Preview of Things to Come?
Anyone else having this problem?
- I have been retired since April 2010 after 37 years of service. Over the last several months, my wife has been seeing a orthopedic physician due to severe neck pain. He prescribed physical therapy and my wife completed 6 weeks of therapy at a facility that we have both used in the past.
We got notice from Blue Cross that they weren’t paying for the therapy and that they would review the claim. Today we received notice from them that they denied the claim because they feel it was “not a medical necessity.” We thought that maybe it was coded wrong or something like that so we called the therapy place and were informed that (at least at this place) the City has been denying ALL city workers therapy claims and that BCBS should have told everyone from the beginning.
So I’m wondering if anyone else has had this type of problem or is Mayor Shortstack diluting our benefits without notice?
We know retiree healthcare is supposed to end in 2013. We're sure Rahm is looking to offload any and everything he can into Obamacare. Is this a preview?
Labels: money questions
posted by SCC at 5:01 AM
170 Comments:
I am still on and went for therapy for 2 herniated discs and severe sciatic pain which prevented me from driving or sitting more than 10 minutes. Obviously not good as P.O. Bcbs denied half my claims so far saying not medically necessary after reviewing medical records that were sent. My bill is up to $15000. They're cracking down on all therapies even if u call prior like I did just to make sure it is covered. Not sure what will happen. I would have never gone if I knew I was responsible for all of it.
Im.not retired but it happened to me. I was denied the same way
strange rahm has money for penny pritzker hotel, shes the one who is building a home for ob in hawii. this is proably just a coincidence but I think not. the cuts in the hospital plan are just the begining. someone has to pay for his grand and noble gestures. we are obviously not on his list to be rewarded. who else is being rewarded at our expense?
Wow! I wouldn't put it past Rahm. He's a dirty rotten piece of shit.
You voted democrat most of your adult life most likely and now that the democrats are screwing you and yours - complain.
Welcome to the real world where pensions went the way of dinosaurs back in the 60's and 70's due to corporate raiders (democrats did nothing then either).
Private health care insurance supplements to medicare and medicaid are pretty much what you have left, unless you are ineligible for those programs because of your employment history.
Might get used to a whole lot of things being 'denied' by those you trusted with your retirement years. They wish that the retirees would go away (meaning die) so they wouldn't have to pay out big $$$$$$ for either retirement or health insurance.
This is the thanks you get for the service you gave. Blame a democrat.
Enjoy everybody. This is what we get for not sticking together. This rat bastard mayor thinks he is Napolian.
I had the same issue with the chiropractor earlier this year, and I'm not retired...
How about Daley's retiree health care? Mumbles is retired, will HIS benefits end on June 30, 2013?
Most likely I will have to scrap for my health care but Mumbles the fucking cocksucking bastard will have his Golden Health Care forever.
Maybe Andy Shaw can check into this one, will Daley's healthcare end next year along with ours.
Anyone taking bets on that one?
“Is this a preview?” Yes, I believe it is. First he will stick it to the retirees on health insurance then he will go after our pensions. All the benefits that made this job palatable are gradually being take away.
Rotten fucking bastard. The people who can least afford it get Rahms circumcised dick up their ass. 22 years of getting buttfucked by Daley and now it gets worse. No wonder Daley took a sneak and left while the getting is good. Replaced by a cold hearted bastard.
We are fucked. Chase the savage beast for 29 years and then we are told go fuck yourself.
Young officers and would be officers: Pay careful attention and conduct yourselves accordingly.
Can somebody post the new SGT's assignments if they have the printout?
Curious to see if a few clouted made their way back to their units already...
Thank,s,
Troll on Furlough
Which insurance do you have???
I bet the Mayor's wife gets treated for neck pain and is allowed therapy!!!!!!!!!
I retired six years. My doctor reminded me I was due for my 10-year colonoscopy. I had it done in June and learned the hard way that it was not covered. $5,000.00 out of pocket. Should have called BC/BS beforehand, but never in my wildest dreams did I think a c'oscopy would ever be considered ROUTINE. Remember retirees - insurance does not pay for anything if it is not coded as diagnostic. I think they just want us all to die and go away.
I retired in april 2007-- moved out of state at the end of 2008. I was referred to therapy but luckily called BCBS first and was told they would not pay.
I'm having the same problems. According to my chiropractor, the codes he uses to bill chiropractic adjustments are the same codes as physical therapy. All my adjustments have been denied this year for the same reason even though BCBSIL allows us 20 visits per yr on the PPO plan. I've never had a problem until this year and have been getting adjustments since 2006. My chiropractor explained that even though Blue Cross processes the claims, the city kicks it back as "not medically necessary". He said he spoke to his colleagues and it's happening citywide to all city workers. If you're a new patient, the first few visits go through otherwise your claims are DENIED.
Retiree benefits are not the same as the benefits accorded to current employees. That may have a lot to do with the denial.
Thanks for giving 37 years of your life to the City of Chicago.
Thanks for working holidays and weekends and missing watching your own kids grow up to help raise ghetto bastard spawn instead.
Thanks for allowing us to shit all over your rights earned thru collective bargaining every chance we got.
Thanks that two of you dummies aren't even able to decide on a lunch location; you pussies weren't, and never will be, any challenge when it comes to running roughshod over contract negotiations.
Thanks for not complaining too loudly that we've decided to hold illegal aliens in higher regard when it comes to receiving medical treatment and services. Same goes for the public school system, if that's cool with all of you.
And most importantly, THANKS for only 23.6% of you slouches bothering to vote in ANY type of election - we anxiously await the same turnout come Tuesday.
- City of Chicago
Call Blue Cross and ask to speak with the medical director (who's a Dr.) explain the situation and ask why denial and how it was coded. Then ask if a rider to policy was put on amending said policy as changes to federal or state law may change terms and conditions. Finally ask what made it NOT a medical necessity as deemed by the orthopedic Dr. Of course you'll have to get ortho doc to write why it is a medical necessity so don't pay until resolved one way or another. God bless you and the family for those 37 years of service and can't wait to hit 20 and get the hell away from here!!
BCBS is doing this for EVERY SINGLE therapy claim. Make sure the place where your wife attends replies to every request that BCBS is giving them for docs, updates, etc... and they will eventually pay.
If you have a legit script from a doctor and the therapy place accepts BCBS then they have to pay.It just takes them months of nonsense to process and pay the clam.
Call the FOP and inform them of your problem. They are taking information on class action suits for non payment
This has been an issue for active members also.Physical therapy and chiropractic bills are NOT being paid.FOP claims that Mayors off ice is putting pressure on Blue Cross not to pay???That doesn't make any sense to me.Anyway FOP has been useless with this case.I've been cut off from the chiropractor,can't blame him.I'm expecting somewhere down the line to get socked with a bill from him for the 10 visits this year as well as 4 weeks of PT at another place.
My wife is in therapy now, so I will find out when she finishes in another week. Both her and I have had therapy at this place and it has been covered.
Often times physical therapy places and chiropractors have a scam going called "day 1/day2" treatments. This is where they rope you in and say you need aggressive or constant treatment. Many places cater to City workers b/c City workers have good insurance. Medical Necessity is needed to provide treatment.) Most of you will discover that your p/t will prescribe orthotics b/c BCBS always covers orthotics. ) Many will offer free incentives through promotions, and subsequently bill BCBS for these “free incentives”. Additionally, it is common that once you come into one of these “Wellness Centers” they will take an x-ray and advise that you have nerve damage. Surprise, surprise….nerve damage cannot be seen in an x-ray. There are several things you can do to protect yourself, and recover your money. It may start with taking the Wellness Center to court for deceptive practices, health care fraud and recover your money. Dealing with BCBS is not that hard, if you want to make an appeal to them. Sometimes, we don’t read our policies, and are supposed to take certain steps prior to receiving treatment due to new regulations from BCBS. There are so many more factors involved that would take up too much space here. If I knew more about your situation, I would help ( completely free legal guidance), but am not about to leave my info on a public post. SCC, kindly advise how the original poster and I can get in private contact. It’s a rough economy and no one should be scammed when trying to get medical treatment through health benefits they pay for. The health care scams are pervasive and oh so common.
