Just a brief update for those who’ve asked: the doctors at Methodist have called Anthem several times, to appeal the denial of my move to rehab.
Anthem’s personnel have not deigned to respond. They have simply not returned any of the calls.
Think about that. I am a patient whose care is in dispute: Doctors and therapists who have actually treated me are advising a certain course of treatment. Functionaries with unknown credentials–none of whom has ever seen me–decline to accept their medical judgment.
And then they blithely ignore requests to even talk about their reasons. The calculus seems obvious: if we don’t call back, these people will eventually tire of their appeal effort and go away. We win!
The doctors, nurses and caseworker are apologetic, but this impasse isn’t their fault. They are frustrated and angry; my situation is just one of many they encounter on a daily basis. They are convinced–as I have become convinced–that Anthem and other insurers care nothing about the health of their policyholders. (A caseworker told me she met an Anthem claims adjuster who cheerfully admitted that denials are rewarded with bonuses.)
We talk a lot about transparency in government. It’s long past time to talk about transparency in health insurance. Indiana’s Insurance regulators need to investigate these practices; to the extent we still have that quaint occupation called journalism, reporters need to investigate and report on them.
If my experience is remotely typical, they’ll find plenty of health providers and patients who are ready and eager to talk.
Your frustration must be palpable! All insurance companies should be not-for-profit. Hoping you can share better news very soon.
Your frustration must be palpable! All insurance companies should be not-for-profit. Hoping you can share better news very soon.
Several years ago, I was in a rehab facility for several weeks. The administrator was very careful about calling Anthem to confirm my continued eligibility at several points during my 2 1/2 weeks there.
After the fact, Anthem refused to cover the last two days, even though they had approved them in advance, so I had to pay for them out of pocket.
I should have sued, but I was still unwell and had to save my energy for going back to work in another week.
What you might do is call IU HR and complain. IUB is self-insured; Anthem is just the plan administrator. I assume that the entire system is, as well. If so, then IU is being charged more than is necessary. They might want to know that. And certainly IU should be advised of the poor service you are receiving from Anthem.
Yep….I am not surprised at all…happens all the time. I am convinced they think that the healthcare team will give up or you will give up and then you will be stuck paying the bill. People blame the doctors and nurses as they do not realize how unscrupulous insurance companies can be….there is a limit of time a clinic has to spend time on this nonsense and I guarantee you are not their only patient who they are having to call on. It pisses me off.
This is yet another reason why for profit healthcare/health insurance makes no sense. A business’ sole reason for existence is to make a profit. Period. The healthcare/health insurance industry doesn’t have to care what you think….what are you going to do, take your business elsewhere? You’re a captive audience.
There’s a state webpage to file complaints against insurance companies. I did this once and did get results. Apparently Anthem does take notice when the state gets involved. And the state did follow through to be sure the complaint was resolved to my satisfaction. (Of course there was a different Governor in power then.) http://www.in.gov/idoi/2552.htm
Have you called the state insurance commissioner?
In 2009 my husband was admitted to the hospital with pulmonary embolisms on Tuesday night. He was in intensive care overnight. His doctor wanted him to stay there through the weekend for a thorough course of treatment with blood thinners. Insurance only would allow three days. He was out on Friday. He had to take blood thinner injections home (which, since not administered in a hospital they were not covered under his prescription coverage). These are the real ‘dealth panels’ and rationed care. Many, many people have died due to insurance companies refusing claims.
Have you filed a complaint with Indiana Department of Insurance?
I was having an issue with a car accident claim last year. Couldn’t get any movement from the insurance company for 2 weeks. Filed a complaint and 48 hours later I had a settlement offer in hand. They process all complaints within 72 hours, so at most you’ll have 3 days before they realize you’re onto them and actually call your medical team.
call your congressperson every time. every time. and repeat, every time.
Apparently IU Health University Hospital and Methodist Hospital will merge into a brand new facility based on low occupancy rates at both hospitals, yet I now am sitting with my husband who is stretched on a gurney in a hall at IU for readmission for a complication following surgery on Monday. Seems IU has no beds available and 25 patients are ahead of Tom. Low occupancy, my foot. The doctor is embarrassed, the nurses are apologetic.
Share this blog far and wide. Give Anthem the publicity they have earned.
One more example od what I have been fighting about these last 30 years. Let’s put the patient first and turn care back to high quality physicians.
