If you don’t think healthcare in this country is messed up…..Posted: 2012/03/26 Filed under: Lovies | Tags: Health care, Health insurance, healthcare, Insurance, Patient Protection and Affordable Care Act 2 Comments
Today I am venting. If you don’t think healthcare in this country is effed up then just try using your insurance, you know that thing they take money out of every paycheck for, for anything other than a normal Dr. visit. Recently we started down the path of trying to find out if MiniMe has ADHD. In case you haven’t been keeping “in the know” on disorders lately, there is no longer ADD and ADHD. It’s all called ADHD now, with different sub types. Even though people, and doctors, still say ADD, it supposedly doesn’t really exist. ADD is the new ADHD inattentive sub-type, which is probably what we are doing battle with here in my house. My go to release of extreme frustration valve is to cry, and though I haven’t had a full on break down yet….it is totally coming. I was reduced to mild tears on the phone with my insurance agency today, this came after I was done politely yelling at them. I managed to not complete break down because the nice lady on the other agreed to try to “problem-solve” this with me. In a minute I will roll my eyes as I type that she was willing to problem solve their own screw up but first I have some previous examples of how badly screwed up trying to actually use your insurance and not go into the poor house truly is. It doesn’t seem to matter what kind of insurance you have either as Babu carries different insurance than the kids and I because his employer graciously provides it for free to all employees. I am not ungrateful for this, but it would be nice if it didn’t suck so badly. I carry the kids and I, and our rates are reasonable. Again I am grateful for this because lots of people have it worse off then we do. I can’t imagine how awful that must be for them because I am telling you right now it is pretty awful for us.
Healthcare in this country has put us, the consumer, at odds with not only the Dr’s who should be treating us, but also the insurance agencies who should be covering us. The Dr’s also like to blame the insurance agencies and vice versa, but neither of them are really interested in talking to each other to work anything out. NO….. if there is a problem or issue with the $$ or the ridiculously overcharged bill, they are coming to YOU, the consumer. The onus is on you, as the consumer to do your home work before you use the product, and then to fight battle on your own behalf should there be any disagreement. So you better not only look up that doc on the website, you better also call the 1-800 waits a long time to answer phone number and hope for a rep that is not a double douche bag to give you what you can only HOPE is good information.. Then, just to be sure you better call the Doc to triple verify that everything is in network and being done under the rules, and you should probably consider talking to not only the front office person, but also someone in billing/insurance/account receivable as well. It is a good thing that you make all these new friends as you are trying to simply set up an appointment, because after you actually use the services and no one can agree on how much you should pay or how much of of this applies to your yearly deductible/out of packet costs/ lifetime maximum you will be talking to them ALL over again while you try to get them to help you. Most of the time they will not actually help you without you nagging, and shoving documentation in their face, or begging them to please just call sally over at xyz because she swore she would help them work this all out for you. During this debacle you will continue to get bills and statements from the doc/hospital/specialist reminding you that their exorbitant sum is now 30/60/90/120 days past due. Sometimes they will even send you to collections when they have told you they were not because they KNOW there are errors/issues on your bills, but they will anyway. Then they will take their own sweet time notifying the collection agency that you’re cool. Meanwhile the collection agency will have already notified all 3 credit bureaus the millisecond the debt hits their books, but will not notify them that it is actually cool without written letters from you. Which they will take their own sweet time doing and you should probably go ahead and send those letters to the 3 credit bureaus yourself. Good luck waiting for those to come off. Yes Lovies, you can indeed go ahead and choose to pay the ridic $$ ahead to avoid some of these things, but really who has multiple thousands of dollars lying around for medical bills they aren’t supposed to have to pay? You have insurance right? You have a healthcare flex spending account right? Oh wait, that’s how we got here. Sometimes your employers insurance rep or HR will “help” you, Be prepared to nag the heck out of them too.
Some further examples of this….
When MiniMe was a baby, about 9 years ago or so, Babu had a bulging disc issue L4 or L5 . One morning he woke up and just couldn’t move. An MRI later Dr. Sausage fingers wanted to rush him into surgery and I flat out refused. The dude was this nasty obese man with huge sausage fat fingers. This was my husbands back and when I asked him in the consult what he thought about physical therapy first, his reply was “Well, you could try it, but it won’t work”. Dr. Sausage fingers apparently had an ex-wife or two to pay for because I put my foot down and forced Babu to go get a 2nd opinion. Guess what that 2nd set of Dr’s said. “Hey, most of the time we try physical therapy with this kind of thing BEFORE we operate.” Huh, go figure. So off to PT he went and we haven’t had a single issue until….. back in October Babu injured his back at the kids combined bounce place birthday party. I fell slightly guilty about this since I was the one who suggested all the parents bounce as well and tried to get as many of them as possible to do it. He could barely pull himself into the the van to get home and by later in the night he was in excruciating pain, the kind of pain where he didn’t even know if he could get up off the couch and get to the van to go to the ER. We went back and forth for a few hours over if he was going to go or not. I think we even tried calling his Dr, after I made him, and the on call Doc was like “well if he is in that much pain he needs to go to the ER”. I could write an entire other post on how screwed up trying to obtain and use pain meds when you are actually in pain vs. some drugged out pain med addicted loser junkie is in this country, but for the sake of time I’m leaving all of that nonsense out of this one. Maybe just file that away in your mind under, another reason healthcare in the country is screwed up. So we went to the ER, the on call doc did nothing but give him some meds and wait for him to be able to sit up and hobble out, told him to go to a Dr. and sent us on our way. Babu picked a new PCP, because his old was was worthless, went to a new appointment, got some meds and an authorization and referral to go get an epidural injection, which he did. And then the bills started coming in.
- The ER bill said out of network because of the location. ALL the other sites for Hospital V are in network, but not this one?
