NO WONDER WHY THIS COUNTRY IS BEING FLUSHED DOWN THE DRAIN. THE WORLD IS ENDING>!

In my case, I was referred from a network provider to a network hospital for emergency care. The hospital assigned me a surgeon that wasn’t covered — who knew through the morphine? So, GHI argues that by selecting the basic coverage (don’t worry, the standard plan is almost as bad), I elected to NOT be covered if a network hospital assigned me an out-of-network surgeon.

I almost fell over laughing reading this! They omitted that by their definition, neither prompt payment nor rational explanation for denials is a “service”. They don’t know what the term usual and customary means, instead calling it a “allowable fee”, as if beneficiaries care about semantics, and don’t bother even trying explaining the difference until it is too late for the beneficiaries to do something about it. That’s called entrapment. They sometime denied becuase the service is not covered in the “group contract”, but won’t provide a copy of the “group contract”. Instead, they refer to a “Certificate of Insurance” whose opening statement implies that when there is a conflict between the certificate and the group contract, the group contract governs. Providers are sometimes non-existent; GHI apparently expects providers to tell them when they stop accepting their patients. Some may even be dead, but GHI requiries them to get out of the grave and tell them they are no longer accepting patients, so they still list them as participating. I’ve wasted many days calling up everyone on their provider list local to me and came up empty, but to them that’s “promptness and quality”. I wouldn’t even give them a single star. Does the right hand know what the left hand is doing there?