Once upon a time Blue Cross/ Blue Shield of Indiana was a mutual company. Their membership actually voted to take the company public. My mother was one of those members. They each received stock in the company and that stock did well. My mother’s stock was valued at $90K upon her death. One thing that wasn’t mentioned in the information packet the members were sent was how much profit would drive decision making at the new corporation.
If it’s you vs. the bottom line, the bottom line wins every time.
Tell them you are an attorney and haven’t sued anybody recently, but that you are giving it serious consideration.
Please write to the Newspapers at once
Shame might motivate them
The Indiana Insurance Commissioner is a political appointee of the governor, so don’t hold your breath.
I am so sorry your good health and well being is jeopardized by the very company that you pay to ensure it and hope that you’ll be fully mended soon. It is well to remember that the doctors, nurses, and even your caseworker cannot set all their other duties aside to advocate on your behalf. They have no choice but to fax or phone in requests for authorization and hope that Anthem will respond in a timely manner. I have found over the past decade that progress happened only after I got personally involved in the process – each and every time there was a glitch. I’m the only one who could take the time to muddle through the process of getting an actual a live person on the phone, or wait on terminal hold for that person’s supervisor and the supervisor’s superior after that. Or to go through the entire process all over again after the inevitable disconnection(s). Some days I spent a solid eight hours dialing and holding and redialing and holding some more. It is frustrating and maddening to be forced to seemingly waste endless hours – listening to wretched ‘on hold’ muzak and Anthem promotions about all the wonderful stuff they do for you – but the end result of finally speaking to a person who has the power to fix the problem right now is truly gratifying. By that time I was most often a near hysterical momma, utterly furious and armed with arguments that had been honed to razor sharpness. I was definitely not the kind of person one would risk denying without exceptionally good cause. And out of the gazillion times I’ve had to go through all that shit to get reasonable care for my child, there were very few in which the ‘big-kid-in-charge’ failed to fix the problem right now. Ask your caseworker for a copy of the request to move you, put your phone on speaker, and go after making those bastards provide the care you’ve paid them to provide.
I don’t know your particular situation. When I ran across similar circumstances while in practice (Family Medicine) we continued with (my) medically suggested course. In every circumstance the insurance company backed down on appeal to their medical consultants.
Try calling this number and demand to speak to a member of the leadership team. (317) 488-6000
Executive Leadership
Joseph R. Swedish
Chairman, President and Chief Executive Officer
Wayne DeVeydt
Executive Vice President and
Chief Financial Officer
Craig Samitt, M.D.
Executive Vice President and Chief Clinical Officer
Brian Griffin
Executive Vice President, President, Commercial and Specialty Division
Jose Tomas
Executive Vice President and
Chief Human Resources Officer
Peter D. Haytaian
Executive Vice President, President, Government Business Division
Thomas C. Zielinski
Executive Vice President and General Counsel
Gloria McCarthy
Executive Vice President and Chief Administrative Officer
Sheila,
Don’t forget to remind them that you’re an attorney.
To quote Sheriff Rick Grimes, locked in a storage container, from “The Walking Dead”: “They’re going to feel real stupid.” His companion: “Why?” Rick continues: “They’re going to find out they’re screwing with the wrong person”.
As a former Insurance Commissioner, I tell you the Department will respond very quickly, even though Sheila is a well-known Commie/Pinko……………….
Adding to the chorus, I had to appeal a decision related to the birth of our daughter. I was able to use my law firm letterhead, cite chapter and verse from the policy language, and enlist the assistance of a family friend who is a physician. I was successful, but that’s not even close to a realistic option for most people.
Sheila; use your vaulted position, you have earned that RIGHT with your years of hard work, giving to the community at large and your professorship. You are not asking for special care or concessions aside from what your paid for medical care covers – DEMAND your needed and physician prescribed medical treatment.
I have no vaulted position but will whine, cry, piss and moan and let people know I am almost 79 years old, deaf, disabled and live alone on Social Security. I have worked long and hard to reach this position in life and don’t hesitate using it if I think it will help;-)
To think there are people out there who believe, with every fiber of their being, that unleashing free-market capitalism on the health insurance industry is the way to fix our country’s healthcare woes!
I have yet to deal with an insurance company (health or otherwise) that actually acts in the interests of integrity. Even “non-profit” insurance administrators are always driven by the bottom line, with no regard for the health of their customers.
Federal law dictates that insurers have to tell you why they’ve denied your claim, and they have to let you know how you can dispute their decisions. I believe their appeal process must also offer an appeal to a 3rd party, but that could just be mine. Good luck.
