A Collection of Problems with the US Health Care System

Medical Claims & Billing Specialist. Texas. Statement 10013.

Categories: Patient Statements
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I have had many problems with managed care plans and have testified in the TX Senate and House for many laws including the first liability law to be passed in the U.S., after my daughter’s life was jeopardized by our PPO plan in 1995.

I have learned that the most common problem is with communication. The employer doesn’t want you to know what is covered for you and the insurance companies aren’t going to tell you what they don’t want you to know.

Although it is very common for people to not know their health plans it is impossible to know about it even when you ask questions or read the plans. They put things in a way a layman can’t understand.

Recently my husband called an ambulance when I passed out. We were told by my doctor to do so because of a blood clot history. When the EMT’s checked my vitals and I was okay I refused to be transported to the hospital as it turned out not to be necessary.

The ins. refused to pay because I was not transported to the hospital. It states in our health plan booklet on one page it is covered but on the definitions page it states it is not. The State Ins. agency has sided with the ins plan stating it is a contract issue.

Then I complained about violating advertising issues regarding “layman’s terms” etc. The Attorney General, my State Rep and other politicians I have written to regarding how ins. companies are getting away with this, are ignoring my complaints. The reason they give is that it’s not costing millions of dollars. The cost to me was not overwhelming. Only $140.00. This amount of money may not mean millions to them but it is half of my life savings account. And it does mean millions if they are doing it to lots of people which they are. I don’t understand why they make the laws if they are not going to hold the violators accountable no matter what the bottom “money” line is. They are still violating the law.

Also it is asinine to think that me going to the hospital would have been cost effective to either the ins. company or to myself as the patient. They would have just told me to see my doctor in the morning which is what I did anyway. And they wonder why the emergency rooms are so crowded?

I am now very concerned about not just the ins. companies but to the politicians who pockets are lined with their campaign contributions. I am concerned with the state insurance agencies that govern over the ins. companies are “continuously” siding with the ins. companies and “not” the consumers.

If they want to know why other people aren’t complaining, they need to take a look at themselves. It cost me $27.00 to send my complaints by Return Receipt and what did I get for it…NOTHING. Even though they all signed that they received it, the state ins. agency and my immediate State Senator have failed to contact me regarding the issue.