Enough is Enough!

[Rower Michelle]

Well you guys know that since the first week of September I've been having all sorts of COBRA issues, but I gotta tell you guys, today was EPIC!  Four and a half hours on the phone today with what felt like insurance armageddon!!!!   

On Saturday, Tim brought in a PILE of mail.  I haven't seen anything like this since I was initially diagnosed (and I got over 100 EOBS).  I will tell you that having lung cancer can cause a total panic attack by something as simple as fetching the mail. So here goes my Monday: 

Anthem:  Had to call and make a request that all the claims from September 1st to present be reprocessed for a THIRD time.  All the claims were denied due to the eligibility problems.  The customer service rep tried to tell me I wasn't understanding the EOB process and I lost it,  "NO, NO, NO.  YOU WILL REPROCESS ALL THESE CLAIMS OR YOU WILL HAVE TO FACE THE DEPARTMENT OF LABOR!"   I heard Tim in the background say- uh, oh, that lady is in big trouble.   (I assume he was talking about Anthem but it could have been me. )    End Result:  Claims reprocessed (again).

TEAMCARE:  We got an envelope marked "URGENT: OPEN ENROLLMENT".  Never mind the fact the letterhead was dated October 1st and we just got it on Saturday!!  There was only three days left to enroll in the 2021 benefit program.   So then they say go on line and follow the "easy steps."  Of course the letter instructions don't match the on line instructions.  When I called UPS, there was a TWO HOUR hold time.     In the interim, Tim clicked on every link in the web link , finally hit gold at NUMBER 50 (no you can not make this stuff up).    The link for  open enrollment for 2021 was buried however the only problem is that we aren't quite eligible for 2020 yet.  We've been given four different effective dates (yeah, that's right four different dates!". )  Therefore we were not able to enroll in 2021 because we weren't in the system.   UPS called three hours later and I asked for a manual override.   End result:  We think we are eligible effective November 10th, but it looks like it might be November 15th before the "eligibility tapes transfer".   Now we're enrolled for both 2020 and 2021. 

Long Term Disability:  This is one I always sweat since it's a large part of our income.  I was very blessed to have earned a generous salary, so the LTD benefits have been really helpful in alleviating the financial burden of having this disease.  We were almost afraid to open the envelope as my attorney said anything can happen after 24 months of benefits.  LTD companies are bottom dwellers who have no problem kicking cancer patients off the rolls.     In the Saturday pile was another packet for benefit verification.   Ok, didn't look too horrible, until this morning when we discovered the benefit payment didn't post to our checking account!!   It should have posted on Friday, didn't see it but wasn't overly worried until no update on Saturday.    My first phone call of the day was to my "case manager".   Although we didn't get a return call,  the benefits posted about 5pm today.   We've never seen a payment post this late in the game.   Not sure what happened there.  

Any finally, the last fat envelope came from Health and Human Services:  EUREKA MY MEDICARE CARD ARRIVED.   I'm eligible in March, 2021.   YAY, THE GRAND PRIZE! 

Tom Petty knew what he was talking about: I WON'T BACK DOWN.....  moral of my diatribe: neither should you!! 

Carry on, here's to a more peaceful Tuesday! 

Michelle 

 

 

[Tom Galli]

Michelle,

Saddly, you are paying or have paid for this madness. COBRA premiums, check. Disability insurance, check, SSI, check. 

Once I thought tort liability law suits were a problem. Now almost every dispute goes to binding arbitration. The sting and forcing function of torts is off the table. We are worse off as a result!

Stay the course. 

Tom

[BridgetO]

Yep, Tom Petty said it!  Michelle, you've been stood at the gates of hell for sure. Good job standing your ground with all of this s***.  I think this should be our lung cancer survival theme song.  I've included a link to the music video for anybody nor familiar with te song, or, if you're like me and can't resist listienng/watching again.

Well, I won't back down
No, I won't back down
You can stand me up at the gates of hell
But I won't back down
I'm gonna stand my ground
Won't be turned around
And I'll keep this world from dragging me down
Gonna stand my ground
And I won't back down

Hey baby, there ain't no easy way out
Hey, I will stand my ground
And I won't back down

Well, I know what's right
And I got just one life
In a world that keeps on pushing me around
But I'll stand my ground
And I won't back down

           --Tom Petty

https://www.youtube.com/watch?v=nvlTJrNJ5lA&list=FLqqYmL66MQ-Lg8R3R9zaG-g&index=129

 

[Judy M2]

Michelle, this is behind the pale! Hope you update the DOL with these latest Anthem shenanigans. 

In my career, I was a commercial real estate paralegal and part of my job closing multi-million dollar acquisitions and mortgage loans was negotiating title insurance coverage. I learned that insurance companies are mostly EVIL and exist to deny coverage. 

Binding arbitration only benefits the deep pockets, and us common folks are forced to be subject to it in many if not most consumer situations. 

Several years ago (after I left law firm life), Anthem was one of the health insurance plans my company offered. I used a different company but it turned out that Anthem obtained the personal information of ALL employees, not just their insureds. Of course, they got hacked and Anthem had to provide us identity theft protection for a year. Evil. 

Congrats on getting your Medicare card! Things should get much easier going forward. Whew. 

[LexieCat]

As we used to say in the Prosecutor's Office, you could NOT make this sh*t up. 

Good job. It sounds like all this crap got caught up in the USPS problems. The one good thing to be said (other than your Medicare card--YAY!!) is that you got this round over in a single, hellish day, rather than spreading it out over a matter of weeks.

 

[Rower Michelle]

What really makes me irritated is how unnecessarily complicated all this has been from day one of diagnosis, starting with the "chemo is a matter of convenience" denial.  I am very fortunate that I had the fortitude to power through this and not accept the BS answers.  I really do worry about how people who are less experienced cope with this.   

When I worked as a Compliance Officer for United Health Group, the big DOI/DOL complaints landed in my shop for investigation/resolution/fines.   I always wondered how some of these complaints that rifled through the system went on for more than two years.  Now I know why!   

It's so important to stay on top of the mail!   I would recommend declining the paperless transaction portals for the insurance companies.  Paper trails help!!  Onward and upward today.   

[LUNGevityKristin]

Wow, Michelle.  Keeping a paper trail is a great idea.  I'm sorry this has been such a complicated mess!

[LouT]

Michelle,

I too am sorry you're going through this, but I also know you are a competitor and you aren't about to lose to a group of bureaucrats.   Keep up the fight and don't give them an inch; they don't deserve even that.

Lou

[Barb1260]

Wow Michelle. It’s almost unbelievable that this bs happens when it’s something either previously paid for or are still paying for.  Stay tough lady!

[Lisa Haines]

This is beyond crazy It's absolutely horrifying to see what you've gone through. 

I know you are one tough cookie and there's no doubt you will get this all handled and resolved.  But what a pain in the *ss, and I can't even imagine how an elderly person or someone without knowledge of insurance would even know where to begin on this kind of BS.  

I'm so sick of insurance regulating our care and then the ridiculous review companies denying care for no reason.  There has got to be a better way.

You're right You really can't make up this stuff -- It's bat shi_ crazy 🥺