Had the same problem with chiropractor this year. You may qualify for a treatment but they will determine if its medically necessary.
No matter how many times they submitted it changed codes etc, they wouldn't cover it.
I just got a notice from BC/BS that they only covered about 15% of a bill for a foot injury that was on the approved list.
Yep, same here. BC-BS has asked for complete records for all of 2011 and 2012.
Did you get a letter from Coghlan Kukankos, LLC law firm with a questionnaire about your case, threatening you with non-payment of your bills if you don't complete and return it?
The beatings will continue until morale improves.
Where the hell have you all been! Insurance companies have been denying patients certain medical treatments since their inception. And push what off onto Obamacare? There's nothing you can push to it because it's not a health insurance plan. It only deals with the way insurances administer health care (example wellness benefits and physicals covered, pre-existing conditions, children remaining on until age 23, and problems such as the one posted, denying crap just for the sake of denying. some of these don't take effect until after 2013) Hence the name affordable health care act not the universal health insurance act.
Self insured! Who is in charge? IOD ALSO!
I too have been denied phys. therapy,but it was deemed no longer helpful for the injury I think they used the term "static" at the PT place....no improvment after X amount of visits and they will no longer cover it! and my PT place had to "hide" the deep tissue massage by a therapist, BC/BC, nor Coventry would cover it, even though it was the only source for pain relief for my injury.This was for an I.O.D., and I ended up with a lot of contraptions, that gave no pain relief...So, I ended up paying the Therapist cash.......and NO happy ending!
Happened to me. The claim was ok'd after more detailed documentation was sent from the therapist. The whole process took about 5 months to resolve. It doesn't hurt to call BCBS a few times to check your claims status. Squeaky wheel gets the grease.
I think the city is self insured and BC is only processing the claims. It is up to the city to decide what it will pay for.
This is why you should always get approval in advance before undergoing expensive treatments. Even if you end up paying for it yourself, at least you will know about it up front.
This kind of thing is common with all insurance plans. They all have little quirks about what they will and will not pay for.
not a cop
You should understand that as a retiree, you don't have the same benefit coverage. Welcome to retirement.
Would it surprise if you the little fairy on the 5th floor is messing around with your benefits?
Now all of you dumb asses who voted for that machine can reap your socialist reward. You'll soon be sent to a non English speaking "doctor" from a third world country and he'll give you a once over to decide if you're worth the expense of any further care.
But don't forget to put that democrat sign in your yard for the election.
Yes!!! The city hasn't paid a Chiropractor bill since last December...I have been going to one for over 10+ years while on the job because of spasms cause by wearing this gun belt...Me and the doc talked it over and after he did some investigating, he found out that it was the mayor. Also said it was all city workers across the board not just policemen. Right around the time the bills stopped getting paid, I saw the governor on the news stating that he was cutting the state workers chiropractic benefits to save money. I never got any notice or pre warning. So I wrote a letter to parent blue cross and they basically said its the city and THEY provide coverage/pay bills etc......Wrote the city blue cross on state and they still denied...was told by the union rep to email one of those yo yo's at FOP and I never got a response. Nothing is on the news about this or any type of reporting...Guess what two people won't be getting my vote! I'm sure to call in sick when my back is bothering me.. How can they just cancel a benefit without any letter or anything..
This would be correct. My PT place confirmed the city's refusal of all claims.
Noticed a new PT place open in the 19th ward with the name Chicago Fix. I wonder if it is owned by the clouted and whether their billing the city is more effective.
Sports and Ortho in Beverly is one of the largest providers of PT to city workers covered by BC/BS. The Beverly Review did a story a short while back that they are having all of their claims from several years back audited. On a personal note, they do a great job.
The Medical Section has been referring IOD's to them for years. For some reason it seems as if the City is trying to drive them out of business. I have been getting notices that claims from two years ago are now being reviewed and the status of the claims are hold.
What about this? I have called the attorney for the case and he has no answers. I guess I am going to have to go and get my own insurance. I know no one wants to hear but when I came on the job retirees paid nothing for insurance. I know the pension is in trouble and now everyone is worried but ofering free insurance to those at 55 was not a great pln either. Some older PO's not medicare eligible will struggle. I will be ok but not happy. Retired Girl
Yeah, I had to contest a denial of benefits because BC/BS decided my son "opted to use an out of network provider" as an ambulance service. Mind you, he was in a severe accident and if you see the run sheet for the ambulance, it was 911 dispatched, being the emergency service for the county in Wisconsin where the accident took place. Also, as he was unconcious I am not sure how he opted for anything. Signs of times to come.
am i reading this wrong?
Where was the therapy?
Welcome to Obamacare, this is a preview of it. Thanks to all of you fools who voted for him, enjoy your chains.
BC/BS has been denying all sorts of things for a few yrs now...assigning "case managers" etc. Documentation required that states "medically necessary" My kid broke a bone..taken to the ER..then onto Ill Bone & Joint to see a specialist...kid couldnt walk on crutches at all due to several broken bones...Dr gave a walking boot...DENIED by BC/BS as NOT medically necessary!! I am STILL fighting w/them about it...documentation was sent from Ill Bone & Joint months ago obviously must have been lost somewhere cause I continue to get the bill each month of over $300bucks...I think i am fighting with a ghost
Contact the FOP
I seem to recall several active duty officer's that had services similar to this denied sometime this past year.
The FOP got involved and I believe it was resolved.
My wife fractured her shoulder in three places last October. The Doctor recommended physical therapy instead of surgery due to the nature and location of the fractures. BCBS paid for the therapy sessions till the end of the year. Starting Jan 1 they have denied all payments. The reason given "not medically necessary". Is something going on?
I have had plantar fasciitis and have had plenty of physical therapy. I have had no problems thus far.
2 officers, one is a P.O. in 013 and the other is a LT. in 015; They have a child who was born with a severe disability and she does not walk.
The child had been given physical therapy since she was born and covered under the city insurance.
As of about a year ago Blue Cross/THE CITY states that the therapy is now NOT COVERED.
The FUTURE is here.
We are now all just 3rd rate scum like the animals we lock up.
EVERYONE should remember this the next time you think twice about risking your well-being, not to mention your life.
whatever you do, do *not* take a first level denial as the end of it. All healthcare companies are required to have an appeals process. This was Dr prescribed therapy and more than likely should be covered.
Never had a problem, but I usually received pre approval from BC/BS, If it is a continuing medical problem they work with you thru a counselor and try to manage the healthcare
My wife has breast cancer and when getting CAT scans, MRI's, etc the doctors office always calls and gets pre approval
This is the tip of the iceberg. Wait till you see what Rahm Emanuel is going to do to those who are retired and are retiring.
This fucking city sucks, only here can a man serve 37 years and be dicked around line this. Any how thanks for your service.....
they did this with cat scan and mri a few years back. The city just stop paying on them without approval first. The union grieved it and won but that took a couple of years. The city said we can't afford them so we wanted pre approval before we paid them. The problem was they never notified anyone they just went and did it.
Rahm needs to keep chiseling away at our benefits so he can continue to cater to the Link, SSI etc. crowd.
Rahm you're a disgusting slimeball. Leave the hardworking middle class city workers alone and let the bottom feeders start fending for themselves.
My son has Cerebral Palsy and needs therapy 2 times a week BC/BS told us if his medicare don't pay they don't so only 18 visits are allowed. why are we paying (retiree) so much when they deny
For whats it worth, retired 2 years ago, didn't use the medical plan for several months afterwards.
Went through a rigamarou over payments.
Long story short, when you retire city pulls payment as an active member, does not reinstate until plan is used as a retiree, saving money during that gap of time.
So a very healthy member may not use plan for weeks, months or even years and city saves a fortune.
Also, if you know you may need a new knee, hip, etc. in near future start pushing for it now.
2013 is almost here and I suspect we're in for a royal reaming.
