obviously, michael hasnt the slightest idea of what i was saying about using photoshop to alter something. at no time did i say anythign about altering a .psd file. DID I?! i was merely talking about using something so simple as taking a screen shot of the email itself and altering it to get the outcome.
but, since you seem to know everything, im sure that no one could possibly use binary to alter the file that you have saved?
leave your ingnorance at the door and stop supporting stereotypes
and perhaps i should clarify the last so i dont confuse michael. when you go to court, they arent going to use an electronic file in a hearing. they are going to have physical documentation meaning its going to be printed . so, as you can see, you will at that point be able to present an "image" of an email. that image can easily be altered to say whatever you wanted it to say. and you know damn well for your piddly ### discrimination case, they arent going to do data forensics nor will they have any idea how an email trail works other than reading the email that is printed. which, as i said, can be altered with photoshop software. NOT DATA ALTERING, but physically altering what it says.
TURD
there are certain things that cannot be disclosed for any parties over a certain age because of the HIPAA regulations. even if you are the account owner, there is information that cannot be disclosed to anyone other than the patient. only general information about the services can be disclosed. things such as doctors name, services rendered, and diagnosis are among a few of the things that would fall under HIPAA. HIPAA is a very serious federal guideline that all insurances have to follow.
when it comes to searching for providers, finding a place that deals with a certain problem is impossible. they would be able to search for providers in your area that deal with mental health issues. but, they wont know if they specialize in what is needed. your best bet in that situation is to find places in your area that provide the services he needs, then look them up to see if they fall in under your plan.
since when did they have rice crispy treats?
derp. hukd in phoniks werks pher ne
a consumer that did not order off of their menu. its not just BWW that does this. go into a movie theater with outside food or drinks. heck, go into any other place and do the same thing. they are going to tell you to gtfo.
you being disabled doesnt make this ok. stop using it as a scape goat
i did repair work for them as an independant contractor and i never ran into any problems with them. their pay rates were better than some of them i have worked for. I dont know what they are like internally, but all my experience with them has been fine
free webmail + chinese sellers will typically mean they sell fake/replica items. since the real retailers website is different, i would say this is probably a replica dealer
they may have commited the same act, but did they get robbed when doing it?
as much as you want to clear yourself because "well, they did it too", THEY were fortunate enough to not get robbed because of it. right now, its time to take your medicine and take responsibility for the mistake. yes, your human and mistakes happen. but, anywhere you go, if this happened, you would have been fired for it. you simply broke a rule that is in place for a reason. and now, you know the reason why the rule is in place.
i make like 1 mil a year...fer realz yo. and i drive an 82 cavalier...
fail troll fails
exactly what cartblance said...they could be going 200 mph but if you fail to yield, your ultimately at fault. goes the same with rear ending someone. the person in the back is getting the ticket regardless of the reason.
like it or not, and you probably wont, its your fault for not yielding. its the way the rules of the road are. period
being along an ocean, i wouldnt doubt that it may be corrosion on an internal part?
if only insurance companies worked like that...it costs more money to try to do exactly what you think they are doing. doctors have no clue as to what is going on. if it wasnt for their billing department, they wouldnt ever get paid because they know absolutely nothing about insurance billing. Yet, they always act like they know about it.
with the days of technology, there is hardly any hands on claim processing. claims processing is handled by a computer system that automatically processes claims. claims may need manual review depending on what it is and that is where you will have someone review the claim, and process it with the need for more documentation.
but, did you know it is actually a doctor that reviews the information that they recieve? so, if a doctor is reviewing the information and saying it isnt legit, more info needed, whatever...what does that tell you?
the doctor that works for the insurance company does nothing but look over the information that they recieve. they dont deny the claim or anything of that sort other than to give feedback to the company as to what he determined from the written documentation.
i understand all of that. i deal with insurance on a daily basis. but, what doctors and a random person doesnt realize is that one persons conclusion can be incorrect. just because you are seeing one doctor, sure he may be right. but, he could be wrong. they would want to substantiate everything tied together. an MRI/ct scan, etc are going to show images of a possible problem. the doctors notes are going to back up his "theory".
there isnt a single person that is an internal working person that is 100% medically trained other than the doctors that that are hired to do medical claim reviews. i would stake my career on the fact that the doctor is questioning something that he sees in the informaton that is sent and questions why your doctor is coming up with what he is.
im not sure how Cigna works exactly, but when money is dealt with, they have to make sure it is going for a purpose.
