Thursday, September 4, 2008

Tilting at Windmills

It seems that I am now about to begin the life lesson of HOW TO DEAL WITH INSURANCE COMPANIES WITHOUT ANYONE GETTING HURT. (including me)

Cue the ominous music now. Dun....dun...dun.

I had assumed, incorrectly it appears, that I would be just fine without this life lesson. Guess again, Missy.

I think I had mentioned before that I have been receiving Explanation of Benefit(EOB) papers from my insurance company. So far I have received about 40- 50 of such good tidings of great joy. Typically it reads something like this:

Amount billed $850.00
Contracted savings: $350.00
Check sent $500.00
My responsibility $0.00.

I like that last part the best, my part ZIP, Zilch, Nada, Nothing. Each EOB varies in the amount billed and saved, but the bottom line is always me owning ZERO. Very exhilarating news. So far, only one of these forms has told me that I owe a $25 co-pay for the emergency room visit. I can afford that just fine. No problem.

Last week I received an EOB for Jared's appendectomy, and it went something like this:

Total Billed: $1847.00
Contracted savings: $0.00
Check sent: $1300.00
My responsibility: $547.00

PROBLEM. Hard as it may be to imagine, I was not impressed with this missive of ill will. Sure I should be happy that they paid the $1300, but I was not suppose to owe anything. Remember the concept of ZIP, ZILCH, NADA, NOTHING!!!!!

Being the assertive person that I am, I sweetly called my insurance company and inquired into this unsettling piece of intelligence.

After sucking away ten minutes of my life on hold, a live person asked what she could do to help me. I told her of my plight and she informed me that the particular doctor who did the surgery is not a "contracted doctor" with my insurance company.

EXCUSE ME!!! I almost dropped the phone. I was dumb founded. I asked her what did she mean by such talk. She replied, that yes it was true, I would have to take up the discrepancy with the doctor in question, and no she did not have the phone number.

I, of course thinking that health insurance should make sense, asked how I could get a non-contracted doctor at my contracted hospital. She at least had the decency to say she was sorry to have to tell me that I should have had the sense to ask the doctor if she was contracted. So let me get this right, as my son was being wheeled into surgery, I was suppose to say "Hey, excuse me Doc, I know that my son's medical condition is life threatening, and I have come to my contracted hospital, but is there any chance that you are not contracted with my health insurance. Oh, no you're not, well then let my kid suffer and perhaps die while we find someone who is contracted." Are you kidding me? Well, silly me, who missed the seminar on "How to navigate the ridiculousness of health insurance 101"

So her only advice to me was to contact the doctor. I used my handy dandy computer skills and googled said doctor. Found a phone number. Called it, only to be told that the doctor in question did not work at that office. Not only that, according to the office person on the phone, they think my appendix removing doctor is very unprofessional, and they are sick of getting calls from her patients wasting all of their precious time, and no they don't know her phone number because they are not going to do anything to help this lousy doctor out. Well, good day then.

So now I must wait for the bill to come in the mail from said doctor. When it does I will be discussing with the real office the fact that I am not inclined to pay them. Maybe they are so disorganized that the bill will never come. Somehow, I imagine collecting money may be the one area in which they excel in follow through. Unfortunately, if I refuse to pay, I think they may be able to send the bill to collections and report me to the credit people and ruin my fico score. Sounds something like extortion, doesn't it?

My biggest complaint is not only do I not think I owe them $547, I think they owe me a healthy appendix. What do they have to say about that, huh? It was removed unnecessarily as in he didn't need it taken out.

So if they think this is over, they are so wrong about that. They may find out that I have taken up the cause to right this injustice just like Don Quixote took up windmill jousting. And I may have similar success, namely disillusionment and death, but perhaps it will result in some adventures worth writing about, so it will not be in vain.


The Webber's said...

Wow! If your insurance company covers everything that is really good. I hope you get that worked out about the Dr! Insurance companies are a pain - Darren has been denied for EVERY insurance he has applied for, including disability and life, because of a disease he DOES NOT have, since he was misdiagnosed!!! It is SO frustrating!!! Now that Darren works we have to have our own private insurance and it is super expensive and doesn't cover much! What a pain! Good luck - Darren now has to deal with getting money from insurance companies and it is a pain!

Pat said...

Goodness Brooke, maybe I shouldn't complain so much. That sounds horrible.

Jennifer Lynn Hammond said...

As we know (well, you know if you've seen A Knight's Tale)...
"Tilting when you should withdraw is knightly..." so here's to insurance wars and winning or even losing the battle. Yes, unfortunately I recently lost an insurance battle over "baby" bills I was told I didn't owe and then 5 months later with more bills added in there they decided I did owe them... Yeah a word to anyone who is pregnant- DON'T MOVE after you've started seeing a Dr. ;^)
I do sincerely wish you the best of luck with that bill though Pat- Yikes!

April said...

I think they recently changed the laws on having it effect your fico score....may want to do some research on that if you ever have the time (I know HAHAHAHA HAAAAARRRR time??? what is THAT!?)

I don't think medical can hit Fico anymore... just a thought. Not sure if I'm right though.

Kris said...

I did read something about it not hitting FICO scores too. I think that you should be able to win this one with luck. I won a battle with the insurance agency, so that they had to pay $800 for an asistant surgan when Michael was born. C-sections require an assistant by law. My Doc gave me a copy of the law and I had to send it to them.

Maybe you could call the hospital and have them explain why they allow uncontracted Drs to opperate on poor defensless kids?

Pat said...

Kris and April, that is comforting to think that it would not affect my FICO score. Honestly it is the least of my worries right now, but some day I am sure I will care about such things again.

And yes I will be calling the hospital and asking the question of how could they do this to unsustpection people.