The night before New Year's Eve I managed to aggravate a back injury from twelve years earlier. Fortunately, we were able to get a doctor's appointement at 3:00 in the afternoon on New Year's Eve. After going through the examination and waiting painfully for the x-rays, I then waited a week for my first physical therapy session. Fortunately, there was no bone or ligament damage, but I did require 3 to 4 months of physical therapy. This is a routine I have done a few times over the past dozen years. It's very painful and we are very, very lucky that my husband's employer has the heath insurance coverage they provide. Or so we thought...
Late this spring came the letter from the insurance company questioning the PT provider and whether we had other insurance that should cover it. Then, before I could get them called, came the phone call asking me to justify the treatment, explain the diagnosis, tell them how the injury occurred, etc. Why don't they just read the damn file?
Then, in June came the pamphlets on "how to care for a back injury". Such a timely piece of information. Wouldn't that have been more helpful to have received such info in say January, or February? Maybe even March or April? Besides, I get all those types of things from the doctor and the PT. I understand they are trying to do this "preventative care will help cut costs" bit, but this week came "the phone call". "I am a nurse with your insurance provider and I understand you recent had a back injury. We sent you some pamphlets about back care. Is there anything you would like to talk to a nurse about?"
"No, I go to a doctor for that."
"We talked to you about your asthma and sent you some pamphlets. You indicated you did not wish to speak to a nurse, but only wanted to receive the pamphlets. Is that still correct?"
"Yes."
"We recently sent you pamphlets about XYZ condition, would you like to talk to a nurse about that?"
"No. I'm seeing a surgeon about that."
Here's my question. Are they keeping track of whether I cooperate with their nurse? If I say "no" to speaking to her/him do I get a demerit next to my name as far as insurability? Will they deny a claim in the future if I reinjure my back and I didn't talk to their nurse about proper back care?
I don't want this company to be my healthcare provider. I want them to PAY my current healthcare providers. When we've been asking for there to be healthcare professionals at the insurance companies, this is not what I had in mind. And one more thing. If I take this nurse's advice on something instead of going to a doctor, can she and the insurance company be sued for malpractice?
If they were't spending my premium money on this, maybe somebody else's claims could be paid