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Atlantis Health Plan Complaint - The patient is not their priority it is the $$$
Complaint
I am an early retiree, and former healthcare worker. What I found with this insurance company disturbs me. My first experience was with an abnormal mammogram. They were going to deny a biopsy, even with a past history of abnormal biopsies. They had proof of continued insurance and in NY the "prexisting condition" is not applicable if you have no insurance lapse.. They were denying the biopsy the DAY of the procedure which had a 3 week advance wait. The finally allowed it but it was a fight to get pathology paid. fast forward to a knee injury. again they played the "pre existing card" Day of surgery they were denying... finally got approved, but in the interim my ortho dropped their plan. second ortho dropped plan third ortho dropped the plan.
Finally, I have a 3 plus family history of colon cancer. I have had 3 colon biopsies since age 42 that have show pre cancerous polyps and a sigmoid resection at age 45 due to acute diverticulitis. They denied a colonscopy even with all this history because I was not 50. I was prepped and ready and after 3 weeks the GI doc had not received word from them. He went ahead with procedure, I understood I may have to pay out of pocket. Thankfully it was clear, I was denied, and paid $3000 grand for the piece of mind. In the past 30 days I have gotten letters from my GI doc, my internist, my GYno, and my ortho that they are all dropping this plan.
Can it possibly be because I am receiving notices from Atlantis now that they are now paying for claims from over 2 years ago that were previously denied and that the doctors offices fought over?
Run away from this company.
Finally, I have a 3 plus family history of colon cancer. I have had 3 colon biopsies since age 42 that have show pre cancerous polyps and a sigmoid resection at age 45 due to acute diverticulitis. They denied a colonscopy even with all this history because I was not 50. I was prepped and ready and after 3 weeks the GI doc had not received word from them. He went ahead with procedure, I understood I may have to pay out of pocket. Thankfully it was clear, I was denied, and paid $3000 grand for the piece of mind. In the past 30 days I have gotten letters from my GI doc, my internist, my GYno, and my ortho that they are all dropping this plan.
Can it possibly be because I am receiving notices from Atlantis now that they are now paying for claims from over 2 years ago that were previously denied and that the doctors offices fought over?
Run away from this company.
Comments:
Posted by Skye on 2010-06-11:
It's sad, but that's how it is. The patient is not the priority, it's all about the almighty dollar, and profit margins. The more they deny you, and thousands of others, medical procedures, the more money they get to keep, and in turn, their profits soar through the roof.
Glad they are paying past claims for you now.
Glad they are paying past claims for you now.
Posted by gothmbodhi on 2010-06-14:
@Skye: I read somewhere that the average health insurance company has a 3% profit margin. As an MBA graduate, I know that there is no way most companies would have any credibility on the Stock market with margins like that. Seems to me it's amazing they are all still in business. It's doctors and hospitals that are screwing things up. How can an MRI at a hospital cost $5000 but at a MRI lab it cost $400 for the same thing.
I don't know that particulars of your case, but I wouldn't blame just purely the profit motive.
I don't know that particulars of your case, but I wouldn't blame just purely the profit motive.
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