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BMonster
:)
Member since 2/06 2959 total posts
Name:
Denise
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I need to vent- I'm so upset!!
I've been having a lot of medical problems since last year. One of these is TMJ related. Once I was diagnosed, I went to a dentist who specializes in this. I paid in full the amount it would be for the entire treatment to come (including a mouth guard, followup visits, etc). Once I found this Dr and paid for the services, I called my insurance company again to double check what they will cover (I had to do the TMJ stuff no matter what). The person i spoke to told me that yes, they only cover consult & surgery, but if it's medically necessary (which it is), they would cover 80% with a letter from my doctor with the services received. I was so excited I called my DH to give him the good news!
I haven't received anything from my insurance in a couple of months (like a check or notice), so I called today. The woman today told me that they only cover consult & surgery and that's it. I explained what I was told before and she looked in her system and it was noted that I was told the same thing before and there's nothing I can do about it. She was unwilling to budge at all!
So now I have to find the piece of paper with the name and date of the person I spoke with (which I don't even know if I still have it) and call back to see what they can do. Complaining will probably do nothing, but I will try. So I'm most likely out $2000  It was a relief before when they said it would be covered, and now to hear it's not is upsetting. I have so many other Dr bills to pay right now- I'm so pi$$ed!
Vent over, I think I just need some hugs now
Message edited 7/26/2006 10:05:12 AM.
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Posted 7/26/06 10:03 AM  |
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Long Island Weddings
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Shanti
True love
Member since 6/05 12653 total posts
Name:
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Re: I need to vent- I'm so upset!!
Oh, Denise...
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| Posted 7/26/06 10:05 AM |
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Ang-Rich
Beyond Compare
Member since 5/05 17988 total posts
Name:
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Re: I need to vent- I'm so upset!!
I am so sorry Denise! I can't believe they are doing this to you now. I hope that you can find what you need to go back at them.
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| Posted 7/26/06 10:06 AM |
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Bri
I Love You to Pieces!
Member since 5/05 9919 total posts
Name:
Brianne
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Re: I need to vent- I'm so upset!!
Message edited 7/26/2006 10:08:44 AM.
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| Posted 7/26/06 10:08 AM |
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BMonster
:)
Member since 2/06 2959 total posts
Name:
Denise
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Re: I need to vent- I'm so upset!!
Thank you, girls 
I'm going to go home for lunch to do some digging. Hopefully I can find what I need then.
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| Posted 7/26/06 10:12 AM |
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lorich
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Member since 6/05 9987 total posts
Name:
Grammie says "Lora Gina"
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Re: I need to vent- I'm so upset!!
I definitely find that it's all who you talk to... I would complain and speak to another person...keep calling until you get the answer you deserve.
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| Posted 7/26/06 10:12 AM |
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dm24angel
Happiness
Member since 5/05 34581 total posts
Name:
Donna
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Re: I need to vent- I'm so upset!!
I work in insurace, My suggestion....Call back, get a supervisor. Tell them what you were told and WHAT can they do for you now. Even if you call back with the girls name you spoke to before, its all gonna come down to what she put in the computer as what she advised you and basically her word against yours. So I would go above them now.
I know how you feel. My insurance ( which I work for) doesnt cover TMJ related stuff. I have had TMJ since I was 17 and its to the point only surgery will correct it, which is over 5K and obviously not something I can afford EVER. I dont get why its not covered by medical or dental??
Hope you get somewhere with this!
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| Posted 7/26/06 10:13 AM |
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SuzyQ
Mama to 3!?!?!?
Member since 7/06 8069 total posts
Name:
Susan
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Re: I need to vent- I'm so upset!!
I'm sorry. That really stinks. Insurance is a pain in the butt.
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| Posted 7/26/06 10:13 AM |
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BMonster
:)
Member since 2/06 2959 total posts
Name:
Denise
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Re: I need to vent- I'm so upset!!
Posted by dm24angel
I work in insurace, My suggestion....Call back, get a supervisor. Tell them what you were told and WHAT can they do for you now. Even if you call back with the girls name you spoke to before, its all gonna come down to what she put in the computer as what she advised you and basically her word against yours. So I would go above them now.
I know how you feel. My insurance ( which I work for) doesnt cover TMJ related stuff. I have had TMJ since I was 17 and its to the point only surgery will correct it, which is over 5K and obviously not something I can afford EVER. I dont get why its not covered by medical or dental??