I wont disclose which insurance i deal with, but i can tell you this, its not the insurance companies money that they are using to pay for claims. its the money that is put in by the employer and the employee (group insurance). when dealing with other peoples money, that employer expects the insurance to make sure money isnt getting expended recklessly.
the piddly amount of the claims that your dealing with, trust me its piddly, compared to the millions of dollars shelled out on a daily basis. i have seen 1 single check to 1 single provider that was almost 2 million dollars. think about it...they arent out to steal your money, as much as you would like to think so. i thought the same until i actually got into the biz. its far from the truth.
i would stake a claim on this to say that SOMETHING isnt adding up when they review your information. it isnt one single person that is going to be dealing with it nor is it just on a whim that they will deny something unless there is soemthign suspect.
My GF also works for an insurance company...seperate from me. she works in provider/patient fraud. neither me nor her could give a damn less about the claims that come in. obviously we do in the people aspect. but, when she reviews something, she is going to look at the information and base her decision on the informaton at hand. her approving or denying something has no effect on her. she doesnt get bonuses or anything of the sort. im in the same situation. the claims i see, all i see is information. i dont get anything out of doing anything differently. the people you deal with at an insurance company are there to make a paycheck and do the job they were hired to do. THEY DO NOT HIRE PEOPLE TO SIMPLY DENY CLAIMS FOR NO REASON. everything is based on information. you wont hear anyone say "im just going to deny this claim because i dont like them/ill get a bonus if i deny this/"enter diabolical reason here"".
it really is that simple. most people will only believe what their doctor says because their doctor would never lie. doctors are far from perfect and most problems are caused by their own billing department. but for short term disability, its something that gets abused alot and they have a reason why they have to ensure that it isnt fraud. fraud in the end, causes your premiums to raise. im sure you have a legit claim...not questioning that. but, to ensure that money isnt being abused, insurance companies will do their homework and request alot of information. i see it happen alot with chiropractic claims. insurance companies will almost always request medical notes because once it stops being therapeutic and not helping anything, they will deny it unless medical notes show progress.
also to mention, if your doctor says "insurance companies are notorious for this" it sounds like HE has this issue alot.
when a physician has a red flag for questionable claim that are frequent more often than not, he may be getting watched for fraud.
the physicians that have a fraud flag are hassled alot with paperwork requests. keep that in mind also. that is only an educated theory, so dont take my word on it. but, that is a possibility since STD is a commonly abused system
how is this racist? it smells (the use of a bodily function) of curry (the smell that it has).
You are trying to play the race card because you are simply applying the word curry to middle eastern culture.
i believe you to be racist. would it have made it any better if the person it smelled like watermelon or chicken or perhaps a saltine cracker?
im not taking it personal, but it does irk me that people assume they know how it works just from the "heresay" that they get from friends, internet, doctors, etc. im simply trying to educate you in this. i am basing my words off of experience and not heresay or words spoken by someone else.
you may not think "My doctor was not going to lie and put his practice in jeopardy" by trying to defraud anything. But, what about the doctors that commit fraud daily. their patients would think that the world is as peachy as you think and say that their doctor wouldnt ever do anything like that either. but, since people are imperfect and greedy, it is a possibility.