You are not alone. It's happening to people on the job also.
but hey....we all have free healthcare!
If Romney doesn't get voted in next week this Country is doomed! I'll be stocking up on ammo, MREs, and survival gear.
My prediction is that if Obama(praise be his name) get reelected that we will all be placed on some form of Obama(praise be his name)-care.
The City BMO will cease to exist as we know it.
VOTE RED
The city has outsourced a company to review all therapy bills. BCBSIL will approve and say it's payable but the company will sayit's not medically neccessary. Another way to cut down costs.
I had an MRI refused this year. My doctor orders an MRI yearly for cancer screening due to high risk of a certain type of cancer. So every year I get this MRI. Until this year when it was denied as "not the current standard of care." An ultrasound was approved instead.
It has been the "standard of care" for the past 10 years but now, thanks to cheapskate City of Chicago, it is not.
Active employee, not retiree.
This is how they are treating us now. Young officers and future officers, pay attention and beware.
Public defender not guilty of assaulting prosecutor
I am an active police officer and my husband retired via the age 55+/free insurance offer. When he was still active, we both paid for separate BCBS policies, because it wasn't that cost effective to be on one policy. When he recently retired w/the free insurance, I stopped paying for my own coverage and I went onto his policy, because it is free for me too.
12 months ago when I was paying for my own coverage, BCBS paid for a specific procedure that my doctor ordered (cancer related). I just had the exact same procedure done again under my husband's policy, and BCBS denied payment saying it was not covered by my policy.
BCBS said it is not covered under my policy. I am trying to find out if this is a recent change to all policeman's BCBS coverage, or if this procedure is not covered only because I went onto my husband's policy.
I have been calling that damn benefits management office, and every time I call I get a different response, because you always speak to a different person. I was able to get a supervisor on the phone one time, and since then she has yet to return my 5 phone calls over 3 weeks.
I did get BCBS to reluctantly agree to review the claim again, only after much begging and yelling and alot of help from my doctor's billing office.
Bottom line, something stinks here, and it sucks having to deal with this shit when one has enough medical and mental issues to deal with.
Now some people are saying retiree benefits are not the same as current employees. Pension board says that is not true. Who's lying?
I'm fighting a claim from October 2011. I had shoulder surgery and BCBS is claiming that the therapy after I had surgery wasn't medically necessary. The therapy place has sent detailed information to BCBS an they're still denying the claim. I now owe $15,000 out of pocket for rehab on my shoulder that should've been covered since I was at 100% out of pocket. It's a headache and terrible to deal with. No one will help you.
Same thing here. The wife is a retired PO. She broke her arm last Dec. The PT place said that everything was approved by BCBS but the city still owes them just under 3,000 as of Nov 2012.
This is the start of obama health care , insurance now recommending pap smears , breast exams and blood work up every two years .
every person will be insured like cuba but you'll wait 2 years for an appointment , then another 1 or 2 years for surgery .
just like mr presidential for a storm , but for attack on a U.S. Embassy with 4 dead , he's no where to be found
Anonymous said...
If Romney doesn't get voted in next week this Country is doomed! I'll be stocking up on ammo, MREs, and survival gear.
11/01/2012 01:13:00 PM
You should have been doing that anyway....
Google New Madrid Fault Line.
Family first. Always.
To 9:58 AM. Oh yes we do sport. Leaving at 55-59 with over 30 yrs on job we were guarenteed. They will fuck with you-either less than 15 yrs on job or afraid to retire-active guys get fucked first precious. Unless assigned here at O'Hare or Midway and work a day off every 5th day for 500.00 dollars. Dar D. been doin it for years at Midway. Bitch slapped his old lady and still even workin off duty for restaurants and businesses at Midway.Cocky thang who should have been fired for beating wife. Owes Lt. Carroll another header. SHAME.
Anyone who is having trouble with the 55 and out health care Please call the Lodge. It is part of the contract and is not going away in 2013. In fact this was a city proposal in the last contract. The City has signed a letter of understanding that all of the contract remains in effect until a new contract is ratified.
These points were all talked about two weeks ago at the gernal meeting.
T.R.P.
Anonymous said...
Public defender not guilty of assaulting prosecutor
11/01/2012 02:08:00 PM
You should know by now that police officers in this city are the only ones found guilty.
People need their doctor to write a letter stating it is medically necessary.
West side,
You are such a jag off.
I seriously hope nothing ever happens to you in your life where you would like support from your brethren. Just blame everyone else instead of handle the current problem.
Assbag.
Any of this related to the $718 million taken out of Medicare to fund Obamacare? Was told if Medicare did not approve something, Blue Cross/Blue Shield would also deny.
Seems like they want all of us older folks to just pack it in.
I`m a CPD retiree not on Medicare with BC/BS coverage. I strained my right forearm this past January and it wouldn`t get any better. In Mar ch I went to my physician who diagnosed the strain and gave me a Physical Therapy order. Two months of therapy (twice a week). No problem getting BC/BS payments to the therapist. Good luck.
This is how we are finding out what is in Obamacare!!!!
@ COLONOSCOPY POSTER: I just got off the phone with BCBS and they told me that as long as it was an in network provider and done as an outpatient procedure, it would be covered at 90% since I had already met my deductible. Like you, I retired 6 years ago also. My last test was done just over TWO years ago and polyps were found and removed at that time. She said that had no bearing on eligibility as long as it was done in the before mentioned manner,i.e. in network and as an outpatient.I had also phoned encompass and was told that precert was not necessary. You need to get back on the horn with someone there and fight your case till Kingdom Come. She even gave me a confirmation number of my call and said that all calls were recorded. Good luck.
Other things aside, everyone is aware that republicans and Romney specifically are anti union and anti collective bargaining agreements right? All political talk on this blog reads pretty hollow when only 1/5 of our local votes.
Daley is over 65 and thus covered by Medicare. Also next year my wife's health care coverage form BCBS PPO is going to 80/20 from 90/10. The future is now.
Troll on Furlough said...
Can somebody post the new SGT's assignments if they have the printout?
Curious to see if a few clouted made their way back to their units already...
Thank,s,
Troll on Furlough
11/01/2012 07:21:00 AM
The 11th district is getting four. One of the females is already going back to narcotics to work "A Wire". Nice that were getting help. Oh, when or if she gets back she's geting a team.
Hey 2:09 PM You could not have your own Health Ins. if you are a P.O. and married to a P.O. Believe me I know. More to story Maam. Why weren't you on his INS with kids from square one? Don't care but now it sounds like you're trying to scam cause U weren't sure maybe a div. after all these yrs. Bite the bullet ole girl. U R fucked. By whom Whoever. Stay on job if U want ins. Came back to bite U in fat Ass. BAWAHAHA. Do U Have a Divorce Decree? BAWAHAHAHAHA!
Not "a preview of things to come," but simply the way things are now.
The sharp stick in your eye is not a prospective event.
I was reviewing an Illinois law last night, and I noticed that throughout it, the word "medical" has been struck out and replaced by the non-word "healthcare."
Sorry, no care for you.
They call this "patient safety" today.
The money that could have been spent on an actual doctor is instead spent on a Director Of Patient Safety and a Wellness Facilitator and a Patient Service Representative and a Performance Improvement Coordinator, none of whom do anything constructive and all of whom have any remaining MDs in the place afraid to do anything at all.
Everyone points at everybody else. No one accepts responsibility.
The patients suffer while the Joint Commitee On Accreditation awards a little plaque to hang in the lobby.
Paychecks all around!
Let me articulate very simply what I am experiencing, and what so many here are beginning to experience themselves.
SICKNESS = WRONGDOING.
"Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality are merely 'lipstick' cost control, more for show and public relations than for true change."
-- Dr. Ezikiel Emanuel
"This is the thanks you get for the service you gave. Blame a democrat."
--11/01/2012 06:42:00 AM
John Kass defined the "Illinois Combine" -- "Cash is king, corruption is bipartisan."
