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Help! $40K of my $250K insurance claim was denied

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12/27/12 3:30 AM	Ignore \| Quote \| Edit \| Warn Admin \| Vote Down \| Vote Up \| Delete Post
Rear Naked Chode 208 Member Since: 11/20/12 Posts: 453	. You have ignored this user.

12/27/12 3:40 AM

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aritwo 41 The total sum of your votes up and votes down

Member Since: 12/23/11
Posts: 887

Authority Figure -
ItBurnsWheniOG - Shouldn't the doctor of ran it by your insurance to make sure they covered it so you wouldn't have to pay the bill?

Doctors are interested in billable work. They don't give a fuck if you can afford it. What they usually do is act like it was an accident that it fell under disallowable work and offer you a payment plan. Which means they actually make MORE on the procedure.

if the doctor was interested in getting paid, he would have made sure the insurance would pay it.

doctors/hospitals actually lose money offering payment plans and asking the patient to pay because they really have no power to force you to pay and you can just claim bankruptcy.

in reality, most doctors just write-off cases like this as pro bono and move on without getting a cent. in this case, the surgeon probably did the same because Conor isn't being charged for the actual surgery. this directly counters your inference that doctors are just trying to get make the most profit.

what happened is that the doctor did what was best for the health of his patient. usually they will cover it, but for some reason they flagged this case for denial. around 10% of our claims denied even when the paperwork was properly filed.

12/27/12 4:49 AM	Ignore \| Quote \| Edit \| Warn Admin \| Vote Down \| Vote Up \| Delete Post
tatooedMillionaire Member Since: 3/19/11 Posts: 259	you'll be back strong, keep your head up always throw this out there but the Magno Almeida fight blew my mind, will never forget that You have ignored this user.

12/27/12 7:02 AM	Ignore \| Quote \| Edit \| Warn Admin \| Vote Down \| Vote Up \| Delete Post
Diaz50-43Failure 912 Member Since: 10/13/08 Posts: 4502	ttt You have ignored this user.

12/27/12 7:46 AM	Ignore \| Quote \| Edit \| Warn Admin \| Vote Down \| Vote Up \| Delete Post
Chomas Member Since: 4/29/09 Posts: 12848	Come on BLAF help the guy out. You have ignored this user.

12/27/12 7:57 AM

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warrendale 1 The total sum of your votes up and votes down

Member Since: 8/8/11
Posts: 94

Mike Russell -
Let it be known for the record that Conor holds no ill will towards Zuffa, Strikeforce, or the UFC. They have been nothing but great to him and he isn't trying to target any of them with hhis campaign.

It's unfortunate that their insurance carrier chose to reject his claim for injuries sustained during his fight with Ryan Couture, but it's not surprising. Insurance companies aren't always as level-headed as they should be.

The point of this campaign isn't to makeStrikeforce, the UFC, or Zuffa look bad. It's to help Conor.

Hope this doesn't get missed..

12/27/12 8:16 AM	Ignore \| Quote \| Edit \| Warn Admin \| Vote Down \| Vote Up \| Delete Post
UGCTT_mrzipplokk 246 Member Since: 7/31/02 Posts: 43143 Mixed Martial Arts LLC, Moderator	Props to Mrs. Bourdain You have ignored this user.

12/27/12 8:37 AM	Ignore \| Quote \| Edit \| Warn Admin \| Vote Down \| Vote Up \| Delete Post
jpm995 Member Since: 11/1/03 Posts: 7002	No doubt insurance companies suck [i'm getting screwed over after house was wrecked by Sandy], Hopefully the appeal process works or Zuffa does the right thing. Could you have picked a tougher way to make a living? TTT for all the fighters. You have ignored this user.

12/27/12 8:42 AM

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Jsteven 26 The total sum of your votes up and votes down

Member Since: 7/24/09
Posts: 7111

Mike Russell -
Let it be known for the record that Conor holds no ill will towards Zuffa, Strikeforce, or the UFC. They have been nothing but great to him and he isn't trying to target any of them with hhis campaign.

It's unfortunate that their insurance carrier chose to reject his claim for injuries sustained during his fight with Ryan Couture, but it's not surprising. Insurance companies aren't always as level-headed as they should be.

