Thursday, June 16, 2011

More Insurance Woes

Kaiser lied to me AGAIN. Today I hate this country. I hate that the administrators have taken over every single system and corrupted it. I hate that everything from the level and standard of education to healthcare to respecting the constitution and it's processes are in a rapid state of decline. I hate that politicians have the morals of sewer sludge. I hate that our postpartum maternal death rates are rising alarminly while in third world countries and all developed countries around the world they are declining. I hate that we have the highest number of incarcerated people per capita yet our laws are being cancelled out by more laws that are being cancelled out by even more laws and lawsuits. I hate that in California, illegal immigrants can apply for and get government financial aid to attend college and other non-citizen people residing here can get free healthcare but I can't even get healthcare coverage for my own child when I can pay for it, and I was born and raised here and pay taxes through the nose. I hate that as a self-employed person, I cannot get into a decent healthcare program, or retirement program. I can't even get an LLC or incorporate as a licensed childcare operator; the State doesn't allow that. I am truly alarmed at the state of this country. This isn't the America I was born to, but a rapidy morphing beast that is being unleashed the destroy the infrastructure of all this country was founded upon.

Last I spoke to Kaiser when I gave them my daughter's SSN, I specifically asked, "Is there anything else you need in order for my daughter to be covered." The woman on the phone replied, "No, her coverage will begin July 1." Today I received a letter in the mail stating:

"In order to continue processing your application, we need a statement from your current physician regarding congenital condition and require a current physical examination within the last 12 months. If you have not seen a health care provider within the past 12 months, we require that you obtain a physical examination and provide a physician's statement on your current health status. The statement should include a full listing of all of your diagnoses, any medications you are taking, current lab results, any unresolved health issues and any anticipated treatment(s) or surgeries needed."

What am I supposed to do? Go to the nearest neighborhood pediatrician's office and ask if they take debit cards like going to Walmart? What current physician do they think my daughter has seen? Oh, yes, she did see one in China at the Medical Exam Office to apply for her visa. Does the eye check count? How about having her blood pressure taken? Gosh darn, I wasn't allowed to open the Brown Envelope so I don't even have a copy of that much! Wait, will they accept the PPD test result? Do you think I can pay for all the necessary diagnostic tests to know the "full listing of all the diagnoses?" This is a catch. I've seen Sick Around America. If they find something, anything, not disclosed, then they cancel the insurance and bill you for all the previous care, take your house, your car, your life. How can I possibly fully know what she's got when I can't get freaking insurance so that I can take her to the doctor and have diagnostics run?

How am I supposed to sleep tonight? How can I look my daughter in the eye tomorrow? What in world do I do if she gets sick or injured while I sort all this out? How dare Kaiser do this to us!


China Dreams said...

Wow! Your state is so very different from mine, so maybe this won't help, but I think you should try Consumer Services in the CA Department of Insurance. Here is their website:
And, for the record, I understand your anger. Our legal, working daughter and her legal, working husband have expensive health insurance with limited coverage and they and their kids are on four separate plans because none of them can afford a good group plan (and neither can their small employers).

Good luck,

Cristy said...

I know this is SO FRUSTRATING!!! So first, BIg HUGS to you Mommy.

Now, you need to call Kaiser, you ned a superviser, get the name of everyone you speak to. Explain your situation. If they don't help, ask to speak to their manager and keep going up the chain. You should tell them that you will contact the State Ins Commissioner to file a complaint against them and DO IT.

YOU are your daughter's advocate and so keep pushing. Check to see if they can request this prior to adding her to your policy.

Celia's wheelchair was denied. Case closed. We asked for a patient representitive within our insurance company and as soon as I explained to her mom to mom, it was miraculously approved.

Just keep fighting!! I did insurance for years, and it's a game. They hope you pay/go away but if you keep fighting them at their own game they will usually do something.

Hang in there!!

Lynnea said...

Keep fighting.
and fighting. and fighting.
It does SUCK and I'm so sorry.
The last thing you need to be dealing with right now.
It is a game....a not fun game.
Hang in there.
I pray it all works out and they will do what is right.

Peggy said...

I'm praying for this to be resolved for you and your daughter. I know what a headache it is. We're going through insurance woes right now also. My husband works for the state of IL and they are in negotiations. So we have until Friday at 5pm to make a choice of plans, but the plans on the table are subject to be withdrawn at the last minute because of lawsuits, grievances, and negotiations. It's a insurance issues usually are. BIG HUGS!

China Dreams said...

PS-If you haven't checked the state website I gave you yet, they CANNOT deny her coverage EVEN with a pre-existing condition; it is your state law. There is a link right on that first page about coverage for children and this is one of the first things it addresses.

Carrie said...

I hate insurance companies! You may also ask for an advocate from Kaiser and/or ask for a case manager.

Since your daughter has chronic health care needs, a Case Manager is a very helpful. They coordinate all your care and will help you deal with the insurance company (get things pre-approved and work out denied claims). I don't know about CA, but they have them in UT and I've heard that insurance companies must provide them.

Your job is to hound them and to be your daughter's advocate. Good luck!