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.