The point of this campaign isn't to makeStrikeforce, the UFC, or Zuffa look bad. It's to help Conor.

If that's the case he might want to change the thread title, goo luck Connor. Phone Post

12/27/12 8:44 AM	Ignore \| Quote \| Edit \| Warn Admin \| Vote Down \| Vote Up \| Delete Post
UGCTT_Jay Edz 47 Member Since: 12/31/11 Posts: 554	I honestly don't get how the American medical system works. This isn't a knock, I really don't understand. In England you get hurt, you get an op and that's pretty much the last you hear of it. That being said, TTT and all the best. You have ignored this user.

12/27/12 8:45 AM	Ignore \| Quote \| Edit \| Warn Admin \| Vote Down \| Vote Up \| Delete Post
UGCTT_mrzipplokk 246 Member Since: 7/31/02 Posts: 43144 Mixed Martial Arts LLC, Moderator	jpm995, what happened ? Did they say you didn't have flood/water coverage ? You have ignored this user.

12/27/12 9:29 AM

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john joe 168 The total sum of your votes up and votes down

Member Since: 8/21/06
Posts: 6145
Fighters Only, web monkey

you have to be the worst kind of cnt to work in medical insurance claims assessment; spending all day trying to catch people out on technicalities

years and years ago, right after college, i had a temporary job in the claims department of a large industrial insurance company (im a law grad). There was a huge class action going on, miners with lung disease against X mining company. Our brief was, find the miners who have solid claims - and who have been laid up with emphysema and coughing themselves to death - who have been unable to work, fighting their case for years, and say to them "look, we dont think youve got a case but we will settle right now, goodwill, for £10k" etc

these miners were actually due upwards of £100k each in most cases; but many were so broke and so desperate they took the chickenshit payoff and believed what they were being told

i lasted one day training, the next day working and the day after that every file that came my way that had a legit payoof coming, i phoned them and told them do not under any circumstances accept this payment, pursue your claim to the fullest. On my fourth day i had not long arrived at my desk when security came and removed me from the premises; the phone calls had been monitored

i had money troubles of my own back then but i didnt care, i couldnt have cheated those people like that and i dont know how these medical insurance assessors can live with themselves either. They disgust me. Money is nice and business is business but to completely strip all common sense and human decency from it is disgusting to me.

its another reason i support socialized health care; we have the system here in the UK and you dont hear too much about people getting fucked over on technicalities. Usually its overworked doctors accidentally leaving scissors stitched inside you or something

12/27/12 9:31 AM

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itswhitty 61 The total sum of your votes up and votes down

Member Since: 12/13/10
Posts: 423

aritwo -
Authority Figure -
ItBurnsWheniOG - Shouldn't the doctor of ran it by your insurance to make sure they covered it so you wouldn't have to pay the bill?

Doctors are interested in billable work. They don't give a fuck if you can afford it. What they usually do is act like it was an accident that it fell under disallowable work and offer you a payment plan. Which means they actually make MORE on the procedure.

if the doctor was interested in getting paid, he would have made sure the insurance would pay it.

doctors/hospitals actually lose money offering payment plans and asking the patient to pay because they really have no power to force you to pay and you can just claim bankruptcy.

in reality, most doctors just write-off cases like this as pro bono and move on without getting a cent. in this case, the surgeon probably did the same because Conor isn't being charged for the actual surgery. this directly counters your inference that doctors are just trying to get make the most profit.

what happened is that the doctor did what was best for the health of his patient. usually they will cover it, but for some reason they flagged this case for denial. around 10% of our claims denied even when the paperwork was properly filed.

Voted up for truth.

12/27/12 9:44 AM	Ignore \| Quote \| Edit \| Warn Admin \| Vote Down \| Vote Up \| Delete Post
Orcus Knows MMA Better Than Goku Member Since: 8/6/08 Posts: 20522	one thing you should do is ask your heroic doctors to lower the bill. they do it all the time. You have ignored this user.

12/27/12 9:47 AM	Ignore \| Quote \| Edit \| Warn Admin \| Vote Down \| Vote Up \| Delete Post
Brian J DSouza Member Since: 1/3/12 Posts: 274	Agree with John Joe on the socialized health care thing, as Canada and the UK share a really good system. You have ignored this user.

