Insurance Company: "Yes Ms. Customer, eye examinations are covered on your policy. Please feel free to get checked out."
Customer: "Thank you insurance Company."
Customer: "Excuse me Mr. Insurance Company, you told me eye exams were covered and I just got an Explanation of Benefits that you denied my claim. Can you explain that?"
Insurance Company: "Yes Ms. Customer, you were diagnosed with X, and we don't cover that, so your exam was not covered."
Customer: "But how can I find out I have X without an exam?"
Insurance Company: "You can't"
Customer: "Then why won't you cover the exam like it says in the packet/contract we have with your company?"
Insurance Company: "Because you were diagnosed with X."
Makes a lot of sense doesn't it. If anyone is wondering the insurance just so you can know in case you ever have a choice on insurance companies. It is Humana.
4 comments:
Insurance is a Love/Hate relationship.
I know this isn't helpful to you.
I've unfortunately worked for 2 insurance companies, and training consists of them furiously urging us, "Find a reason to deny this claim!" It is sickening.
Well I would tell them since you have X you cannot read the bill, and since they will not cover your exam to get X fixed you will never pay your bill because you will never be able to see to read it. Maybe when they realize that being able to see is IMPORTANT then they will actually cover your exam. People are so stupid!!!!
I still think that they should cover the exam! I would totally understand that, if they do not cover the X disagnosis, then they would not cover the TREATMENT for X.
But if they cover EXAMS then they should pay for EXAMS.
It will be interesting to see what you find out.
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