As deposed Sen. Peter Fitzgerald said, "...that Illinois political class that's not committed to any party, they simply want to make money off the taxpayers."
http://articles.chicagotribune.com/2008-03-23/news/0803220254_1_illinois-sen-peter-fitzgerald-combine
Here, the Combine in full swing, harvesting dollars --
http://communities.washingtontimes.com/neighborhood/bill-kellys-truth-squad/2012/oct/3/rahm-emanuel-donors-buying-illinois-gop-griffin/
http://articles.chicagotribune.com/2012-10-01/news/ct-met-republican-money-managers-20121001_1_shape-illinois-politics-reboot-illinois-aragon-global-management
"The city has outsourced a company to review all therapy bills. BCBSIL will approve and say it's payable but the company will sayit's not medically neccessary. Another way to cut down costs."
--11/01/2012 01:30:00 PM
Another way to INCREASE costs.
Better $20 spent to "review" care than $1 spent to provide it.
SICKNESS IS WRONGDOING.
"...assigning "case managers"..."
--11/01/2012 10:39:00 AM
You don't get it. Hiring whole buildings full of "managers" and "coordinators" and "facilitators" and "directors" reduces health care costs.
I think "parasites" is the word I'm looking for.
COLONOSCOPY update. The gal I spoke with at BCBS phoned me back and wanted to give me additional information based on her digging a little deeper into my question about coverage. She says that "ROUTINE" colonoscopy procedures are not covered. WTF? She couldn't answer what the difference was between routine and "medically necessary" but said that I should discuss with my Doctor what coding would be used to have the followup procedure done. She said that I could phone them with the code to determine if it would be covered under that code. Since I had polyps removed last time that it would seem to be a slam dunk for me, but I still think that I will be sure to tell him that there is blood in my stool also, just to be safe. I would also suggest this approach to anyone wanting to have a colonoscopy. Document it as being a medical necessity and not just a precationary procedure. Gut problems and blood. Colon cancer is one of the the most successfully treatable cancers there is when it is caught early. Why BCBS wouldn't look at the big picture here when it comes to costs is beyond me. That's all folks.
My husband retired 2009 age 60. He just had PT in August on his neck. All bills were paid. Did receive a letter from a lawyer wanting to know if work related.
He called the lawyer and left a message with the file # and he is still waiting for a call back.
"...every time I call I get a different response, because you always speak to a different person. I was able to get a supervisor on the phone one time, and since then she has yet to return my 5 phone calls over 3 weeks."
--11/01/2012 02:09:00 PM
You don't get it either. Your problem has been "addressed."
Not solved. Not taken care of. "Addressed."
That means "Shut up and go away, I'm trying to file my nails."
Used to have one doctor who took care of me twice a year. Now I have about nine "team members" who don't take care of me, about sixteen times a year.
...and you wonder why they're scraping the bottom of the ghetto barrel for "medical billing coders."
This is, uh, a racket.
I have the same thing but I am not retired. My notice was mailed from Telligen they are hired by Blue Cross to review theraphy. On the sheet of paper it had the wrong medical coding and diagnosis for my ailment. I called the FOP and spoke to Jessica. She told me to appeal to CAC on 333 State St.
Wait til Wellness is upon us. They will then have documentation to reject/increase/ chisel awy at our benefits. CPD and Teachers lookout.
The Teacher
"Did you get a letter from...LLC law firm with a questionnaire about your case, threatening you..."
--11/01/2012 09:29:00 AM
Better $20 spent on lawyers than $1 spent on a doctor.
Lawyers! Threats!
SICKNESS IS WRONGDOING.
...but you should see it when they chip a tooth or contract Dingbatism.
>cut to TV commercial for brand new 23rd Century hospital, vast asymmetric pile of mirrored glass with "protons" coming out all over the place<
"We are now all just 3rd rate scum like the animals we lock up."
--11/01/2012 11:17:00 AM
"Have vs. Have-not" is coming up a lot faster than people thought it would.
As a physician that enjoys reading this blog, the lead article strikes a nerve, and is describing the problems that I have had getting services for city employees. I dont order therapy unless I feel that it is necessary. What you dont understand is that BC BS doesnt do the review. And independant company reviews the claims for the city and then instructs BCBS not to pay. BCBS is only the disburser of funds. The city hired another company to do reviews and they are really (I edited my word...) in my opinion. They only know how to deny requests and tie up physicians with phone time and paperwork. They typically deny necessary hospital days and then send a letter to the patient (dont worry, you wont be responsible for the denied days..) to undercut the appeal process. If we dont get the patients backing, we eat the costs. The same holds true for drugs prescribed. Cant use the best drug, gotta use the inferior cheap one.
Physicians can only back up a patient so much. Remember, it is YOUR insurance, YOUR life and YOU have to fight for your benefits.
"I think I am fighting with a ghost..."
--11/01/2012 10:39:00 AM
Hey, buddy, it is you or them.
The ghosts make their living fighting with people.
After all, if a doctor got paid, if medication were given, if care was provided, there would be no money left for ghosts.
Firefighter friend of mine was going to PT once a week for his knee. Recently got a large bill for his co-pay that he thought was supposed to be paid once, much like a female would pay only one co-pay when going to an OBGYN for a pregnancy...not 10 times. He got hit with a large bill that were PT copays that had built up for over a year....yea, he got surprised too. Sure, could see how people would blame him for not knowing his own insurance, but he told me he would have dropped the PT and done his own at the gym had he known insurance wasn't paying for the co-pay.
Anyone who gets denied a claim should file an appeal, file a grievance with FOP and file a complaint with Department of Insurance. All these changes occurred Nov 2011 with no notice from FOP or the city BMO.
Fucking the very people who protect decent citizens from the shitbags. Real nice Rahm. Hope you all vote this piece of shit out with all the behind the scenes screwing he is giving you all.
Troll on Furlough said...
Can somebody post the new SGT's assignments if they have the printout?
Curious to see if a few clouted made their way back to their units already...
Thank,s,
Troll on Furlough
11/01/2012 07:21:00 AM
Who gives a fuck which newly promoted person goes where? What the fuck difference does it make? You want the front of the Titanic lifeboat or the middle?
We are getting really screwed on health insurance and pensions are next and dumb fucks are worried about which new sergeant with clout goes where, jesus h. christ. It doesn't fucking matter! They will get screwed on health care and pensions just the same.
Remember the strokes who bleated, "Jeez, give Rahm a chance, he's got some good ideas, I think he means well, let's give him a chance and see what happens."
Well, how does it feel now? You same people probably wrote to give Jody Weiss a chance.
Yeah, give Rahm a chance, see what happens. The same kinds of things were said about the Gestapo and the Nazis, give them a chance, they don't seem so bad, they mean well, let's see.
most city workers are brain dead ,voting democratic because ballerina boy , BJ clinton tell us the republicans will take away our pensions , health care .
in this state , city of chitcago , crook county , it's the democrats that are reducing our retirement benefits ,raising taxes , busting unions .
CPS will soon close schools replaced by non union teachers.
If you didn't vote early & often , you better think before you vote another democrat in .
I just retired and went for my yearly mammogram which is NOT covered now unless it is coded as Diagnostic ~ I called the union which is clueless about our decreasing medical benefits
So...
Get blown up in car crashes.
Tumble down concrete stairs in a pissy project stairwell battling savages trying to gnaw the meat from your bones just because you wear a blue suit and are interfering with them doing what they want to do?
Broken/Fractured fingers...
Torn up shoulder...
Bad back...
Bad knees...
Etc. Etc. Etc.
And these dirty cocksuckers want to raise the minimum retirement age on top of this B.S. with BC/BS?
Oh... And they want to attach a "fee" if you have the nerve to leave Chicago/Illinois?
The people making the conscious decisions to fuck with Policemen like this...
May karma catch them AND THEIR family members/loved ones with their drawers down...
A pox, some pestilence, the bloody flux and plain bad ju-ju on all their houses...
The reason I voted Republican!
Chicago Democrats in the White House and House and Senate is NO GOOD for America!
Da Pelon
All the more reason, I refused to do shit for this City anymore!
