Damn, new year now. 2022 claims! 2023 somewhere around 200K.
I hate insurance companies!
- Thread starter Dave N
- Start date
Something as simple and routine as a colonoscopy took me over a year to get done through United Healthcare. They will only authorize the procedure to be done at an "Ambulatory" service center. I called 4 places and they either were totally booked up and not taking any more patients or they were more than 2 years out. The fifth place I called scheduled me as the 364 person in line and the doctor only performed those procedures at the "Ambulatory" center once a week. I explained my predicament, explaining my family history of colon cancer and all the places I called to get in. She then started asking about my health. Thank god I have type 2 diabetes (sarcasm) and they were able to get me approved to have the procedure at the hospital in about 6 weeks.
The appeals are under review. Now that we started a new year of deductible and out of pocket expenses I decided that I would rather pay for the nursing care and not get bent over for supplies. I ordered a bunch of stuff to last for quite awhile for way less than just one item costs through the home health care outfit. Screw that!
Addicting
Well-known member
If you were divorced and she had to be on Medicare/Medicaid would you still be able to be her caregiver? That could potentially change your insurance issues with it only being responsible for you. Let the Gov cover most of it for her.
I've thought about that and VERY carefully slipped it into a discussion a while back. Seems like she ain't going for any divorce stuff without getting half of our stuff no matter the reason behind it. Not sure if it would actually work in the first place. I left it alone after that. If I win the appeal it's all good. Everything should get paid for and I will have one more bit of info to store away regarding the process. If not, then I'll have to work on the provider for a discount for the nursing visits and call them out for raping me on supply costs. Having the actual cost to compare with the charges is a plus!
I looked at possibly changing insurance companies and just by comparing them online I have to stick with what I have. My premium went up to $450/month and the deductible went to 1K and maximum out of pocket is $3500. No other policy came close to the coverage I have. I save a fortune on the cost of her prescriptions. I shouldn't complain about it but when something goes south it usually isn't something small and I tend to get pissed off and frustrated pretty quickly as I get older!
SD_Prairie_Goat
Well-known member
One of the issues we have in the US, if they deny you and you have to sue them, there is no penalty applied if you win, they just have to pay out for the treatment you're suing over.
So the laws are in their favor, deny more people because who's gonna sue? And even if they do worst case scenario they just gave to pay what they were already going to.
Pretty eye opening when I read about that little hiccup in our justice system
Addicting
Well-known member
Just be careful as if something happens to you that you are not able to care for her, all the stuff will be gone.
We are currently paying 7500 a month for my mom, who is still ambulatory, to be in assisted living. Lori’s bill would be significantly higher at that facility.
The bitch of it is the folks there that don’t have assets don’t have to pay that much. The facility takes whatever the state pays.
Sucks because we liquidated everything and mom has money in her bank account so she has to pay thru the nose. If she was broke she wouldn’t pay and still get the same care.
Educate yourself on who pays for what in your state. Here it’s 3 years worth of income/assest reviews with a net worth of under poverty level to qualify for the state benefits.
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That was part of the discussion. I looked into assets and income requirements for nursing homes when this first happened. I never dug around too much but I thought it said our house and a car would be safe because I had to have a place to live and a way to get around. After that I don't remember. I did see any income she had would go straight to the home and she would be allowed something like $30 a month for hair care or whatever. When she started arguing about the mention of a divorce and money I shut up. I may have to bring it up again when a nurse is here and ask about options "in case something happens to me".