12/27/12 9:53 AM	Ignore \| Quote \| Edit \| Warn Admin \| Vote Down \| Vote Up \| Delete Post
Jsteven 26 Member Since: 7/24/09 Posts: 7112	Brian J DSouza - Agree with John Joe on the socialized health care thing, as Canada and the UK share a really good system. They share really good taxes as well You have ignored this user.

12/27/12 10:00 AM	Ignore \| Quote \| Edit \| Warn Admin \| Vote Down \| Vote Up \| Delete Post
johnonguitar7 Member Since: 6/6/12 Posts: 781	NHS > Obamacare You have ignored this user.

12/27/12 10:01 AM	Ignore \| Quote \| Edit \| Warn Admin \| Vote Down \| Vote Up \| Delete Post
Steven McTowelie 35 Member Since: 3/15/10 Posts: 164	Jsteven - Brian J DSouza - Agree with John Joe on the socialized health care thing, as Canada and the UK share a really good system. They share really good taxes as well And here I am, living perfectly fine under said tax system... You have ignored this user.

12/27/12 10:03 AM	Ignore \| Quote \| Edit \| Warn Admin \| Vote Down \| Vote Up \| Delete Post
michelleNrogersdumpsterbaby Member Since: 7/6/12 Posts: 397	I kept scrolling down through every page hoping to see DFWjr saying "fuck the insurance company, i got u covered"....way to let me down DANA You have ignored this user.

12/27/12 10:06 AM	Ignore \| Quote \| Edit \| Warn Admin \| Vote Down \| Vote Up \| Delete Post
UGCTT_mrzipplokk 246 Edited: 12/27/12 10:07 AM Member Since: 7/31/02 Posts: 43151 Mixed Martial Arts LLC, Moderator	^don't do that again, fren . I deleted the name calling post. You have ignored this user.

12/27/12 10:22 AM	Ignore \| Quote \| Edit \| Warn Admin \| Vote Down \| Vote Up \| Delete Post
Loser Born Natural 1097 Member Since: 10/14/10 Posts: 8476	Good luck Connor! You have ignored this user.

12/27/12 10:25 AM	Ignore \| Quote \| Edit \| Warn Admin \| Vote Down \| Vote Up \| Delete Post
Neil Funk Member Since: 2/17/11 Posts: 8300	Ottavia Bourdain is a great lady! You have ignored this user.

12/27/12 10:27 AM	Ignore \| Quote \| Edit \| Warn Admin \| Vote Down \| Vote Up \| Delete Post
jujubre Member Since: 1/1/01 Posts: 31292	Glad i live in France... Yes i pay more taxes but at least i will never be in a position where i have to pay 40000 for my health. Ttt for conor and Obama. You have ignored this user.

12/27/12 10:43 AM	Ignore \| Quote \| Edit \| Warn Admin \| Vote Down \| Vote Up \| Delete Post
RLL 119 Member Since: 11/17/08 Posts: 7593	Suck Zuffa can't help you out a little outside the insurance company. Might make you think twice about getting injured under their umbrella again. You have ignored this user.

12/27/12 10:53 AM

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Filo_Beto

Member Since: 11/24/10
Posts: 385

Jsteven -
Brian J DSouza -
Agree with John Joe on the socialized health care thing, as Canada and the UK share a really good system.
They share really good taxes as well

You have a shallow understanding of your own healthcare system. You think because the money doesn't come out of your federal taxes directly that you are not being taxed which would make you grossly misinformed.

If a person with a family of 4 wanted purchase their own healhcare because their employers don't provide them it run any where from 1500/month to 2000/month depending where you live and what type of options you choose.

If your employer does provide you with healthcare it's still not free. Some of that costs are handed down to you and taken directly from your pay check. For a single person it could be 400/month and for a family of 4 it can be as high as 700/month.

Let's not forget the bleeding doesn't stop here. Everytime you go to a doctor there is a copay fee(tax) then when you go to pick up the medication you have to pay another copay(tax). Let's not even talk about the dentist office which for many procedures it only covers 50%(root canal.) Which costed me about 600 dollars the other day.

Moral of the story is stop believing in the right wing propaganda of other countries paying higher taxes for universal healthcare when the cost of health care in your own country per capita is more then double many european countries with less succsessful outcomes.

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