THEIR RULES, OUR PAIN

Real stories of people trampled by the insurance companies

“Years ago, my then 12-year-old son was hit by one car and run over by the next vehicle when crossing a street. He spent a month in a coma. The neurosurgeon assigned to his case required CAT scans and later on MRIs to treat my son. However, my insurance company decided that these tests were unnecessary. Just like that. No tests, no treatment. One kid in a coma and no way to find out the extent of his injuries. I had to sign a waiver agreeing to pay for the tests out-of-pocket (which took me years) so that my child could be treated.

“In a more recent development, my husband has muscular dystrophy and has been confined to a wheel chair for the past 5 years. He works full-time and needs to be independently mobile. In the summer of 2006 he submitted an application to his insurance company for a new wheel chair because the old one was causing pressure sores. It was a hand-me-down that is not quite right for him because it was built for a shorter person. He went in for a physical as requested. Months went by and we heard nothing about his application. Finally, we found out that the person who did the intake neglected to forward the application. So we waited some more. Seven months after filing the application, my husband got a letter saying his claim was denied because there was no evidence that he required a wheel chair. He appealed, but we were back to square one. The deadline for the appeal was closing in, so he called to make sure the application was being processed. First they told him that there was no appeal; then when he produced copies, they 'found' it on someone's desk. After a year and half of waiting, he finally got his chair.

“We paid out-of pocket for the deductible, co-pay, and the "special options" (like raising the chair to reach cabinets and shelves and reclining to prevent pressure sores). We thought we were all squared away. Now all of a sudden we are getting statements that seem to indicate that our insurance carrier may not have paid their share in full. It is very confusing and we are getting conflicting information. Getting to talk to someone who can adequately explain what is going on seems to be impossible."

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