Wednesday, November 22, 2006

We Have the Best Medical Coverage???????

I just called GHI to find out about the status of the procedure I am waiting approval on. They, of course, don't handle it and put me through to Care Core, the company that does handle it. Care Core callously tells me that my claim has been rejected. "So you are just going to wait for me to get sick and die?" is what I said to the claim representative. She then answered that my doctor is at fault. They requested additional information that my doctor never sent. I know my doctor well. This was not the truth, but I called my doctor to check anyways. The receptionist said "They lie! GHI is the worst. They reject these claims all the time. I'll resubmit on Monday, but I don't know what good it will do."

And the UFT suit that came to my school kept insisting that we have some of the best health coverage in the country.


Anonymous said...

Knowing GHI, they're just as likely to accept the application next time as they were to arbitrarily reject it the first time.

Make sure your doctor's paperwork is exactly perfect. Any deficiency, even a minor one, is the standard reason for GHI's denying an entirely reasonable claim.

I've had a similar experience with them, and it all worked out OK after some initial frustration.

As tricky and irksome as GHI can be, they're still better than any alternative I've come across in my umpteen years as a teacher.

Happy Thanksgiving!

Pissedoffteacher said...

My son needed some surgery a few years ago. I couldn't get approval until a week before the operation. My husband's insurance gave the okay in less than five minutes. Unfortunately, I was primary so we had to go through GHI first.

Anonymous said...

My claim for my daughter's emergency room treatment was denied because I didn't list a secondary insurance company. But GHI is the only coverage that my family has! The third time that I resubmitted it was finally accepted.

NYC Educator said...

Actually your secondary coverage is Blue Cross. I've had similar problems with GHI, but I've always won in the end. It seems a standard practice to deny everything and hope you'll pay out of pocket.

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