Hope you get somewhere with this!
Thanks, Donna
It seems like they record conversations. Don't most ins. companies do that? I figure if I can find the info, I can tell them exactly when and with who I spoke with and they can review it? I don't know. I just want to be armed with as much information as I can be. I know ppl lie, but I'm not one of them!
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| Posted 7/26/06 10:19 AM |
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Re: I need to vent- I'm so upset!!
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| Posted 7/26/06 10:21 AM |
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dm24angel
Happiness
Member since 5/05 34581 total posts
Name:
Donna
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Re: I need to vent- I'm so upset!!
we only record a few calls on each person a day. And we usually dont review them unless you are VERY insistent. I mean liek freaking out ( which you could do anyway). But if that call wasnt recorded, then what?
I would look though for sure, but ask for a supervisor no matter what.
Not that the reps , I am one  dont know what they are doing. Its more that as a rep we are limited to what we can do for you. We cant do much. A supervisor has the ability to open more doors ya know?
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| Posted 7/26/06 10:21 AM |
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Christine
2nd verse same as the 1st
Member since 5/05 15287 total posts
Name:
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Re: I need to vent- I'm so upset!!
I would keep calling back & fighting them on it. I remember when my father was sick, we were trying to get hospice coverage and one person said something along the lines that it was covered. We later found out it wasn't but my mother stood firm and fought them on it and they eventually accepted the claims for it.
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| Posted 7/26/06 10:22 AM |
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Jenziba
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Member since 5/05 6265 total posts
Name:
Jennifer
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Re: I need to vent- I'm so upset!!
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| Posted 7/26/06 10:24 AM |
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BMonster
:)
Member since 2/06 2959 total posts
Name:
Denise
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Re: I need to vent- I'm so upset!!
Thanks
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| Posted 7/26/06 11:04 AM |
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azoodie
Member since 8/05 8377 total posts
Name:
Team SEXY BACK
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Re: I need to vent- I'm so upset!!
awwwwwwwwwe denise that stinks!!! i hope you can work it out with the insurance comp.
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| Posted 7/26/06 11:13 AM |
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GoingNutty
Our family
Member since 5/05 2272 total posts
Name:
Jennie
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Re: I need to vent- I'm so upset!!
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| Posted 7/26/06 11:19 AM |
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karacg
Babygirl is 4!
Member since 5/05 17076 total posts
Name:
Kara®
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Re: I need to vent- I'm so upset!!
I feel for you - just got a bill for $7,500.00 for IVF that the insurance co. told my clinic they would cover...and I have another coming up in September...
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| Posted 7/26/06 11:21 AM |
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Diva
I am what I am
Member since 12/05 2825 total posts
Name:
Jennifer
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Re: I need to vent- I'm so upset!!
Denise, I'm so sorry
Dont give up, though. Keep on calling and complaining. Dont give up without a fight.
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| Posted 7/26/06 11:30 AM |
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KPsquared
Member since 5/05 4663 total posts
Name:
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Re: I need to vent- I'm so upset!!
Uggggh that royally stinks Sorry Denise!
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| Posted 7/26/06 11:37 PM |
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Tany
Becoming a different woman
Member since 5/05 24460 total posts
Name:
Tania
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Re: I need to vent- I'm so upset!!
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| Posted 7/26/06 11:40 PM |
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neenie
Member since 5/05 22351 total posts
Name:
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Re: I need to vent- I'm so upset!!
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| Posted 7/26/06 11:44 PM |
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puppylove
LIF Adolescent
Member since 10/05 561 total posts
Name:
Summer
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Re: I need to vent- I'm so upset!!
That really stinks! Insurance can be soooo frustrating! Hopefully everything will work out and they will cover at least part of the expense. 
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| Posted 7/26/06 11:57 PM |
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VirginiaDeb
Don't eat me, hippo!
Member since 5/05 9252 total posts
Name:
Deb
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Re: I need to vent- I'm so upset!!
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| Posted 7/26/06 11:59 PM |
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2Pisces
Life Coach
Member since 2/06 3337 total posts
Name:
Paige
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Re: I need to vent- I'm so upset!!
thats terrible Denise.....well I wouldn't give up. I would sepak to a supervisor and write a letter or do what I felt necessary.
Good Luck.
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| Posted 7/27/06 12:02 AM |
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