I know I should not complain. My children, and myself to some extent, are lucky. Their father works for the state and he is required to carry health insurance on them. State plans, while not cheap, are very good as far as coverage. Yet, I have a love-hate relationship with health insurance. Here is my most recent hate experience.
Number 5 went to Florida in January with his college swimming and diving team for training. This is a normal occurrence with a lot of college teams. When he got home, he was having knee issues and pain. Rather than screw around at college – we had tried that when he hit the diving board in October – I sent one of the older kids to get him the day after the team returned and managed to get him into the doctor’s here. He has had a small meniscal tear previously so we don’t usually mess around with knee issues. While he could not get into the orthopedist we see, the hospital his Primary Care Provider is part of could do an MRI the next day and he could be back at school in time for the next team meeting.
Now comes the fun part! (How do we type in sarcasm as that is the tone I would be using if I were talking to you face-to-face?)
First, I get two bills from the group that read the MRI. One is for $32 and the other a little over $200. Now, I will tell you that the MRI was pre-approved by the insurance company as all items like this have to be. I know that the approval part is important and also difficult as we had issues with it and #2 when he had appendicitis while at college. I knew that there would be some issue but was unsure what these issues would be with the MRI as they seldom go through insurance without a hitch. Then, came the big letter from the hospital. It stated that the claim had come back from the insurance company and they – the insurance company – needed additional information. The hospital would resubmit in ten days so contact your insurance company promptly as you may be responsible for the entire bill if not taken care of. The total of this bill – $2,501.00.
I called the toll-free number on the back of the insurance card. Little did I know they had actual office hours and I was calling in the evening and no one could help me. Because the phone answering system is automated, this call took almost 10 minutes to get to the part where I was being transferred to a person and then told said person was not there as it was outside office hours.
The next morning I picked up the phone again. Clarisse was very helpful. I had the wrong option. Hospital charges were administered by Blue Cross and I had the United Healthcare portion of the company. She did check and manage to tell me that they also needed additional information to pay the bills for reading the MRI. I took down what could be sent in to verify that #5 is indeed a full-time college student. Without telling subscribers, this particular state plan has suddenly changed to wanting this verification per semester as opposed to per year. Since we didn’t realize that, the kids’ dad had not done it again in January. No small overlook since we currently have three full-time students over the age of 19.
Clarisse transfers me to Blue Cross where a representative tells me that the hospital has not only received payment but said payment has cleared. Now, I am getting testy – not with these people but with the local hospital as I have now spent a total of almost an hour on the phone only to find out there was not truly a problem, at least not the problem about which they wrote me.
To make matters better, I received an email today from the ex. The claim – which was awaiting information regarding #5’s student status – was also paid out several days ago as he just received the Explanation of Benefits.
While I am not necessarily a fan of what is going on in Washington at the moment, I am 100% sure that something has to be done to improve the way health insurance functions in our country. I happened to have the time during the day to go through this red tape. Many people would not as an employer would not allow that time on the company dime. This is not the way to run an industry that is 100% necessary!
Nicki's Nook 
Nikki,
My husband thinks all the fat cats in Washington should lose their health insurance until they pass the bill. This will speed things up and ensure the health care will be something suitable for them as well as average American people!
People in NY have been saying the way to fix our state government is to get rid of everyone there. Unfortunately, it never carries through to the ballot box – ooops, voting machine. I think that something like that may work. Hopefully, something will give soon.
Nicki, I share your frustration and I worked as a bodily injury auto adjuster for 18 years! I know insurance inside and out but my health insurer sends me EOBs that are so obscure that I can’t figure out what they mean, and I’ve been trained in EOBs! Or they’ll pay a bill, then reverse a payment and then reverse their reversal! So I have to be sure and not call when I get the reversal, remembering to wait for the reversal of the reversal so I, too, don’t waste my time!
Insane.
And one thing about that MRI bill of your son’s. The hospital was about to ask you for $2500 but I guarantee you that your insurance company paid them about $600-800 for it, a discount not available to you if you had to pay it yourself.
Linda – that is so odd. I have never had a letter like the one from the hospital come before this. I called the hospital after getting off the phone with the insurance company. I told them that they had the money so why did I receive the letter. “Must have crossed in the mail.”