Understanding Your Insurance Coverage

Some insurance companies are no better; you spend half your life paying premiums, but, when you become sick it’s another issue. This is especially true when certain items are not covered or you live outside the coverage area. We are residents in the Las Vegas area, basically only two hours out of the service area and because of this we were denied service, medical equipment and other necessary items. Keep in mind this was a very sick person that needed medical attention. For over 30 years he seldom used his medical plan. It was used for only for outpatient appointments or services… no major medical until this incident.

The politics we experienced were unbelievable. When you think you have heard or seen it all, something comes along that tops it off. My love one needed a pad in his wheelchair for a wound when being transferred to therapy. We were denied the pad because we live outside the service area. This was unbelievable because he was an inpatient in the rehab facility for over four months. What did this have to do with service area when he was an inpatient in his health plan’s own facility. We received the pad because a staff member thought this was ridiculous and gave it to me and stated “put his name on it and don’t say a word!”

I was told by a nurse advisor that my love one needs to be transferred to a hospital facility for an outpatient procedure at our expense. The procedure was deemed medically necessary by the primary physician and required transportation by paramedics. I was told this was not covered by insurance and payment was needed prior to transportation. Most people are not aware that any procedure determined to be medically necessary by a physician is a covered item. This procedure was expensive. When I told the nurse that I knew the law and refused to pay it, she disagreed and stated that she would speak with the doctor. Later that evening she came into the room and stated that the hospital and the doctor agreed to waive the charges. I saw this happen to other patient’s family members who paid with their credit cards. I thought, this is wallet biopsy. In some case you can recover from surgery quicker that you can from wallet biopsy.

I have worked in the healthcare industry since I was nineteen and have knowledge of medical claims, billing, compliance, appeals and insurance policies but had I not known the business they would have pulled one over on me. Ask questions and find answers about your benefits. It will help save your sanity if not your pocket.