Catamount Blue's "screw you" policy

It's pretty bad even when you have "insurance." (4.00 / 1)

I don't want to go in to details about my situation and I certainly do not want to diminish Julie's plight, but I want to add that it's pretty terrible when you get sick (not only because you are sick) even when you have insurance.

I got rather ill in early 2008 requiring about 4 or 5 visits per week for several months.  Then, I lost my job (so much for compassion).  Luckily, I retained insurance through my partner (thank GOD!).  However, in short, it became a full-time job fighting with BC/BS about what was and wasn't covered.

After a few months of this, it became crystal clear that the Blue Cross status-quo for doing business (and have no doubts--it's all about profit) is for Blue Cross to automatically reject legitimate claims and hope the patient will gullibly accept the indecipherable paperwork that comes in the mail and pay out-of-pocket.

Like Julie said, "I can't imagine what this is like for people without means."  In a way it was lucky that I lost my job; being unemployed gave me time to get well and to fight Blue Cross.

We need to make it easier for all people to receive medical care, not more difficult.

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by: BloggyDoggy @ Sat Jan 24, 2009 at 22:25:01 PM CST

Strangely enough (4.00 / 2)

I've actually, for the most part, had really good experience with BCBSVT: with one exception, they've approved every special request I've made: I've had several medications and procedures which fall into the "need prior approval" category and they've never disallowed a one of them, but I know these horror stories like yours are true.

This is actually the first time I've ever had a really bad experience with them, and I'm still kind of gobsmacked by it.  I've had a couple other bad experiences involving medical insurance payments, but those were the faults of my care providers, not the insurance company. (i.e., their paperwork mistakes that cost me additional money).

But like I said, I'm just astonished by this.

Musician, Web Designer, Photographer

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by: JulieWaters @ Sun Jan 25, 2009 at 03:54:31 AM CST

[ Parent ]

Single-Payer. (0.00 / 0)

This is not astonishing at all, Julie.  It is more or less typical for the private insurance company health care system that Douglas covets so much.  I've been through it even before Catamount, fighting with insurance companies for every bill.  For me, it was two years ago.  While I was nearly dead with liver disease, I had to battle the insurance companies for every bill or live in dread and fear that the $20,000 dollar bills for my operations would actually be covered.

I would love to get people to bring all the "claim denied" forms to the governor's office and have him take a look at what private insurance really is, Catamount or otherwise.  I finally had to get a lawyer and threaten my ex-company (which had "eliminated my job" to save benefits) with lawsuits if they jacked me around any more.  In insurance lingo, it is called "the game."  With your premiums, they employ thousands of people to look for potential mistakes that can warrant a denied claim, like you not checking off the marital status box.  

As for being without insurance I can tell you right away what that is like.  It is hell.  After the company laid me off, I needed yet another operation.  I had to negotiate with the hospital for the price.  They wanted $19,000, $13,000 without insurance.  I told them that I could go to Canada and get it down five times cheaper; that got them down to $9,000.  But you get nothing for that: no tests, nothing, no x-rays, nothing, just the room, the scapel, and when you can walk a few feet without crashing onto your face, you are shoved out the door.  

We have to have a single-payer system now.  I hate to plug it, but to that end I've joined up with the Vermont Worker's Center in their fight for single-payer system.  There's a forum on 29 January at 7:00 at the old labor hall in Barre.  It's us against the insurance companies and we know who our politicians, Demo or Repub, favor.  


When you wake up each morning look around you.  It might be the last time you get to do it.  

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by: Watercloset @ Sun Jan 25, 2009 at 12:43:55 PM CST

Ditto (0.00 / 0)

Catamount Health Care needs some Tech updates as well. Instead of doing all those mundane steps, where they mail you a letter and then you mail it back to them (repeat these steps like 3 more times, plus stopping by their office to show your passport). You finally get a decision, and then you are off into the hands of Blue Cross Blue Shield or MVP, which takes up to a month to get you signed up.

Would it not make since to have an online application? It would also make since that you would be able to pay your premium by phone or online.

Good thing I am healthy, because this whole process can take up to two months.

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by: qwerty @ Mon Jan 26, 2009 at 09:39:05 AM CST

The situation's changed for me a bit, but... (0.00 / 0)

...I'm still just so pissed off at this process.

The situation's changed for the better: I just discovered that my new insurance is retroactive to my start, so I won't have a full month's gap, so Catamount is now unnecessary to me.  I wonder if they'll refund the two months worth of premiums I paid.

Musician, Web Designer, Photographer

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by: JulieWaters @ Mon Jan 26, 2009 at 15:03:46 PM CST

[ Parent ]

luck (0.00 / 0)

You lucked out, Julie. I would not bank on those premiums getting paid back to you.  It is sad how in this country health insurance is a matter of luck so that a few can get rich.  

When you wake up each morning look around you.  It might be the last time you get to do it.  

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by: Watercloset @ Tue Jan 27, 2009 at 01:34:48 AM CST

Oh I'm not banking on it. (0.00 / 0)

but I'm also not afraid of taking the state of Vermont to small claims court :)

Musician, Web Designer, Photographer

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by: JulieWaters @ Tue Jan 27, 2009 at 01:41:55 AM CST

[ Parent ]

Go for it (0.00 / 0)

Go for it.  Get Douglas and company to pay up.  I may have to, yet again, go through the same ordeal if VHAP upgrades me to Catamount, like they might.  But I've been through the system before and am no stranger to how you have to fight for it here.


When you wake up each morning look around you.  It might be the last time you get to do it.  

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by: Watercloset @ Tue Jan 27, 2009 at 01:46:56 AM CST