Dying For Insurance: "We are not your medical provider, We are your insurance company!"

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"We are not your medical provider, We are your insurance company!"

Many of the more strange statements made by my insurance company occurred during the most difficult and expensive time of my wife's journey to function because of a ligament problem. There was a period of about 6 months when we called for Pre-Approval and received no information, contact or payments for any of the procedures that were done. I had made many calls and sent letters and emails during this time with no response as to approval or denial of claims. By the time I realized that we may be out $25,000 in a matter of months, I was told that the procedures were denied.
My main problem was not the denial (that was really my main problem financially), but I was very upset about the lack of any information from the company as to the Pre-Approval. After going up the chain of command, I was finally put in touch with the top person at the company who could make decisions. I could tell that she was frustrated with my complaints because I had kept very detailed records of my conversations with each person. After I specifically asked her why the 72 hour Pre-Approval only seemed to benefit them and we had not been contacted, she lost composure and said, "We are not your medical provider, We are your insurance company!"
I do want to reiterate, for those who may not have read my earlier post, that I do think that they are basically good people. They are trained in a manner that works when dealing with people that do not understand or read their policies and they have developed a skewed sense of logical thinking. I am sure that they really believe that, at some strange level, the fact that I was not told anything was somehow my fault.
After having spent tens of thousands of dollars in each of previous years, and now having the additional costs our responsibility, made it clear for the first time that we were really on our own for paying to solve this particular problem. What she really was saying is that we can have whatever medical care we want, as long as we are willing to pay for what they don't. That would only be fair if one were told prior to procedures if it were covered, or not.
Later, they actually did act as our medical provider by interfering with a second opinion by an excellent specialist that they picked, by contacting him after his initial letter and having him reverse what he had told us; Their reasoning was ridiculous, but that will be for a later posting.
TVP

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