You don't look out for us well then fuck you and this City!
I do NOT Feel Guilty when I check off with zero activity!
This is the future for us Police!
Could some of it be caused by all the hi priced claims for that quackery disquised as medicine called chiropractic? About the same as getting bled for a toothache. This is the 21st century not the 16th....jeeez
Where is the FOP on this matter? We called and had same stuff happen....denied.... not a necessity. I'll give you a necessity, just come here and let me twist your neck and see how much pain you'll be in. What the hell is happening here FOP? Silence from you guys because you are in cahoots with City Hall? Think it's funny?
1 2 3
1. The City is self insured with BC&BS PPO ACTING AS AGENT. The City,His highness and the 50 thieves, tells them that to do!
2. Their is NO policy or contract with the EMPLOYEE or the City. The highness" Practice of Corporate medicine Act had been modified to allow the City to provide their OWN list of Services/ doctors/hospitals etc etc Who are also willing to practice Corporate Medicine. No malpractice insurance IF they deny AFTER services rendered IN ERROR, PRE APPROVAL cancelled only after HIPAA IS CIRCUMVENTED.
It's all about who's going to pay and when City, Medicare/ Medicaid ( Obama is their accomplice / co-defendant in The White House but: A. He Will throw 9.5 under the bus.
B. Quinn too. Goes too.
C. Obama can get political asylum in several countries that would love him SIC his money.
And three!
The have an inside partner! FOP and every lawyer who want to eat out of the ALL YOU CAN EAT OTHER STEAL taxpayer blood bucket.
Sue the CEO of the City Of Chicago CORPORATION for a forensic AUDIT!
TRANSLATION: IRS and the Elected but paid for by the Corporate industrial CABAL? No! the medical social security Foreign aid CABAL?
How?
Are you ready for a revolutionary solution? Unfortunately the real enemy has infiltrated our potential ranks with their parasites which Will become our enemy within.
The latest predictions have 90 million plus watching the Election coverage reality show on TV with out personally participating. NY & New Jersey can't vote!
Yet the race is going to be a photo finish with a broken camera! "They shoot horses don't they?" TRANSLATION: IRS"THEY STEAL VOTES,DON'T THEY?"
VOTING IS A NON VIOLENT OVERTHROW OF A TYRANNICAL GOVERNMENT, WITHHOLDING THEIR REVENUE IS ANOTHER.
THE FINAL WAY IS.....FINAL!
I VOTED AND ARE PRAYING TO A MERCIFUL GOD WE DON'T FACE SLAVERY! CIVIL WAR OR OBLIVION?
GOD BLESS YOU ALL!
Anonymous said...
Troll on Furlough said...
Can somebody post the new SGT's assignments if they have the printout?
Curious to see if a few clouted made their way back to their units already...
Thank,s,
Troll on Furlough
11/01/2012 07:21:00 AM
Who gives a fuck which newly promoted person goes where? What the fuck difference does it make? You want the front of the Titanic lifeboat or the middle?
We are getting really screwed on health insurance and pensions are next and dumb fucks are worried about which new sergeant with clout goes where, jesus h. christ. It doesn't fucking matter! They will get screwed on health care and pensions just the same.
Remember the strokes who bleated, "Jeez, give Rahm a chance, he's got some good ideas, I think he means well, let's give him a chance and see what happens."
Well, how does it feel now? You same people probably wrote to give Jody Weiss a chance.
Yeah, give Rahm a chance, see what happens. The same kinds of things were said about the Gestapo and the Nazis, give them a chance, they don't seem so bad, they mean well, let's see.
11/01/2012 07:44:00 PM
Hey ... the guy just asked a question. Lighten up, Francis ...
STOOPID said...
Where is the FOP on this matter? We called and had same stuff happen....denied.... not a necessity. I'll give you a necessity, just come here and let me twist your neck and see how much pain you'll be in. What the hell is happening here FOP? Silence from you guys because you are in cahoots with City Hall? Think it's funny?
11/01/2012 08:53:00 PM
SRSLY? GFY loser. FOP does more for its members than any other union in this city. You have no fucking idea. And you're going to twist necks? If you were a real tough man, you'd sign your name. Put your neck on the line. Pussy.
Anonymous said...
Now some people are saying retiree benefits are not the same as current employees. Pension board says that is not true. Who's lying?
11/01/2012 02:36:00 PM
I don't think anyone is lying; it's simply a question of interpretation. I don't believe that retirees keep their dental and vision coverage. I think they are covered for a few months after they retire but then have to play for it themselves if they want it. There are a few other differences according to friends who have retired but not much, really.
When are ALL you people finally gonna Wake Up? Our City Government is run by Communists. They're letting everything Capitalist in nature fall apart, and putting all efforts and Taxpayer Dolars into Socialist Programs. If you think this is bad, or an exaggeration, just wait. If obama gets in again, this will be Childs Play. Get it Now people, before November 6th. You will get the big picture eventually, buy after November 6th, Election Day, it will be too late .
Vote Straight Republican, and Pray...
If you think this is Fucked up now, wait till full Obama Care kicks in. This is only the beginning. The Real Disaster is only months away, unless Romney wins the Election, and stops it. Think long and hard about who you vote for this time. Don't be nickle wise and Dollar Foolish. Don't fall for the Kool-Aid and Free Government Cheese Routine again.
This mess is a grain of sand on the beach, compared to the sandstorm thats coming under Obamacare. Socialized medicine, a Nightmare Everywhere.
Vote Straight Republican November 6th
We hear all the time about athletes and entertainers working hurt, sick or dying.
They ARE playing Russian Roulette with their health and their."Golden Years".
But consider this:
They get drugs to keep.going, immediate diagnostics, surgery And a chit load of money.
We get threatened, coerced, punished and delayed. Any health care center Will only keep us ALIVE until the medical section or the Quislings at BS&BS (BULL S￦§€ AND BULL CRAP ) gives them some " house comp. chips to play with with promises or more, maybe).
Yes after a long delay or and few denials of proper care you might get XxX sessions? of physical BS therapy or an injection or two but until their odds makers/ bean counters say the liability or publicity or even clout tips the scales!
Your sick time is disintegrating and the pain isn't half as bad as seeing your life span and family or freedom flashes by! You surrender to not second best but last best.
You can always jump into the private sector meat grinder and let some gel hair protect you or your loved ones? You can become a dog ass spy, traitor or parasite?
But you Will NEVER GET THE MONEY OR THE GOLDEN YEARS UNLESS you can agree on where to go to your 29 1/2 minute lunch VOTE!
They want us to camera"play" CHICAGO
ROULETTE THATS done with two semi automatic pistols and two patriotic Brainwashed Americans!
VOTE AND DON'T PICK UP ANY WHORE'S OUTSIDE LAW SCHOOLS, THEY CAN GIVE YOU A FATAL DISEASE !
COME SOON JESUS, COME SOON!
When you're too lazy and stupid to vote, or you vote for communists calling themselves democrats, this is what you get.
well off topic... but after seeing the latest story... which is a bombshell naming 12 exempt members of corruption and protecting dirty cops i think its safe to say Deb Kirby may retire... She is named in this complaint also.. along with cline, weis and 9 commanders... more to come tomorrow at 11 when the lawsuit is released on the illinois northern districts website.
Get a copy of your medical records so you can cite the medical opinions stating that therapy is needed. Then Keep asking for appeals to review claim. They denied my son's hospitalization(30,000) for shortness of breath/ elevated heart rate at children's memorial ordered by his pediatrician. Obviously it was medically necessary. It took three appeals to get it approved by an expert. 1st a nurse reviews case and Blue cross blue shield doctor who get bonus's for refusing treatment to keep costs down. They hope that people just go away and give up. the 1st review they will often deny claim. So then after 1st appeal ask for a medically reverent expert to review your file such as an orthopedic specialist to review case cited. ( For my son they had a Child cardiologist review his case on the third level of appeals) Keep asking for appeals. Do not give up. Also contact fop for assistance if you continue to get no where. . They have been doing this for large bills for the last 3 years.
