I am sad and angry about my insurance not covering my cataract operation

Canada
January 7, 2008 4:22pm CST
Well, I went for my cataract assessment today and was told that finally, after a long wait of four years, they are "ripe" for the plucking. My specialist is very good and she told me all my options: we have our provincial health plan but it will not cover all the costs associated with the operation. I felt positive enough, though, because I am paying $425 dollars a month for extended health benefits (family coverage--hubby and me) through my work, and felt sure that my insurance from work should cover it. I called my provider but was informed that any service provided by a medical doctor is not going to be reimbursed, because the province is supposed to pay for medical doctor services. I was extremely upset because of this, but what can I do? My only other option is to not go for the operation, because the extra cost will not be affordable for me. The insurance company will not even pay for any costs at all! not even the services of a cataract specialist! I am sorry for ranting and raving, my myLot family, it's just that I am very frustrated and if I were to hold it in I shall burst! Have you ever experienced having to pay through the nose for insurance but get nickel'd and dime'd to death when it comes to reimbursement? Grrrrrr!!!!!
1 person likes this
2 responses
@gabs8513 (48715)
• United Kingdom
7 Jan 08
Do you know this makes me so angry You pay all that money every Month and then when it comes to you needing to claim there is all these little Clauses Never mind the Health of the Person they just care about not parting with their Money That is so wrong when you pay all that Money every Month I wish I was rich I would send you the Money This makes me so mad you need that Operation it is just not fair at all
1 person likes this
@gabs8513 (48715)
• United Kingdom
7 Jan 08
Ok I got so mad I forgot to leave you a big Hug (((((((((Hugs)))))))))))))0 and Elf sends you lots of Kisses
1 person likes this
• Canada
8 Jan 08
I guess nothing is really fair in this world, isn't it, gabs...I know what you mean--but you know, it's not even about the money now, it's really the principle of the thing. Can you imagine the irony of "medical benefits insurance" not being allowed to cover for the services of a "medical doctor"??? A big joke. In parting I told the insurance customer service lady that I guess I have no choice I'll just have to go blind! Don't worry, sweetie, we WILL be rich and you and I will be laughing at the system. Your thoughtfulness is very touching, and I am in tears at reading that you would be sending me money for the operation if you had it! That is the kindest thing anyone has ever said to me today and I am absolutely blubbering! Bless your heart and lots of hugs and kisses to you and the Elf...{{{{{{{{{{{{{{{{gabs/Gissi}}}}}}}}}}}}}]] Say--why not join me over at the Cocktail Club, our virtual happy hour happy place where we let it all hang out? Go to the myLot discussion of the Cocktail Club and you will get there you are way smarter than I am in these things (I don't know how to do the link, tee-hee!) Luv ya lots and lots!!!
• United States
23 Jan 08
I agree with you gabs8513: This is so unfair, unjustified. How would they like that happening to them? OTOH they're probably so rich they can pay for the operation themselves.
1 person likes this
@mugwort (78)
• United States
23 Jan 08
Really how callous, uncaring of your insurers. My HMO permits its customers to appeal if they disagree with their decision. Does yours. Sure hope so. If it does, wishing you good luck. One more thing. Giving you a great big HUGGZZZ mugwort
1 person likes this
• Canada
23 Jan 08
Hi,mugwort! Unfortunately, my insurance carrier does not allow for appeals. I made the mistake before of getting a procedure done--my hubby had a cyst on his gums by his upper lip and it needed to be surgically removed. A dental surgeon removed it, it had grown up inside along the side of his nose and impeding his breathing. It was the dentist who found through x ray and referred him to a dental surgeon. Yup. We paid out of our own pocket. OHIP (Ontario Health Insurance Plan) did not cover it and neither did our insurance benefits provider. Up to now we do not understand why and why not! Thanks for the good wishes. A great big hug right back at ya, sweets!!! {{{{{{{{{{{{{{{{{{{mugwort}}}}}}}}}}}}}}}}}}}