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Health care coverage restored - sort of...

mrmike08075
So short back story synopsis...

In early October I received my health care coverage renewal paperwork (horizon blue cross blue shield) to which your eligibility is determined by a NJ state government agency (an Orwellian nightmare)

I sent the paperwork back within 3 days - filled out correctly and completely - only changing one thing - I switched email contact points from yahoo to gmail

October 31 I received a call from my horizon healthcare insurance nurse advocate (they assign one to anybody with a terminal illness or certain extreme conditions) telling me she just got an automatic notice my policy had been cancelled for failure to renew and I was now ineligible for benefits

Horizon by the way is fantastic - they are helpful - they care about the patients - they are just amazing (where NJ family care is most definitely not - just the opposite)

So no notification to me - no letters or phone calls or emails or texts or voicemails or telegrams or carrier pigeon messages or jungle drum beats (cause why collect all contact info and than not contact you at a critical juncture)

So I call and it takes days - you call in and an automated voice tells you call volume is high call back tomorrow (5 days in a row???) Or you spend an hour navigating the system before they let you attempt to contact a actual human being - place you on hold for another hour - I can't help you - transfer you around - more waiting - than you get transferred to a voicemail of someone who never calls back or still works there or died 3 months ago - get disconnected or hung up on - start over again

I call the agency that oversees them and complain - now I get a supervisor and her boss - they say no renewal so you in effect cancelled your policy and you now have to start over and apply again like a new client which may take 120 days...

I ask for emergency review status and play the brain cancer card - they say they will consider it and contact me with a decision (remember my email switch referenced above)

48 hours later I get a gmail update saying I must start over again because I failed to return my renewal paperwork...

That's when I realized I had them. That's when I knew I had been screwed. But that's when I knew I could hurt them...

I called the supervising agency and asked when my file had last been accessed and updated (date and time and terminal and id code recorded in their computer system) and they can see that mid October somebody accesses my account and edited my contact info...

And they knew they had been caught - that somebody screwed up big time (accessed late on a Friday - unfinished and never completed)

So again I get an emergency status review and today the automated system says eligibility restored - so I call my doctors office and ask them to check if my health care works - nope still inactive

Turns out based on my complaint and my health they voted to restore my existing account and Grant me eligibility - but starting December first

So no prescription meds (which have run out) and no doctors visits and no hospital care for a few weeks - despite the fact that I am dying slowly and this interruption in treatment may kill me

No way to complain on Monday cause it's a federal holiday - I will try but good luck getting through tomorrow after a three day federal holiday weekend

Ravaged and crippled and disfigured fighting one terminal cancer - an ostemy but no access to supplies - and a brain tumor - just wait a few weeks???

Very frustrating - and may have dire consequences.

I will rejoin the fray tomorrow and battle on.

Mike
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Comments

11 comments

Date Votes
  • hillbille
    may be time to get lawyer mike, many specialize in insurance cases, if nothing else you may get the satisfaction of knowing someone got fired for their incompetence, sorry to hear you got run around, I have just the opposite case, I retired in January lost my insurance in febuary but I have VA so no big deal, my company insurance is still reimbursing the VA for my visits, I have contacted them twice and told them of this, I just quit calling, the VA knows is was cancelled, they tell me the insurance company will let them know when it is cancelled, basically till then they keep billing, I could care less at this point I figure the VA needs the money more than my company. I figure the VA is just getting back some of the coverage money I was refused in the last 40 years of working.....
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  • mrmike08075
    Certainly not your fault if the company keeps paying - but when they finally realize their mistake despite your frequent attempts to put them on notice do not be surprised if they bill you or try to recover from you...

    The last time I was hospitalized after blacking out (broken ribs and head lac) the emergency room used a trauma code that indicates an accident - not the one that indicates complications or side effects from a preexisting condition

    So the state of NJ wants me to tell them who caused the accident - if someone else they will go after them or if me they will not pay

    It's ridiculous.

    Also when I was treated in the hospital they made a dosage error on a medication - pushing 5 times the normal dosage and sent me home

    I ended up in an ambulance and back in the hospital 24 hours later and had to be pumped full of high levels of a counter agent to prevent heart failure - they coded it as adverse effect of angiotens convert enzyme inhibitors / initial...

    Not an administered over dose or or error in dosage

    So the state wants to avoid paying or wants me to blame the attending physician at the hospital

    The initial over dosing almost killed me and the counter treatment can cause strokes or heart attacks (it's risky and painful)

    An attorney would be nice but I cannot pay a retainer

    There are times that the bureaucracy seems more harmful than the cancers

    Mike
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  • hillbille
    quote:Originally posted by mrmike08075
    Certainly not your fault if the company keeps paying - but when they finally realize their mistake despite your frequent attempts to put them on notice do not be surprised if they bill you or try to recover from you...