Anonymous said...
Could some of it be caused by all the hi priced claims for that quackery disquised as medicine called chiropractic? About the same as getting bled for a toothache. This is the 21st century not the 16th....jeeez
11/01/2012 08:47:00 PM
Don't know what medical school you graduated from,but I've got 2 family members and a good friend who are MDs and they all agree that chiropractic is effective therapy for back and spine problems.Yeah,I can tell ,you're some little know-it-all who somehow scraped together a couple of years of college and now fancy yourself an expert at everything.Jeeeez.
Temporary banned by SCC for being rude and confused said
you need some fuckin professional help and meds dude
To: Temporary banned by SCC for being rude and confused said...Whoa there dude person....you definitly gotta unmodgelate your dosage! Turn in your sharp objects and crawl under cover til this passes! You are totally deranged, get neautered and lets pray thats covered!
I'm self-employed, mid fifties, non-smoker, un-married w/borderline high-blood pressure, BCBS has on average increased my premiums to the point I now pay $10K year on a $2,500 deductible plan.
When I have them quote me as though I was a new customer, the quote is half as much with everything else being equal. When I ask them about that, they tell me I have an old plan that many people have left and migrated to one of there billions of new confusing plans. When I say, fine put me in one of those "new" less expensive plans, I'm told I have to re-apply & of course, I am denied migrating to a less costly plan.
When denied, by law, I am entitled to all the records used in evaluating my claim or request for a new plan. What they gave me was vauge bullshit.
As I investigated the evaluation process of my request, I learned that BCBS gave my 15 year med. History (virtually no claims w/Dr. Visits & $500/mth Lipitor and blood pressure Meds paid by me out-of-pocket. Three pills a day cost as much as my monthly premium) to a third party for evaluation for denial or acceptance or underwriting. Who are these 3rd party people who make the decision and what is there accreditation or expertise? Are they in India?
I got to thinking, given I have a long-term history w/BCBS, they now my history-- little or no claims--and they have decided to give me a policy for $10K a year with a $2500 deductable. I should be able to take more exposure on the front-end and pay a higher deductible like $5k or $10K and have lower premiums but the fuckers won't let you do that.
This will be the next big rip-off as we all age. The insurance companies will fuck us just like Wall Street and D.C.
Nothing will change if competition is not allowed in the Ins. Biz.
Can some one tell me where you sign up for ObamaCare? I mean it's been four years. Where are the practical/logistical specifics.
Happened to me this year. They kept denying me but the therapy clinic kept resubmitting and eventually they paid most of it. Not all of it though. Same excuse. Medically unnecessary.
Hurricane Sandy is Obama's Katrina. He campaigns while people are eating out of garbage cans.
I think the city is self insured and BC is only processing the claims. It is up to the city to decide what it will pay for.
This is why you should always get approval in advance before undergoing expensive treatments. Even if you end up paying for it yourself, at least you will know about it up front.
This kind of thing is common with all insurance plans. They all have little quirks about what they will and will not pay for.
not a cop
11/01/2012 09:55:00 AM
What part of 'this is a recent and dramatic change in how our coverage has always been administered' do you not understand?
Have the claim appealed. Make sure you have all the documentation from the referring physician stating that it was necessary treatment (referrals, etc).
If any of you have a Worker's Compensation claim, you are NOT supposed to be billed, period.
In PA, there is a 3 mo period for a WC claim for you to see the company doctor. Not sure what it is here in TN or IL, but if I remember correctly, they're all the same. Those docs that work for the city will deem you fit to go back to work, whether you are healed or not. After the time you have to see their doc is done, immediately find a doc who has no affiliation w/ the City of Chicago and is looking out for YOUR best interest, and not the City's.
Call you ins. company & don't ask to speak w/ a rep, ask for a manager. And if need be, get an attorney, especially if it's Worker's Comp.
If your handbook states that these services are covered, they should not be denied. The ins. co. should be paying at the fee schedule rate & everything else is supposed to be written off if it is a Worker's Comp claim and the pt is not responsible for whatever the ins company's contracted rate is.
And by all means, if it's ever a Worker's Comp case and you see the City appointed doc, more than likely you'll have a nurse case manager join you for one of your visits. Say NOTHING to him / her because they will do anything to screw you over. And if you do have a case manager meet you for a visit, be sure to tell the doc you do NOT want them to accompany you in the room for your visit.
Expend every avenue that you can because the last thing you want to see happen is for that claim to be turned over to collections if it's not a WC claim.
Can any of you tell me what the Reason Code for the denial was on you Remits / EOB's (Explanation of Benefits)?
Also, one last question, for those of you who were denied, was the provider in network?
I'll help in any way I can possibly can.
Sorry for the long post.
Could some of it be caused by all the hi priced claims for that quackery disquised as medicine called chiropractic? About the same as getting bled for a toothache. This is the 21st century not the 16th....jeeez
11/01/2012 08:47:00 PM
You have obviously never had a sciatic nerve problem. Besides a chiropractor, the only other option is surgery. And why the fuck are we paying such high costs for healthcare? So we can get denied? Our claims are being reviewed by idiots with a GED, not a doctor. Anything not coded as necesity is denied.
The reason I voted Republican!
Chicago Democrats in the White House and House and Senate is NO GOOD for America!
Da Pelon
11/01/2012 08:35:00 PM
You know it! Hopefully, when the sun rises on November 7th, it will bring us a new day and a newly elected President-elect Romney.
Anonymous said...
Could some of it be caused by all the hi priced claims for that quackery disquised as medicine called chiropractic? About the same as getting bled for a toothache. This is the 21st century not the 16th....jeeez
11/01/2012 08:47:00 PM
You're living in the 16th Century if you think chiropractic is quackery. I'm not saying there aren't bad ones out there, of course (as there are doctors and dentists), but many people find that chiropractic offers tremendous relief. Don't put down a great alternative health option just because you had a bad experience or are afraid to try it.
I got a boatload of letters requesting more info from docs and reports for a child with spina bifida that has had therapy for years with no problem and found out therapy was denied months ago. I will appeal but this therapy has helped her improve her abilities and am afraid they will be lost.
I was hurt IOD on the job this summer, was transported by ambulance. I filled out the waiver for the ambulance. I was approved. I recently received notice from blue cross, the city turned it over and applied the ambulance fee to my insurance.
Hey 2:09 PM You could not have your own Health Ins. if you are a P.O. and married to a P.O. Believe me I know. More to story Maam. Why weren't you on his INS with kids from square one? Don't care but now it sounds like you're trying to scam cause U weren't sure maybe a div. after all these yrs. Bite the bullet ole girl. U R fucked. By whom Whoever. Stay on job if U want ins. Came back to bite U in fat Ass. BAWAHAHA. Do U Have a Divorce Decree? BAWAHAHAHAHA!
11/01/2012 04:20:00
Hey crazy, we have no children. We met on the job, and that is why we each had our own BCBS policy, and we kept it that way after marriage all the years until he recently retired. Have another cocktail bub.
11/01/2012 09:04:00 PM
a fucking masterpiece of a comment, if ever there was one.
and preserved, for posterity, and review, well after he sobers up.
priceless.
My wife completed and submitted the questionaire prior to going to Athletico. Therapy was approved and after receiving the $3400 invoice, we've been back and forth with Blue Cross trying to stay out of collection agencies. what shit!
Anonymous said...
West side,
You are such a jag off.
I seriously hope nothing ever happens to you in your life where you would like support from your brethren. Just blame everyone else instead of handle the current problem.
Assbag.
Please don't tell me you're a parent. Do you not get the point the original poster is trying to make? I never understood what they meant when they said there's a place for everyone on this job. I do now. Your place should be hosing shit and barf out of squadrols cuz you're as fucking obtuse as they come. Shut up and leave the important stuff to the big boys and girls.
Yup..Active duty with PPO. went in for neck pain, Dr. sent me to get an MRI never having a problem in the past when I had one done for my back. Dr. called me at home told me not to go that he recieved notice Ins is not goin to cover it without seeing a specialist first and then having him submitt for MRI. Really I thought thats why I have a PPO...
