Wednesday, September 16, 2015
NorCo Worker Deals With Illness, Insurance Denials
Married for 24 years, Jim and his wife are currently putting their child through college. as anyone with kids can tell you, that's an expensive proposition. "We're back to living paycheck to paycheck," he admits.
No time is the right time for someone to become sick, but it has happened to his wife. Recently, she began experiencing bloody bowel movements and was not feeling well. She eventually ended up in the office of a gastroenterologist, who is concerned. He has ordered a colonoscopy and a CAT scan. He also prescribed barium for the procedure as well as Nexium for the acid reflux that has accompanied his wife's other symptoms.
And Northampton County's medical insurance carrier, in its infinite wisdom, denied coverage.
Now the insurance provider quickly reversed itself on the colonoscopy and CAT scan, but still refuses to pay for the barium medication needed for the colonoscopy. It also is refusing to cover Nexium, telling this guy's wife she can get it OTC.
Fortunately, the doctors are involved and are going to discuss this denial with the insurance provider. But in the meantime, this guy is a wreck. He told me that if he pays for the medication himself, he will be $400 out of pocket.
According to Jim, this is not the first time. Last year, he was denied coverage for the removal of a lump in his chest. The claim administrator had denied coverage, arguing it was cosmetic It took a lawyer and doctor tag team before the insurance changed course.
For Jim, the excised lump was benign..But changes to these health plans are a cancer on the morale and health of the county workforce.