Let’s Hear Some Juicy HMO and Insurance Stories

And that’s about all we have to say. This post could end right here. But we want to expand our editorial horizons and that means whipping you into giving up the ghost we parasitically digest and regurgitate in the form of helpful and entertaining information.

Honestly, we don’t know much about insurance or HMO’s, except there’s gotta be some really bad stories out there. Is this because the complainants end up dead or so embittered they don’t speak out? We dunno. School us!

Send in your HMO and insurance horror stories and tips to tips@consumerist.com.

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  1. The_Truth says:

    Im not allowed to :-(

  2. RumorsDaily says:

    I had a bad insurance story that turned good. In fact, it’s really about the hospital and not the insurance company, but close enough. I had oral surgery to remove a pair of Wisdom teeth. The hospital, for whatver reason, took both my dental and health insurance information and then only billed one, sending the rest of the bill to me. After six months of dancing with the hospital over the phone, I got them to bill the second insurance company and get me back some portion of my money.

    The catch was that they had made some mistake due to the irregular process and somehow billed the two insurance companies for more than the cost of the surgery, and gave me all of the money. I made $150 dollars. It was great!

  3. Franklin Comes Alive! says:

    I think that girl just bought her ice cream from Amy’s.

  4. Amy Alkon000 says:

    Dr. Judith Mann at the Culver-Marina Kaiser denied me anything more than a mammogram. Cancer runs in my family, including female cancers, and I have (stop drooling!) pretty big boobs (the mammographer laughed the first time she saw the results of the mammogram because very little could be seen [big boobs plus young make for poor readings]). After one office visit to Mann, two letters to her and two times on the phone (the second one ending with me screaming at her for denying me proper care) she agreed to send me to a breast surgeon and let him/her decide.

    When I went to the breast surgeon, it took about 20 seconds for him to say I needed an ultrasound in addition to a mammogram. He also felt, with my family history, I should have BRCA testing to see I didn’t carry the breast cancer gene. Now, I’m a pain-in-the-ass rather articulate newspaper columnist. What happens to the ordinary person who doesn’t communicate as well, isn’t as vocal or as persistent?

  5. i don’t recall all the details that eventually came about about the guy’s situation, but as far as i’m concerned, one need look no further than the guy in l.a. who tied up a freeway interchange a few years back and blew the back of his head out with a shotgun. on live network news. after laying out a banner on the pavement condemning his hmo.

  6. Ishmael says:

    I work for an insurance company. Ben, do you really want me to send you a research paper on the differences of policy types, and the reason for most of the denials that I see?

  7. My husband and I are both lawyers, and he actually does legal work for our hospital, handling a lot of their insurance and billing and privacy policy stuff and so forth.

    I fell down a flight of stairs and broke my tailbone. I was in incredible pain, and we’re sitting there, looking through the benefits summary and contract and all the legal language from the insurance company figuring out what it’s going to cost to go to urgent care vs. the ER vs. waiting until Monday to see my GP. (We’re on a tight budget with massive student loans.) I’m sobbing in pain, and we can’t even find where it lists the damned co-pays for emergency care.

    We finally went to urgent care, but I find it appalling that a) LAWYERS, one of whom works in the field, can’t decode insurance company benefit statements and b) I’m paying out the ass for health care coverage that I’m afraid to use in a minor emergency because the co-pays are so high.

    They send me like six statements every time I see a doctor. Apparently they’re all different, but I can’t tell how. I have to read them all really carefully to figure out which one is the actual bill. (It would be embarassing to forget to pay since my husband does their deadbeat collections!) At least my prescription coverage only feels the need to send me two random statements every time I go to the drugstore.

    My sister, who contracted a degenerative disease at 16, is considering moving to Ireland permanently. She will be “graduating” from my parents’ insurace later this year, and simply can’t afford coverage in the U.S. without a 6-figure salary. My parents’ insurace company didn’t want to cover her illness because, they said, “She wasn’t sick when you got the policy, and we shouldn’t have to cover her getting sick.” (!!!!!) Lawyers were required. Her drugs (prices inflated by big pharma) cost $3000/month just for the most expensive one.

    In Ireland, even when she’s just there as an exchange student, the Irish Health Care System provides her expensive and expert care for free.

    It’s a little sad when the “best and the brightest” have to flee the country because otherwise they can’t afford health care that keeps them from DYING.

  8. RandomHookup says:

    Actually it’s part of a government plan to outsource our sick and disabled overseas.

  9. Ben Popken says:

    @ Ishmael: yes.