is nothing more than an accounting ploy. They didn’t want to include X dollars worth of claims in their quarterly earnings report so they randomly picked accounts to deny coverage to and sent out the letters knowing that most individuals would appeal the decision in the next few months, and they could figure that into their projections for Q4. I have friends who have worked in the industry who tell me this sort of crap goes on all the time. Meanwhile, these decisions have pretty significant impacts on the lives of real human beings like us. THIS is why I get so worked up when I hear how stupidly our legislators are talking when it comes to healthcare reform.

Hi Elizabeth- any movement on your situation? There’s none on mine- very frustrating…

Eric’s endo submitted an appeal just last Friday so it’s too soon to tell. Did you get your endo involved? The more records and evidence you send, the better, says my endo.

I had submitted untold forms and papers from my endo prior to my approval. That’s what makes it all the more strange that I’ve been unapproved.

Hm… that’s just plain weird… I would definitely appeal it, and if they still don’t give it to you, contact your state’s insurance commissioner. If your doctor is saying this is medically necessary and the insurer is trying to say no it isn’t AFTER they had initially agreed, that’s something I’d put in front of the insurance commissioner! Just keep your documents in order…