It started a few yrs back..I have a PPO, went in for a MRI and could'nt get one.. I had two in the past never without a problem. Now you have to see a specialist and have them send in a referral to the INS co first..WTf..thats why I pay for a ppo go and do what I want..
If your wife is on birth control Pill your PPO doesnt cover that anymore..BUt we pay more and more for our PPO and get Less n less
Pay attention to the post on 11-1-12, 5:43PM, from a physician who explains what the problem is with the FOP/BCBS/middle-man "review board" who actually reviews AND deies the claims (BCBS is only the money dispurser).....
This IS the plan your union bought for you...and YES, this "review board" is the same type of
"review board" as described in the 2000+ page obomacare plan...which NOBODY read. This "review board" will determine who will get what, and when they will get it, and IF they will get it, based on a specific criteria. In this case, the "review board" is NOT BCBS...they are a agency who review and deny claims...BCBS only dispenses the funds to pay those claims that this "review board" authorizes. This "review board" is also a cheapskate outfit that will deny procedures/therapies/drugs that they deem too expensive and/or substitute cheaper, less expensive options, or deny the claim outright.
THIS IS THE PLAN THAT YOUR UNION/CITY OF CHICAGO HAVE CHOSEN FOR YOU. Another case of the right hand givith, and the left hand taketh away. It will be up to you police officers to fight for a better insurance plan...and better union representation....long overdue.
Welcome to obomacare. See you at the polls and be sure to REMOVE this socialist/marxist/communist oboma from power in Washington. Unless you like obomacare????????, to name just one socialist/communist/marxist policy...look to Cuba for more examples of how life will be in the USA IF oboma is not removed from power next Tuesday, November 2.
See you at the polls.
RETIRED-On-Duty said...
2 officers, one is a P.O. in 013 and the other is a LT. in 015; They have a child who was born with a severe disability and she does not walk.
The child had been given physical therapy since she was born and covered under the city insurance.
As of about a year ago Blue Cross/THE CITY states that the therapy is now NOT COVERED.
The FUTURE is here.
We are now all just 3rd rate scum like the animals we lock up.
EVERYONE should remember this the next time you think twice about risking your well-being, not to mention your life.
11/01/2012 11:17:00 AM
Hey, the third rate scum we lock up gets better health care than we do. Fuck with their health care and you will end up on 60 Minutes as discriminating against whatever minority they are and you know you cannot treat illegal undocumented aliens like, well, illegal undocumented aliens.
Only in this fucking country do we treat those who came here illegally better than our own citizens.
This blows.
Important note*****
My chiro doc says city is now reviewing all chiro claims too. Seems rahm thinks we use chiro for well being instead of need. Fop u hearing this crap?
Folks: the guys that you voted for and did political work for have spent this State into the sewer. Now you are complaining that there's no money to pay for the impossible promises that were made. During the decades that no funding was done (and you continued to vote for the same crew), what were you doing? Hoping that the Ponzi scheme made it past your retirement?
I'd bet Rahm's famly's claims get paid. Eddie's too
The end of retiree health care insurance in 2013? Maybe, but I doubt it.However, you can count on a very serious increase in price for the retired.
If you like paying alot of money out of pocket, stick with that PPO instead of HMO. You can find good doctors in HMO.
Got nothing to do with OBAMACARE..insurance companies have been playing this game for years.....one year had to take wife OUT OF THE HOSPITAL because the insurance company was refusing to pay beyond a certain amount of days. Luckily we had a doctor that knew exactly how to get around it...its all what and who you know and how you play the game. Most insurance companies will asked you to call before you allow yourself to be subject to certain medical procedures...alot of people don't...and some times those actions will come back to bite you in the wallet, the city is only responsible for paying the bill, sometime the city pay them, sometimes they don't.. determining who get what, when and where.....its the insurance companies call..you have to be aware some insurance companies give their employees bonus for saving the company money so denial of procedures is some pencil pushers way to increase their salaries
I don't think anyone is lying; it's simply a question of interpretation. I don't believe that retirees keep their dental and vision coverage. I think they are covered for a few months after they retire but then have to play for it themselves if they want it. There are a few other differences according to friends who have retired but not much, really.
11/01/2012 09:53:00 PM
Really? You do not have all of the facts. Retirees are paying around $750 for themselves and a spouse per month. There are many things not covered by retiree health care, namely things that women need on an annual basis such as mamograms, other female specific tests, medical hardware if often denied and mental health care is far less. The pension board is full of it if they say otherwise. Retiree health care is specifically exempted from many changes under Obama care to include keeping your kids on until 25 . Obama let the insurance companies off of the hook when it came to " reform" as well as many large unions. The republicans wanted insurance company reform but lost out to the liberal democrats who were in the pockets of the insurance industry. Things will get worse. When you retire, try to find a doctor who will take medicare. Not easy. You will pay everything upfront in case and file your own claims and hope to get a small percentage back.
Anonymous said...
You voted democrat most of your adult life most likely and now that the democrats are screwing you and yours - complain.
With everything else in this state being corrupt, you really think the voting is legit???
my son was born premature. he was born so early that the doctor was telling me that he believed that my son's chances of survival were less than 50% if he even survived the birth. my son survived the birth and NEEDED to get transported to university of chicago because they have an amazing children's hospital. to give my son the best opportunity for survival i was told he needed to be transported immediately after birth to u of c. BCBS told me they would not cover the transport to u of c because it was "not necessary." that transport cost nearly $5000. we fought tooth and nail with those cold-hearted rahm-esque fuckers and still had to come out-of-pocket damn near $1500. this was all earlier in the year and we are still paying hospital bills because BCBS fights us with most bills saying certain procedures are "not needed". my son's hospital bills cost about a million dollars by the time he was released so i got my money's worth with the insurance i suppose. and here's a hefty FUCK YOU to those sniveling snakey insurance fucks who could give two shits what families endure when they need their insurance most.
"This kind of thing is common with all insurance plans. They all have little quirks about what they will and will not pay for."
not a cop
--11/01/2012 09:55:00 AM
"What part of 'this is a recent and dramatic change in how our coverage has always been administered' do you not understand?"
--11/01/2012 11:18:00 PM
Quirk here just likes to run with the big dogs.
Retirees health insurance is not the same policy you had as an active member! No one will admit this but it is not! Mammograms are covered for active members but not for retirees. I'm sure there are a list of other items too, but the city or FOP wouldn't give you that info.
I also retired in April 2010 and have been to the chiropractor as well as my wife. No problem with the bill, you get 20 visits a year
The FOP got involved and I believe it was resolved.
Thanks Paul you are the greatest, all you have to do is ask.
Call Paul Geiger at FOP he is the complex litigation attorney. 312-733-7776
Anonymous said...
Retirees health insurance is not the same policy you had as an active member! No one will admit this but it is not! Mammograms are covered for active members but not for retirees. I'm sure there are a list of other items too, but the city or FOP wouldn't give you that info.
11/02/2012 02:13:00 PM
Mammo's are covered if the order is Diagnostic.
55 and out ins. not ending! Active POS are the ones who have to worry.
My husband (retired)was admitted to the hospital after being brought into the E/R for a heart issue. BCBS is not paying the bill because they were told not to by Telligen. Telligen's first response was that my husband's cardiologist should not have ordered a stress test, it could have been done outpatient. After calling them back they said he should have been released from the E/R. I am no medical expert, but when 16 people rush into an E/R room and administer multiple meds in an attempt to regulate an out of control heart rate, I think it's serious. The union, of course said, oh just do what Telligen asks you to do. He now has a notebook filled with the names, dates, times, and call reference #'s from BCBS and Telligen. It's absolutely fricking crazy. Hey thanks for your 41 years of service.
Stop gripping get an attorney and file suit in federal court. You will win big.
