The Daily Gripe #16 - Medical Insurance

It's time for The Daily Gripe, from Average Joe American.

In March I wrote about how terrible the vision coverage in my employer's medical insurance is. This past week I learned a lesson that at least the medical portion of the plan is no better.

At my wife's urging, I finally decided to have some moles removed. I don't currently have a Primary Care Physician because I was completely unimpressed by his people skills. My mother-in-law recommended a Dermatologist who had done similar work for her. I called the Dermatologist to make an appointment. My insurance plan doesn't require a referral for such treatment, but this Doctor requires a referral to accept new patients. Not having a primary Doctor, I had no one to get the referral from.

My insurance company provided me the name of the only other in-network Dermatologist within fifty miles of my home. He was accepting new patients, but had no appointments available until March 2007!

I filed a complaint with my insurance provider about the first Doctor's unendorsed referral requirement and asked about my other options. I was told I could have an out-of-network Doctor request an exception to treat me at in-network rates. I found a Doctor and asked him to submit the request. I was supposed to receive the decision by mail within seven to ten days.

I waited.

And waited.

And waited.

Frustrated, I called the Doctor who submitted the request. I was told that the insurance provider told him that he was already in-network (after having told me he wasn't). I called the insurance provider for clarification, and was again told that the Doctor was not in-network. I was told I could request a "non-par review," apparently another method of reviewing non-participating Doctors for in-network coverage. First I was told the Doctor had to submit the request. After some expression of my frustration, I was permitted to submit the request, and was promised a decision by mail in ten to fifteen days.

Again, I waited.

And waited.

And waited, and waited, and waited.

Notification came by phone last week. DENIED! Why? Because I can use out-of-network benefits and because there are two providers in my area who are in-network. The same two providers who are unwilling to see me without a referral or unable to see me for eight months. That really gripes me!

I'm trying to have a minor elective treatment that will help to prolong my good health, and I'm effectively being denied treatment by the very Doctors and insurance provider who are supposed to enable my health care!

Yesterday I received my notice by mail. I have the right to appeal. I have fifteen days. I wonder if they'd like it if I keep them waiting.

And waiting.

And waiting.

Joe