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View Diary: An Obamacare enrollment trend to strike fear in the heart of Republicans (76 comments)

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  •  I used to process claims, for an insurance co. in (1+ / 0-)
    Recommended by:
    puakev

    northeastern Wisconsin.  Prior to 1988 a few large Insurance companies here would rob each other of experienced Claims Analysts. I got my job, in the fall of 1989, when one of these companies decided to train their own Claims Analysts. I had started as a night temp and was able to get in as an Associate Claims Analyst training to be an Analyst. I had no medical background, but had to  take a Medical Terminology Class, so I would recognize some of the medical terms on incoming claims.  We had to do 2 types of investigations, one was for Evidence (don't remember just what that entailed), and Pre-existing.  I had to request medical records, if the claim was flagged for possible evidence or pre-existing, then read the records, when they came in, even if they were in doctor's handwriting, which is unreadable and it was my job to determine if it was pre-existing.  I had no medical background, only a class learning Medical Terminology.   This was supposed to help me, when I read the medical records to determine, if a claim was pre-existing. Although I liked the job, I was very uncomfortable denying someone's claim, when I knew absolutely nothing about medical conditions.  They eventually had a special unit, with retired RN's & Drs reading the medial records, to determine if they were pre-existing.  They also had a one million cap on claims and when that cap was reached, they wouldn't pay anymore.  Once someone was denied for pre-existing I think they could get coverage, but would have to wait a certain number of years.  It's been a while, because I was so stressed out, in October of 1995, I was eating Rolaids, like candy, which a team mate chastised me for doing. I gave 2 weeks notice and quit.  Even though I had insurance, when I quit, there was no way I could afford COBRA.  Now we have a goofy REPUBLICAN governor, who decided he didn't need the ACA money, from the Feds, to expand Medicaid.  WI is one of those states with a RED GOVERNOR, who, who don't like Obamacare, and decided he was going to show Obama and not accept the money.  Fortunately, I am disabled, have Medicare and had been eligible for Medicaid, but because I was able to get a part time job, working from my apartment, doing Customer Service over the internet, no longer am eligible for Medicaid, unless I have over $4,500 in medical bills.

    •  About my Medicaid.... (1+ / 0-)
      Recommended by:
      puakev

      My Social Worker sent me a paper application, for the ACA and suggested I fill it out, to see if I would qualify for help from the Federal government.  I haven't done it yet, but am going to do it soon.

      •  You have until March 31 to sign up (0+ / 0-)

        however if you have Medicare I believe you would not be eligible for an ACA plan.  But if you need more than what standard Medicare is providing, there are Medicare supplemental plans available that cost a little more but are more comprehensive.  Good luck in getting the care you need.  

        "Those who have wrought great changes in the world never succeeded by gaining over chiefs; but always by exciting the multitude." - Martin Van Buren

        by puakev on Thu Feb 13, 2014 at 09:22:18 PM PST

        [ Parent ]

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