"I do not think the insurance company is reviewing claims with the goal approving claims that are valid but looking for reSons to make them invalid. "
with this, it goes back to the representatives being cruel and punishing. the person reviewing it is basing everything that they are doing off of paperwork that is presented. i guarantee that if you had the ability to have a sit down and explanation session with the person doing the review, you would get a whole new understanding of what is needed or any of the reasons. right now, your just a third party hearing something that was told to someone else and may not be getting told the truth or the full story.
that "representative that is reviewing your information is following procedures. their procedure isnt to find a reason to deny something. it is going to be to question anything that can be questionable. there isnt a reason to question something if its 100% valid and complete. and yes, there will be multiple doctors that work with insurance companies. the people that work for an insurance company arent medically trained. it isnt their place to say that something isnt valid for whatever medical diagnosis or procedure. they will have a doctor review the information as well and consult. all major insurances have a physician consultant that is an MD. my girlfriend deals with an MD consultant all the time for fraud claims to verify the validity. in fact, if you look at job postings for major insurances, you will see job openings for those consultant positions.
its human nature to try to save face when they are wrong. is it possible that something wasnt faxed-yes ; is it possible that a fax wasnt recieved-yes; is it possible that the doctor isnt telling you everything-yes ; is it possible that the doctor is trying to save his reputation-yes ; is it possible that the doctor is being fraudulent-yes ; is it possible that this whole situation could be because the information isnt explaining enough-yes.
on the same token, yes, it could be complete incompetance of your insurance. but, you are focusing on the insurance thinking that it couldnt possibly be the fault of the doctor. and that is the part that really digs on me. people think that their side of the story couldnt ever be incorrect. ...as you will see in almost 80-90% of the complaints on this website.
im not trying to be argumenative by any means and i apologize if it seems like it. But, insurance, banking, law, arent easy subjects to grasp because of so many different procedures that are not seen. people usually only focus on the wrong being done to them. the person doing your review isnt being devious and doing this purposely. it would have saved the company money and manpower to have paid this instead of requring multiple reviews and research.
i actually heard from a very reliable fraud investigator for an insurance company that aspen dental is one of the providers that is flagged for fraud
although, i would imagine that you probably do have a legit case, there are crooked providers regardless. i am going to make a general statement that is not directed toward you. but, providers will do things to get a better outcome for the patient which is another form of fraud.
i see it happen pretty often with normal medical stuff. a provider will change diagnosis's and procedures to either help the patient pay less or to completely benefit themselves.
having a lawyer look at something really doesnt make anything true. hes an attorney not a doctor or anyone that deals with insurance. he will build a case with the information at hand and piece in anything else with smooth talking. lawyers have the ability to build cases without having to know insurance or all of the facts. the information you have, any lawyer can piece something together and make it sound good. lawyers are all about smooth talking and persuasion. in the end, they have only enough informaton to be dangerous and to pressure the insurance into doing something just to avoid court proceedings.
in the end, you have to remember that the person working your case is someone that really gains nothing from approving or denying your claim. they are taught how to look for things and need information to make an educated decision. it really is that simple. that person doing the review is not being coerced by any other factors. in fact, that person is practically a customer service person that works for a paycheck and goes home at the end of teh day doing the job with the guidelines they have to follow.
but, i cannot say it enough, all insurance companies have doctors on staff that review the information. if that doctor questions anything, the person that is doing your case is going to bring up that question as well. no one in the insurance field is medically trained so, they arent pulling this out of mid air. i again, cannot say it enough that the person reviewing it is not "the insurance company". people will generalize insurance companies as one big monster just as i would a lawyer. but, i think lawyers are bad because i havent worked in the legal system to see how it really works. which brings me to the real point. until a person works in the biz, everything that is told to them, although some may be true, everything that is said is complete heresay unless that doctor, lawyer, etc has actually worked in the field directly.
i cannot vouch for what Cigna is doing exactly because i dont know their appeal process. But, there are many things that are universal like required information and the actual people that review that information.
i get requests to correct claims all day. most of them are preventative. or at least, the patient thought so. but, what is recieved by the insurance is what is processed. nothing more nothing less. and yes, some of the escalations i deal with are legit reasons and we simply do what we can to fix our error. but, if information is needed, its needed. i hear the "i sent it already" all the time...sure, you sent something but it isnt what was needed/requested.
obviously, i can only assume things in your case. but, with what i have heard already, i am lead to believe that something is really missing.
i wish you luck. i know it sucks when you get stuck in the loop and i most definately have an open mind this. but, i would also have to wonder what is really causing this to happen.
at least this troll is mildly amusing
