Insurance struggles, any advice??

I've been dealing with a short-term disability claim with my insurance company for five months now. They keep stalling, sending more forms, refusing to make a decision without more information, and telling me that, since I applied after my active treatment, they can't actually approve it anyway, because regardless of diagnosis and recovery and doctor's recommendations, they don't approve any claim for anyone that's not being actively treated (read: medicated). I'd have applied sooner, but they also don't accept or approve claims until after other resources have been exhausted (in my case, medical EI, because my employer has no sick leave policy), so I had to wait until all of that was done before I could start this claim.

(It all seems very underhanded to me, but of course, they're out for profit, not to help their customers, and their system is set up to maximize their profits and reduce the number of claims they approve, so I'm not surprised. Disgusted, yes, but surprised, no.)

Oh, I should note that this is an insurance policy I had through my employer, a group policy.

At this particular juncture in the process, I've been chasing the latest demand from the insurance company for six weeks to no avail, under threat of having my claim denied outright without it. They need yet another form to be filled out by a doctor, and nobody at the Cancer Agency wants to help me. I've been to three different appointments this past month (to say nothing of the multiple phone calls and arguments I've had with secretaries, etc., trying to get help and answers and being told to figure it out myself, ugh), and everyone I've dealt with has had the same response to the form - "Well, I can't fill this out, but I can send you to someone who can." Finally, today, I hit what is likely to be the last brick wall - the one doctor that was supposed to actually be qualified to fill it out, and the very first thing she said to me when I met with her was, "Well, I can't fill this out." She wants me to try one more doctor, then see her again to make up some stuff for the form. That'll be five different appointments with four different people over the course of six weeks, and I'm so frustrated, I can't even express myself. Nobody gives me a straight answer, nobody is helpful, nobody seems at all interested in helping a 30-something sort out insurance coverage to stay solvent (despite the fact that every support staffer I've spoken to says that they do this sort of thing all the time and it won't be a problem), and the only systems they have in place are set up to help older folks who are retired or almost retired.

(In fact, the useless clinical counselor I spoke to told me that the best thing I can do for my anxiety right now, which is caused by this financial situation and the difficulties I'm having getting assistance, is to just not think about it. Because, somehow, ignoring my problems, my bills, my paperwork, will magically make it all go away or something. If I wasn't terrified of losing my apartment and being homeless, I'd skip paying my rent and then bring her my eviction notice and ask her how "not thinking about it" was supposed to help my stress levels. She also suggested I get myself declared disabled so that I can never work again. I was flabbergasted, I'm not even remotely disabled, I couldn't believe my ears.)

I'm at my wit's end with this. I need this insurance money, I haven't had any income in almost 8 months, my life's savings are exhausted, I'm racking up debt that I can't afford to maintain just to cover basic living expenses, I have zero financial support or assistance from anywhere (I'm ready to go back to work, but my contract expired while I was on medical leave and my employer didn't renew it, likely because of my situation, so I'm job-hunting but having no luck), and no matter who I ask or how much I beg or how many hoops I jump through, I just can't seem to get any help with this claim, and the insurance company feels like a pack of wolves, circling me and waiting to pounce and destroy me once and for all. I also can't afford to just keep running around to all of these useless appointments, it costs money that I don't have just to get there, every wasted appointment adds needlessly to my debt load, and it's all just a lot to deal with right now. I feel like I'm bashing my head against the wall.

Does anyone have any advice for how to get this sorted, and if there's anything I might be able to do to increase my chances of having this claim approved?? I get that insurance companies thrive on denying claims, that's where their huge profits come from, but after everything I've been through this past year, I just can't believe that some office drone with zero medical experience (which I've encountered first-hand when she tried to tell me what my diagnosis meant and got it ALL WRONG) is going to tell me that I don't deserve to access the short-term disability coverage I paid for, it's seems unfathomable to me. I've worked so hard to get to where I am and have some sort of career and financial stability finally, with precious little help from the people around me, and it's all disappearing right in front of my eyes because of this diagnosis and I feel helpless to stop it.

Comments

  • vlnrph
    vlnrph Member Posts: 1,632
    edited March 2019

    What a nightmare! I don't have much advice seeing that you are in Canada other than obtaining a strongly worded letter from a lawyer threatening to sue. Is there a pro bono/free legal service you could access? You don’t actually have to file suit but maybe that prospect might induce them to cooperate.

    Vancouver is such an expensive city (from what I understand after a very pleasant visit there) I cannot imagine trying to pay rent without any income...

    If you were in the US, I would suggest you file a complaint with your state insurance commissioner's office. They will go after a company which is operating in bad faith like yours seems to be and fine them, perhaps even bar them from doing business. I wonder whether the provinces staff a similar government entity, designed to protect the consumer. I hope someone else comes along who knows about possibilities to work within your system.

  • AnxietyGirl85
    AnxietyGirl85 Member Posts: 74
    edited March 2019

    Such a nightmare, I don't have the words to describe how frustrating all of this is. At least my GP agreed to provide some additional documentation to go along with whatever the shrink might give me next week, so that's something. I saw her first thing this morning, she told me she'd have something for me to pick up at the clinic tomorrow (and she even agreed to waive the fee, since I'm beyond broke and she knows what I've been dealing with). It may not accomplish anything, but it's literally all I can get from anyone right now, nobody is willing to be properly helpful and the insurance company is being exceptionally difficult (as they tend to be - they've rigged their systems in their favour, after all, they're set up to not pay out).

    Vancouver is exceptionally expensive, and getting more so every second - nobody that I've begged for help seems to appreciate that, they don't seem to understand that not only do the bills not stop when you're sick, but the cost-of-living in this damn city never stops increasing, either. Guess that's what happens when you're trying to get help from people with six-figure salaries, they can't relate. Just got my latest rent increase notice, going up another $50 a month starting in June. *sigh* It's not a very forgiving place, this city, and no place for people with financial difficulties. I didn't have a ton of savings, but they didn't stretch nearly as far here as they would've almost anywhere else.

    I'd look into legal help, but I'm not quite sure what I'm looking for, and it would certainly have to be pro bono, my finances are completely exhausted. Guess I'll see what I can come up with, unless someone has some ideas for me.

  • Leydi
    Leydi Member Posts: 146
    edited March 2019

    Unfortunately, I really don't know how these sorts of things work in Canada. In the U.S., I wouldn't be able to successfully claim even short term disability if I was "not even remotely disabled." Is that why your doctors do not want to fill out the forms?

    Is there any kind of unemployment insurance/payments that may be available to you? Since you are out of work and looking for new work, that seems to be more applicable to your situation.


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