Saw the comments regarding the Colonoscopy. My wife and I (retired 8 years) have them scheduled. Called my wife and she inquired of the Benefits Management office. If it is just screening, they will not cover. Have to have a "diagnostic" reason ie: rectal bleeding etc. We cancelled. I am 62. She is 56. Thought these were recommenderd to CATCH Cancer before killed you. Guess the City would rather pay for treatment than prevention. Kinda stupid, huh?
"Guess the City would rather pay for treatment than prevention."
--11/02/2012 08:47:00 PM
...the exact opposite of what the entire "healthcare" industry claims is the New Strategy.
I guess when it comes down to it they're all lying, huh?
...but the Wellness Ladies get their paychecks...
Thank you to the original poster on this subject. After I retired, I learned that mammograms and
women’s wellness exams are not covered. I did not know that colonoscopies were not
either. So much for breast, cervical and colon cancer screening eh?
Mammo's are covered if the order is Diagnostic.
11/02/2012 05:47:00 PM
Just try telling a doctor's office how to code their insurance forms.
See how that works out for ya.
FYI this not just the city. All health plans will stop paying or severely cut physical therapy. Home healthcare will be gone too. Its all due to obamacare being enacted in stages. My wife learned this at a seminar for case management nurses.
Anonymous said...
Saw the comments regarding the Colonoscopy. My wife and I (retired 8 years) have them scheduled. Called my wife and she inquired of the Benefits Management office. If it is just screening, they will not cover. Have to have a "diagnostic" reason ie: rectal bleeding etc. We cancelled. I am 62. She is 56. Thought these were recommended to CATCH Cancer before killed you. Guess the City would rather pay for treatment than prevention. Kinda stupid, huh?
I see this all day long with my job, but the insurance company I bill for is Florida Medicaid, which literally makes me sick to my stomach. The amount of illegals that are getting free health coverage here in the U.S. upsets me to the point where I have anxiety attacks. They spit out their anchor babies and we're all stuck paying for these kids for the rest of their lives.
Re: the colonoscopy, it's something you might want to reconsider. I have a life long friend who went in for a routine test and she's now fighting cancer. I know it gets expensive - between the facility charges, anesthesia fees for the meds & the anesthesiologist, the surgeon - it all adds up.
Since I deal primarily with Medicaid, I don't know off the top of my head what kind of discounts could be applied - and the only ones that are in my Matrix are for anesthesia only. But ask about discounts - usually if you can pay the final amt after ins kicks in, it's usually a good deal.
If you can't do any of that, set up a payment plan. I just had a recent trip to the E/R for kidney stones, and although I have a very high ded (which is nearly met) EVERYTHING else after that is covered at 100% - no co-pays, co-ins, nada. I set up a $25/mo plan but trust me, if you don't have it and can only send in $5 a month, the providers will work w/ you. On my phone days, I set up plans like that all day long for patients. It's whatever they can afford.
And I know I rambled on and on (my apologies!), I hope you & your wife will reconsider the procedure. It's better to be safe than sorry.
Good luck to both you and your wife in whatever you decide on this in the future.
BTW, I'm beyond exhausted & didn't proof the post, so try to decipher anything that doesn't make sense.
You all be safe.
kk
Unfortunately when we (retirees) were young officers and voting on our contracts we did not think about being retired and how our benefits would change. We did this to ourselves, we can not blame the current mayor or even dumb ass daley for this one. I'm just laying it out like I see it. Our retiree medical benefits suck, but these are the benefits that we voted on when we were only thinking about being the working police. Now we are reaping what we sowed. I've paid out so much money for medical care after having both knees totally replaced and now needing dental work. So, there goes my vacation money.
Its no longer turn your head and cough. Its bend over and grab your ankles.
Anonymous said...
I don't think anyone is lying; it's simply a question of interpretation. I don't believe that retirees keep their dental and vision coverage. I think they are covered for a few months after they retire but then have to play for it themselves if they want it. There are a few other differences according to friends who have retired but not much, really.
11/01/2012 09:53:00 PM
Really? You do not have all of the facts. Retirees are paying around $750 for themselves and a spouse per month. There are many things not covered by retiree health care, namely things that women need on an annual basis such as mamograms, other female specific tests, medical hardware if often denied and mental health care is far less. The pension board is full of it if they say otherwise. Retiree health care is specifically exempted from many changes under Obama care to include keeping your kids on until 25 . Obama let the insurance companies off of the hook when it came to " reform" as well as many large unions. The republicans wanted insurance company reform but lost out to the liberal democrats who were in the pockets of the insurance industry. Things will get worse. When you retire, try to find a doctor who will take medicare. Not easy. You will pay everything upfront in case and file your own claims and hope to get a small percentage back.
I didn't claim to have all the "facts" and I certainly didn't mean for this to be a post about your personal opinions regarding Obamacare. Frankly, no one gives a shit about your political views, moron.
Anonymous said...
Mammo's are covered if the order is Diagnostic.
11/02/2012 05:47:00 PM
Just try telling a doctor's office how to code their insurance forms.
See how that works out for ya.
11/02/2012 11:40:00 PM
When it comes down to getting PAID, they'll code it properly.
When it comes down to getting PAID, they'll code it properly.
11/03/2012 11:59:00 PM
In a perfect world, yes. But that didn't happen for me. A few years ago, I had an unpleasant outcome with a Dr. Kimberly Mullin, Obstetrician / Gynecologist in Palos Heights.
I noticed a sign posted in the patient check out area. “Please do not ask us to change insurance codes”. In all the years of taking my Mom & Dad to various doc offices, I never saw anything like that.
I didn't put much thought into that sign until after I was billed by her office.
As far as this one doctor is concerned, she doesn't care.
What should have been coded as diagnostic, was coded a wellness exam when I checked out. I was responsible for the entire bill.
I was out of luck, and her staff would not budge an inch.
Obviously, I never went back again, but this is my own personal experience with a real doozie.
Retired in 2010, had heart tests and followup treatment/meds I can say that absolutely just about any bill not coded for "diagnostic" will be refused by BCBS PPO however my docs offices always rebilled with corrected codes if billing errors were made. I also had my first colonoscopy at Northwestern and highly recommend anyone to do it there...never get any tests done as preventative! Always give a reason for diagnostic test to be ordered..."blood in stool" "pain" whatever to be sure insurance pays the largest sum of bills. Be proactive in making sure your doctors office orders the tests under diagnostic CODES from the start. Second and equally important verify when you ck in at outpatient hospital facilities that the intake clerk/nurse also codes your test diagnostic and not switched by careless intake to a "wellness" test. Its not hard to do these things as the patient, but sometimes impossible to change the mistake after the whole billing has been processed. Even so if error occurs in billing never give in to paying for that which is allowed coverage under our insurance! Hang in there if you need mamograms, colonoscopy, pap smears, heart scans, whatever...you do not have to wait until you are sick or cancer stricken use a decent doctor who will bill insurance correctly and take good care of yourself. It really is all about the codes......
If you recieve a letter from BCBS that asks for additional information, ANSWER it! They will hold up your claim until you send it in. They ask for other insurance information and asks if the claim is work comp. It is a one page form letter. Its easy to fill out, and if you dont, then the insurance is denied.
Does these denials have anything to do with the COVENTRY DENIAL OF DUTY INJURIES?
I am the owner of Sports and Ortho one of your bloggers mentioned my facility. It is absolutely true that BCBS has been denying therapy for ALL city workers. I have found 13 different PT places and we have been all denied on every single patient. We are being put through hell just to get anything paid. We send records, they say they never got them. We write appeals, they always deny them. The City of Chicago has basically put the burden on all of you and all of the providers. I urge all of you to complain to the FOP and call BCBS and let them know that you know they are doing this to everyone and that you demand that they pay your claims. If enough of you write to Lisa Madigan, maybe she will listen.
Nothing makes me happier than to make people better and I continue to accept City patients knowing that I won't get paid because I refuse to hurt the patients and let them win. I am planning a class action lawsuit against BCBS with other practice owners so if any of you have been treated at a facility and your claims have been denied please email me the name of the clinic at Dfahmy@sportsandortho.net.
God Bless you all.
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