- Apr 3, 2001
Yeah, I have a procedure I go in for regularly that's explicitly covered in my insurance documents, and has been paid out month after month. But first it has to be submitted, then get automatically denied, then have someone else (working within the SAME insurance company, mind you) resubmit it, and then they pay out. It's stupid and I hate it.Not mental health related, but my kid just went in to their GP for a checkup etc and he suggested they have some tests run, so we did.
The insurance refused to cover one of the tests sighting it "medically unnecessary" (akin to what was said in the Last Week Tonight clip). So if a doctor prescribes XYZ, the insurance company can overrule the doctor AFTER the fact and just leave you holding the full bill? That is INSANE.
On a similar note, a few years back, my son needed spinal fusion surgery. It was required by his doctor,. a back specialist and the surgeon . We happened to get an opening in the surgeon's schedule so everything was a little "rushed". The day before the surgery, insurance called up and had a million questions, and were refusing to cover until things could be discussed etc (we're talking a $300,000+ surgery) There was no time for further discussion etc, surgery was 7am the next morning. But they left us hanging.
We explained it all to the surgeon (whom we loved, and know many people who have had him and speak nothing but praise) and he was like "they do this EVERY time, it's easy to fix, but they do it every time... We'll just prep your son, get him wheeled into surgery and before I scrub up I will call them and explain that we're little in the room etc and they will cave and approve it."
and sure as shit that's what happened - exactly as he laid it out. It's disgusting that that's how it has to happen. AND apparently, happen often.
Sorry, I got off the Mental Health Care topic, but it's all related.