Insurance Woes

Posted on February 25, 2009 @ 2:29 am
by Haylee Landford

Nothing compares to having your first child and sharing in all the joy that comes with it, that is nothing except starting your dealings with the insurance company. In the cases of premature babies, the last thing on your mind in the payment of medical bills. Regardless, let me share with you what comedy has occurred since we have began our relationship with our insurance policy.

Firstly, we received a bill shortly after this whole experience for the transportation of our son from the hospital he was born in, to the children’s hospital where he was being cared for. This bill was near $1,000, and the note on the bill said our insurance had denied coverage because it was not a medical necessity. So, I guess it really was our fault that we didn’t try to plug the incubator into the cigarette lighter of our car first. Since, it has been appealed and covered.

Since we are students on the university plan, we are required to first see our on campus health center for all our doctor’s needs. My son was born in a different state, and so it really wasn’t an option to go to their health center. Perhaps we could have flown our son to the health center for all his many doctor’s appointments, but even that would have been more expensive than the doctor’s bills we now have to pay out of pocket for because he wasn’t treated at the health center.

Especially in the topic of immunizations, we needed to get them at the pediatrician’s office. Then we were told they weren’t covered because they weren’t given at the on campus health center. So, now we have moved back on campus and I took my son to the school health center for him to get updated on his shots. Would you believe that they don’t even give immunizations at the health center?

So, the insurance company obviously writes their policies without ever communicating with the health center. We are held responsible for not going to the health center for services that they don’t even offer. Is this as funny to you and it is to me? Good.

Another conundrum follows a pretty substantial bill we received from the Neonatal doctor’s office that saw my son daily in the NICU at the hospital. We talked with the insurance when this first happened and they assured us that the hospital was covered and would be no problem. So why did we get a bill for the doctor that treated him there?

It seems that the doctors that worked in the hospital weren’t covered, even though the hospital is covered. I forgot that it wasn’t important to see a doctor while you were in the hospital and should have opted for my son to not be seen by them. What’s the point of going to the hospital without seeing a doctor? I don’t see how this works.

It is also being appealed on account of the policy making no sense, along with the complete lack of control we had in the doctors seeing our son anyway. My son went to the hospital while I was still in the hospital myself. Then they put a safety device on his ankle that prohibits anyone from taking him even as far as the elevator without being arrested. Plus who would say, please don’t take care of my three pound son that can’t even breath by himself because there’s a chance the insurance won’t cover it.

The insurance company must employ a man somewhere in their crevices that has never been to the doctor in his life, and he is the one assigned to write the policies of how it is to be done. It seems that all the employees at these companies must miraculously be free from needing any sort of medical attention, or else they would be more aware of the problems that exist in their policy. No wonder it was frequently a topic of debate for our last election.

Believe it or not, there are people we found within the insurance company with a knowledge of their flaws and a desire to help. So, when you do finally meet these people, it would be wise to ask them if they could personally assist you in all your further claims. Maybe if it feels appropriate, even get their email and extension so you can get directly to them without wasting time with the call center ignoramuses that got the job because they can read a prompt. That is the mostly useful advice I can give.

Their is always an appeals process to anything going on that you know is incorrect, so don’t be intimidated to use your rights as their client. Before you pay a bill, contact the insurance so they can check the system and insure they have done all they are required to do for that particular claim. Then, check again with the doctor’s bills to keep them from charging you over the agreed rate they made with your insurance, without you knowing it. Make note of things the insurance company tells you so that if it comes to a misunderstanding, you have a clear recollection of what you were told.

What it comes down to is that these people are trying to do their job, and we can help them know how to improve in it. It can’t be helped dealing with this in order for us to have healthcare, so all you can do is take a deep breath when you are frustrated. The best way to avoid these problems, just don’t get sick, and you’ll be fine.

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