Scarlet Letters

The not-so-private thoughts and rants of Elizabeth Donald, journalist/author and founder of the Literary Underworld.

Monday, December 21, 2015

Elizabeth fights insurance companies.... or, Day Ending in Y

In the last few weeks, I've had to do more than the usual amount of fighting with medical insurance, the clinics and companies that provide us with health care. And frankly, I am royally sick of it. This shit was supposed to end when we got the "good" insurance.

• My "winner" this round is the mail-order prescription service contracted with our insurance. They have reached new levels of incompetence. One of my medications was running low, so I put in an order in November. Two weeks went by and it hadn't arrived, so I called to find out my status.

I was informed the order was canceled. Why? There's a form my doctor is supposed to file with my insurance company verifying that I really need the medicine he has prescribed. Otherwise they won't cover it. First: If I were a doctor, I'd be goddamn insulted that form exists. "Yes, she needs the medicine. That's why I wrote the prescription. I didn't write it because I love the sight of my own signature or because she thinks the pills are M&Ms." Second: My doctor filled out that form when I first got the prescription a year and a half ago, and I'm pretty sure it's still on file. Third: Anybody consider making a damn PHONE CALL about this instead of just canceling my order?

Sure enough, they did. They called my husband's cell. Oh really? Why call my husband? Am I a child? Am I mentally defective or otherwise incapable of handling my own goddamn health care? (For the record, Jim recalls getting a call from "unknown number.")

So I called my doctor and got them to refile the stupid Yes I Really Meant It form. And I told the pharmacy to please update their records with my cell phone number.

Imagine my surprise when I still don't have the prescription ten days later and it's canceled again. They claimed the FSA charge didn't go through. They're not even pretending to call anymore, they just canceled the order. Turns out they were charging the wrong FSA; mine ran out of money months ago. I gave them the debit card, reminded them again that I have my own goddamn cell phone, and they promised the scrip was on its way.

Tonight I feel awful. Just terrible. Because I've been out of that med for weeks now, it's cumulative and any vestige of it is now gone from my system. So I check again.

You guessed it. Canceled again. So I called, while I was doing the car exchange with Jim, and he mimed strangling while I was listening to a customer service rep explain AGAIN that the FSA was declined, they don't seem to have my debit card information anymore, and the number they have is my husband's cell.

I didn't swear at her. I try to be a decent human being. Flipping the table was becoming a real possibility, however. In the end, I have given them my FSAs twice, my doctor's numbers twice, that Yes I Really Meant It Form twice, the debit card twice, and the number of requests to please call my cell instead of my husband's stands at FIVE. Will it finally be entered into the system this time? Taking bets.

For the record, she was very polite, and said she was going to have the prescription overnighted to me because I have waited so long. We'll see. In the meantime, I don't feel so good. And I have a paper copy of the Yes I Really Meant It form - good through 2018 - that I will scan and email to the next idiot who tries to deny me medication.

• We got a collection notice on a claim that was supposed to be covered at 100 percent as a diagnostic. The insurance company insisted that the claim was approved and paid. The lab company insisted they'd never been paid. I told each of them to talk to the other. In the meantime, it's on our record. How nice.

• Another claim was marked with a balance I know we don't owe. I called the lab, and they indicated payment had been made, but not for the full amount. I told them the EOB from the insurance company clearly shows the payment was reduced according to their network contract. They said, "Oh, sometimes they just send us a partial check without an explanation and so we assume that the remainder is the patient's responsibility." Nice try. You know very well what your contracted amount is, and you're hoping I'm a moron who looks at a scary bill and says, "Oh, I owe you more money! Here's a check."

• Another claim, this time from a lab company insisting they'd never been paid. Once again I pull the EOB, and it shows that the claim was approved at their network rate. Only... the system doesn't show the payment actually being made. Er, it was from March. Maybe my insurance company could get off their asses and write the check? So I have filed a claim inquiry with Insurance prodding them to pay the lab company. Problem: The lab company won't do any more tests until Insurance pays them. And Jim needs another round of blood tests. Argh.

• Finally, as most of you know, Jim recently had a delightful trip to the emergency room and subsequent hospital visits for fun CAT scans and MRIs. For the record, going to the ER with stroke symptoms and getting a CAT scan costs $3,898. For once I'll say thank God for insurance, because our copay is $250. Wait, did I just say thank God for a $250 bill?

Of course, every time you go to the hospital, the bill from the hospital is only part of the problem. There's also bills from the ER doctor, the radiologist, the lab tech, the specialist who evaluated your test... I'm pretty sure the guy who empties the trash also bills separately. All those are still pending, and if they are as competent as the blood lab or the mail-order pharmacy, I can expect a whole new slew of fights.

Then there's the ongoing saga of Babe Ruth, or whoever decided to swing a baseball bat at the back of my car a couple of weeks ago. The estimate is in, and it's nearly a grand. Again, insurance is a good thing, but our deductible is... wait for it... $250.

This comes on top of the FSAs running out of money at the end of the year, so our prescriptions and doctor visits have been on a cash basis since Halloween. And the saga of Jim's broken dentures, which will require their own insurance appeal because apparently they only cover dentures every five years and his snapped in half at 18 months. That's $1400 unless the insurance ponies up.

So in between fighting insurance companies and medical providers with questionable billing departments, I have to find at least $500 under the couch cushions before January comes and I have to find $160 for Boy's ACT prep class and his driver's ed fee of... wait for it... $250!

Merry Christmas?

Labels: ,

0 Comments:

Post a Comment

<< Home