Well, we just got some disturbing news... HUMANA HEALTH INSURANCE is saying that Doerenbecher Hospital is OUT OF NETWORK, and therefore, they will pay even less in his insurance for his treatment there.
It doesn't matter that we called and got a "pre-certification" within the 72 hours as required by HUMANA. It doesn't matter that they told us that Doerenbecher was covered under the plan - that was just for the emergency visit. NO ONE told us we would need to move him to another Cancer Treatment Center after he was released. Continuity of care, especially for Cancer is important! We aren't just going to go to another cancer center, and risk Alex's health care and his life!
We were told there are other hospitals in the area that are covered under HUMANA's insurance - however, as they listed them off, NONE of them had the Pediatric Cancer unit like Doerenbecher.
We were told we can file an "exception" - but that would only be for claims going forward - the previous claims could be "appealed" IF the exception was granted...what do YOU think our chances are...hmmmm.....
I'm beside myself with frustration and anger.
We were also just told that the lifetime coverage cap does not start over in January, when Eric's company moves to Anthem Blue Cross Blue Shield (which, by the way, do cover Alex's doctors at Doerenbecher) - so, every dollar the insurance company does pay, is one less dollar Alex will be able to have available to him later - IT IS DISGUSTING!!!!!
I think that if I wasn't on Prozac and Xanax right now, I would be throwing things out the window...
We are continuing with Doerenbecher for Alex's care - and If I have to send $50 per month for the rest of my life to pay off what HUMANA won't pay, I'll do it - I'm also going to look at the state of Oregon, and see if Alex would qualify to be on that state plan (although I hear we would have to liquidate any assets (like our savings, retirement, etc).
Here we are, being responsible, and not racking up debt, and everything we have worked hard to save may be gone in a flash...Merry Christmas HUMANA - I hope you all can sleep at night - I know I won't be!
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Sara: I feel your rage. It seems to me that insurance companies have various ways to scoot around their own rules. Is it possible that if requested, you can ask that a patient be referred to other medical resources. For instance, I know of someone covered by Kaiser who wanted to be seen by a specialist at Stanford Medical Center. I believe she was given a referral to Stanford and was covered. I'm not sure if this is helpful, but I have hopes there is a loophole for you somewhere. Is it time to see an attorney, perhaps? Stay strong. You are doing a great job evidenced by how well Alex is responding to his treatment. My best wishes.
ReplyDeleteAnn Adair,former neighbor from Martinez.
Sara,
ReplyDeleteI am so sorry. Why couldn't this part be easy for you guys??!!!??!!!? HUMANA health insurance has gone to the top of my evil eye list. I wish there was something that we could do, but healthcare is out of my league. I am glad you had somewhere to vent. Hugs to your whole fam,
Taegen
Sara,
ReplyDeleteI have been seething about this since you called yesterday. I wish I had some answers for you, and really hope you can find a loophole somewhere. You shouldn't have to deal with this at all. :( Damn HUMANA!!
More hugs for you. I'm here if you ever need to vent, day or night. Hope Alex's appt went well this morning.
xoxo
Erin
Hi Sara,
ReplyDeleteI'm also angry and upset to hear this...like you don't have more important things to be worrying about! I'm not sure if it will do any good, but you should also file a complaint/grievance with the Oregon Insurance Commissioner's office or whoever is responsible for regulating Humana. This is outrageous! I wonder if there is a local news organization that might get involved, such as the Michael Turko Files in San Diego (http://www.kusi.com/features/turko/) I'm sure that Humana wouldn't want the negative publicity.
Wishing all of you the best,
Ron
Sara,
ReplyDeleteThis sucks! I know that health insurance companies can be awful to navigate. Does Eric have someone in his office that is the benefits manager that can help you with this? They usually have the contacts. Also, I have found it helpful to go up the food chain in insurance companies, whomever you get on the phone, just ask for their supervisor outright. I know that I have gotten 10 different answers for the same question from the customer care people depending on the screen they are looking at or who trained them! supervisors usually know more, if you can get them on the phone.
I am sure you have already done these things. I just so want to be able to help and fix this for you! This is the last thing you need to be dealing with now! Let me know if there is anything else I can do.
Love and comfort
Deb, Laura and Sarah
Sara -- you are doing an incredible job! Hang in there! Insurance companies are unfortunately about one thing -- making money! They are a business, they have no heart or soul -- and you have to fight for everything you want. It sounds as if you are a good fighter and as if you are going to get what you need..........you will win this entire battle in time!
ReplyDelete