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SBD
Admiral
Joined: 19 Aug 2004
Posts: 1022
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 Posted: Tue Jun 26, 2007 12:55 pm Post subject: Pacificare gives new meaning to "adding insult to injur |
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My email to the Director of the California Department of Managed Health Care.
Link to recent letter received from Pacificare!!
| Quote: | Dear Director Ehnes,
On behalf of myself and others similarly situated, let me start by thanking you for your hard work and increased enforcement actions against Health Insurers who rescind the policies of individuals who become sick.
You may recall that I had contacted you directly following the DMHC hearing in Los Angeles at the beginning of the year. Your staff was very helpful and answered my questions. The only issue that remained involved my request for an IMR which the DMHC denied. I had given up on the issue and decided to just let the courts resolve the payment for the $65,000 surgery performed by the Cleveland Clinic to remove my kidney.
That all changed after I received the attached letter from Pacificare last week. I believe that the contents of the attached letter deserve your direct attention. I find both the conduct involved and the total lack of integrity by Pacificare to be appalling.
Is this Pacificare's idea of a joke?
Attached is a recent Pacificare letter I received that says Pacificare paid $5.00 to Cleveland Clinic. The bill says it was for Urgent services, doesn't their payment for this service hurt their claim that the surgery at Cleveland Clinic was not Urgent when they now expect me to pay $100.00 as an Urgent Co-Pay?? They just paid $5.00 for what appears to be an Urgent service dated the day before my surgery at the Cleveland Clinic over a year ago.
So out of a total $65,000 hospital bill, Pacificare seems to believe that a $5.00 payment is all they owe. Does this company have any decency at all?? I already know the answer to that question, but thought that as Director of the DMHC you should also become aware of the answer as well.
I believe that they have just proven that my surgery at the Cleveland Clinic on May 12, 2006 was Urgent and therefore should have been covered. Their measly $5.00 payment is an insult to the entire system and should allow the DMHC to reconsider the denial of my original IMR.
The DMHC should not allow Pacificare to insult myself, the Cleveland Clinic, or the regulatory system of the DMHC by paying only $5.00 of a $65,000 claim.
Pacificare gives new meaning to the phrase "adding insult to injury".
Thank you for your time and attention to this matter.
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SBD |
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Navy_Navy_Navy
Admin
Joined: 07 May 2004
Posts: 5777
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| Posted: Wed Jun 27, 2007 1:24 am Post subject: |
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That's just appalling. 
No excuse for that kind of crap - how awful.
How are you doing? I hope that you are all healed up and feeling good, by now!
_________________
~ Echo Juliet ~
Altering course to starboard - On Fire, Keep Clear
Navy woman, Navy wife, Navy mother |
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