    Mike


    that was my question last time, I actually ask for letter stating I would not be held liable, never got it though, but was told they had to go after the payee, who would be the VA, just thought to myself good luck getting money from them, but do have an e-mail from a girl in my insurance office stating I would not be responsible and she was notify the carrier again, this was in june. we changed insurance carriers in January from our company and I was lost in the cracks as I retired at the same time.

    sorry to hear of your runaround, as I quit talking to the insurance people, I get so mad I usually just end up cussing and hang up. My wife took care of it, though my health is no where near the extent of yours and not as life threatening as your case either. you may try a call to your state insurance regulatory board to see if they can help, I know they do in the case of auto/home insurance, not sure if they will get involved with health care, good luck and god bless
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  • spasmcreek
    we had a state insurance commissioner here in Kansas in the past that was a whiz...get stuff fixed muy pronto...don't know about the new one... could wish a long debilitating case of the squirts on some of these govt screw ups lasting several of their paychecks
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  • nmyers
    Cases like yours are their reason for existing:

    https://www.nj.gov/dobi/enfcon.htm

    Neal
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  • dav1965
    Mike what about disability? My wife filled out the paperwork online and they sent it to my cancer doctor and i was approved in about a month.

    I had to go 1 year before i could get actual disability. So i lived off of retirement while laying there.

    There is a short term disability and long term disability. I was approved and 3 years later i had to reaply.

    I had my family doctor, pain doctor and my cancer doctor write a note saying i will never work again.

    I have been going to my family doctor for over 20 years. We are the same age. LOL In my late 20s she would see me bring my school books to doctor appointments.

    I was surprised when she picked up an electrical text book and told me she remembered taking this class.

    Mike i know you do not like the idea of disability but neither do i. I know i cant work anymore. After 2 hours i have to eat pain meds like candy and i do not stop hurting.

    The next day after doing something is even worse. I hate to make plans for a specific day because i do not know how i am going to feel that day.

    It seems every time something is planned i am having a really bad pain day.

    Put in for disability that is what it is for.

    I am the only one to get help from the government in our family since we came to this country.[V]
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  • mrmike08075
    Basic medicaid restored - scrips will be picked up tonight and tomorrow

    Been on the phone for over seven hours straight - over 40 calls and 32 texts and 18 emails and 12 voicemails

    Horizon coverage may be restored sooner - they will call me Wednesday or Thursday with an answer - another level of emergency review that they denied existed or was possible

    Horizon has been amazing - even after the state cancelled the policy and even though coverage is not effective until December 1st they are still helping with the heavy lifting - they are not obligated

    They actually suggested that if I could not get my scrips to go to the emergency room and stay in the hospital till December 1st and have them dispense the meds - can you imagine what that would cost...

    Trying to make follow up and referrals appointments.

    It's been a rough day - may just collapse soon.

    I don't have the energy to do this anymore.

    Mike
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  • Maalox
    Glad to see your coverage is back in place. Take a rest tonight and work on the new appointments tomorrow. Take it one day at a time or for me sometimes it is even as little as one hour at a time.
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  • Wild Turkey
    I wish some of the people who think Government Health Care is such a great idea had to live through some problems like yours.

    Maybe they would see the light[;)]
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  • mrmike08075
    Dave,

    No disrespect to you or anybody here...

    They have been pushing me hard from all sides to apply for social security disability insurance status

    I really never expected to be alive on the two year anniversary of diagnosis - I figured on dying before needing disability coverage

    It's hard for me - I have worked my whole life - I do not deserve it

    I am crippled and disfigured and hideous. I am scarred and physically altered and have an outing and am a broken empty shell of a man

    It's humiliating and emasculating and mortifying and embarrassing to have to apply for and accept social security - and it feels like I would be admitting that I won't get better - not ever.

    When I dream I am not a disfigured scarred monster - I am me again

    They tell me I am eligible and I deserve it and qualify for it - that cases like mine are why the program exists.

    I have been putting it off - stripping myself of assets and possessions to pay medical bills with no income and no job and no ability to work or drive - I can no longer contribute to the family financially or take care of myself and my responsibilities

    And I have been neglecting that aspect of how I care and provide for them or contribute to them

    It's just been hard and tears me up inside - causes heart arythmia - chest pains - soul crushing and ego bruising

    I did not want things to go like this

    But that's were it's headed.

    Mike
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  • mrmike08075
    So no meds since October - but the pharmacy has everything ready except for the schedule III pain stuff

    Makaila took my vitals and did a general assessment - I took the meds correctly and broke into my secret stash - I keep a bright blue engine turned cylindrical screw top pill safe on a break away lanyard around my neck

    I had one solitary ms contin time release morphine 60 and used it - the others should finish emergency review status and over ride sequestration today or tomorrow

    I woke up approx 3:30 am to Mackenzie doing a "is he alive" check and drank some water while she took the animals out I to the back yard - I knocked down the fireplaces and added some more fuel and bundles

    I took some more meds - that were in the cue and and on schedule - will drop into a stupor shortly

    Thank you for the emails and voicemails and thread postings - they are spiritually uplifting and reinforce the fact that you care

    I have lost weight and look awful.

    I will eat something and hydrate.

    Mike
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