For those who say that a non-profit would treat you any better…they won’t. I’m a health insurance broker and have seen equally shoddy treatment from For-Profits, Non-Profits, PPOs and HMOs. I’ve also seen superb customer service from them all. The worst case I’ve seen recently involved and auto accident and a large non-profit HMO. A husband who was confined to bed and required regular nursing care was sent home to be taken care of by his wife. She had two broken arms from the same accident. Appeals got absolutely nowhere.
Talk to Dennis Frick, Director of the Senior Law Project for Legal Services of Indiana, or to Fran Quigley.
Why don’t the hospitals have rehab facilities within? I know that several have in the past, in fact when my mother broke her hip twenty years ago she recovered in the same hospital that did her surgery but she was moved to the rehab wing and she received wonderful care and was actually rehabilitated. She was up and walking continually. They taught her how to walk up and down steps, they came to my parents home to make certain she had everything she needed and along with my father, made the necessary changes.
Three years ago she fell and broke her pelvis at the age of 89. She went to the same hospital and the rehab unit was gone. She was sent to a “rehab” center which was really a nursing home and the only time that she received therapy was when the physical therapists came, which was one hour per day, 5 days a week. With them, she was up and walking. The remainder of the time she was put in a wheelchair and taken to the bathroom. The nurses or aides did not even help her to get out of bed to eat.
She may have been better off staying in the hospital. Healthcare in this country is in very bad shape. It’s getting worse and at the same time more expensive.
Sorry, I was watching the debate as I was writing and now that I’ve read what I wrote I realize it sounds as though the nurses took my mother to the bathroom and left her there, in the wheelchair, whenever she wasn’t getting physical therapy, which was most of the time. Not true. She languished in bed, hallucinating from the drugs they gave her which included a completely unnecessary drug for restless legs. That from the hospitalist! Ugh.
The faction that denies your coverage , and is rewarded is the ” DEATH PANELS” that I , and other Obamacare TRUTHERS warned his supporters about . I am on disability , and my income is more than 400% below poverty line. That means my wife , and I are literally too poor to qualify for free health care under the present Obama care system.
In the words of George Bush , ” How uniquely American .”
Welcome to life outside the Matrix , Sheila .
Mark
For the life of me, I can’t understand why the Democrats didn’t respond to the right wing’s claim of “death Panels” if the ACA became law: “We already have death panels – they’re called for-profit insurance companies!”
My mother faced a similar situation, but with Humana instead of Anthem, in the summer of 2014. She had metastatic brain cancer and was prescribed treatment by Gamma Knive to alleviate four large tumors in her brain. Everything was scheduled for over two months, but at the last minute, Humana declined the procedure. Everyone called to ask why. We were all told that the decision was further up the food chain. After a month of “asking”, my sister called and told them that she had prepared a law suit and was going to the courthouse to file it. They relented (but I do not know whether the true threat was the reason). But, when my mother went into surgery, there were many more tumors that had turned up in the intervening two months and died two months later. Who knows if the outcome might have been different (if we might have had more quality time with her) if they had not played games.
Yet another case where the insurance companies are standing in your treatment room, rifling through your pockets while you’re naked on the exam table. They assess nothing. They diagnose nothing. They prescribe nothing. They are the profitization of your health outcome and the bottom line of your health and treatment is traded like pork bellies at the stock market. People ask how a middle aged, educated woman can support Bernie Sanders. This. This is why. Single payer. Medicare for all. Payment connected to outcome so that physicians can practice according to their training and expertise. I’ve been an RN for over 20 years, and I work at the hospital in question – The intellectual gymnastics required to embrace the unethical practice of profizing health in the US needs to be held up under a glaringly bright light for all to see. This is us. These are our parents and our kids. At the end of the day its a form of human trafficking. The insurer determines which medication you can take, which facility you can be treated at and what level of care you receive – because they have the power and the ‘freedom’ to determine their own bottom line. Not to make sure everyone gets treated, but to make sure that someone can afford a private jet, and a tax shelter, and to ensure the right percentage of returns for the stockholders that own your health and access to care. I’m sorry for your situation, but I applaud your bringing it to the attention of Hoosiers everywhere that have no idea that it even happens.
I wonder if this type of issue is to the medical professionals what vouchers (or “reform”) are to the teaching profession. I can’t imagine physicians like having ppl who are not medical professionals make medical decisions (usually to the detriment) for their patients.