- The ER Doc said out of network, because Hosp V contracts with some other Doc service. I’m sorry do I have to ask every person I come into contact with at a facility to see if they are in network? It. is. the. ER. Insurance coded it as in network and put a $$ on the EOB. Doc group tried to tell Babu they don’t have to follow that because of thecontract and sometimes people can get a one time adjustment. WHAT??? Isn’t the EOB supposed to be the bible of what I pay?
- Injection got coded as out of network, b/c of the location. Anyone seeing a trend here? You can see DR A at place 1 and 2, but not place 3.
MiniMe has plantar warts. They are too big for her wonderful Doc to remove so we have to go to a dermatologist. Armed with 2 cards I looked up the names online and called the one I’ve been to for poison ivy and made an appointment. Front office person A, asked me if the doc’s were in my network. I said yes I looked them up online they are there. She asked me if I wanted to talk to billing. I said no, I looked them up on-line. Why is she arguing with me I wondered? She made the appointment for 3 weeks out and I hung up. Then I looked closer on-line, the practice has roughly 6-7 Docs, all of their names were on the on-line list, except the one we were given an appointment with. Really, that happened. I shoved it to the back of my mind for a week or so because I thought, my insurance company is not a bunch of d-bags like Babu’s. Maybe she is just new and hasn’t shown up yet, I’m sure it will be fine. I know I couldn’t just hope it was ok. I had to be sure. I called the insurance company only to find that the doc is not covered at that location, only at a different location. What? Yes, that happened. So I called the Doc’s office back and talked to a front office person. I told her the Doc was not covered at that location and I needed to switch to a doc that was. I’ll transfer you to finance and you can talk to them she says. NO>>>>>>>>> I’m not fighting this battle, we need to switch to a Doc I know is covered. So we did, only now instead of having clear feet next week MiniMe will be waiting another 4 weeks to get it taken care of. We are on the cancellation list.
The final straw…. A few week’s ago we finally bit the bullet and decided we would rule out ADHD for MiniMe. I called the Dr. and got them to fax me the forms, filled them out, had her teacher fill them out and took them in myself back to the Dr. the next day. Dr. called within 2 days to talk to me and said yes, she has ADD, here is what you need to do next so we can find out for sure what kind, how bad, is anything else going on etc. Frustration in our house is high over this situation. It is new, it is not fun, I’m glad we are finding an answer and I want to start her down a path of management and coping asap. Specialists, test, meds, Kumon, private tutoring, whatever it takes as soon as possible so she and we can all start to feel better. I initiated the school portion, it takes 50 school days. If it is going to be faster we are going to have to also attack it oursleves. So I called the 1-800 number on my insurance card and spoke to a very nice lady who gave me the few names and numbers that are in our network. She made a point to tell me we don’t have to pay for this very $$$$$$$$$$$$$ testing out of pocket, it should only cost me a co-pay per visit. That was a giant relief because we are still fighting the battles I listed above. I called 2 places and one was awesome. I loved the front office person, she was nice. They had a very formal and well laid out process. they have an appointment for within a week, she took time to explain the whole thing to me . We went and we loved it. The Doc was great, the office was great. She thinks it is probably just ADD and nothing else. MiniMe has to go through 4 hours of testing to be sure it isn’t anything else and I got her scheduled into that on Thursday with her follow up appt a short 2 weeks after that. Amen, Alleluia there is a light at the end of this tunnel. We could be starting on meds soon and if we are lucky the first one will do the trick. Except for one small problem. I went to check out and they wanted $250. No, My insurance sent us here, they said I only have to pay the co-pay. Then the billing person had to be fetched. We are out of network, she said. No you’re not I verified. They agreed to take the $40 co-pay and work it out with the insurance company. I’m not falling for that one, we have $1700 of testing scheduled for Thursday and I don’t want to fight that battle. I called the insurance company from the parking lot and guess what.. That Doc and that group are NOT IN MY NETWORK. I absolutely lost my socks
- I called, they put me on this path of care. This is frustrating
- Who is paying this doc $250 and for these tests b/c I’m not going to.
- You have now had me introduce my daughter to yet another new provider who isn’t going to be able to help her with a new and scary situation b/c you screwed up.
- I have wasted over a week of my time and her time and we are in a time sensitive crunch.
- Did I mention YOU GAVE ME THIS DOC’S NAME AND NUMBER WHEN I CALLED YOU FOR THE INFO!!!!!
At this point I am crying, not sobbing but I am breaking down. She tells me that we can brain storm together. That is mental health professional speak for shut up crazy lady but we both KNOW this placed screwed up and I fully plan on making them fix it. The lady tells me that maybe she can get a case-by-case basis contract deal worked up so MiniMe can get her tests and follow up visit. She makes sure I don’t want ongoing counseling, I agree we don’t need that. I just need to get my poor sweet child tested and into the right meds so she can focus and hopefully some other behavioral issues that come with this ADD package will get better too. But everyone is in a meeting this morning so it will be several hours before she can get me an answer.
I really am truly praying that answer is a good one because although I have calmed down a bit since inception a few hours ago, I really don’t know how much more stress I can take before I have the giant sobbing mental breakdown that is trying to work itself up inside of me. I know lots of people have it a lot worse than we do. Healthcare is our country is really effed up. I don’t have an answer, I haven’t seen anyone person come up with anything that resembles an answer and I don’t even dare hope for an answer in the foreseeable future. I guess we will simply hunker down here, continue to hoard cash for medical bills, spend way more time that we should have to managing these processes and screw ups and hope for the best.
03/27 Update: I heard from both the Dr. and the insurance today. They have worked out a single case agreement and will be covering what we already have in process under my normal insured benefits, which should be only the $20 co-pay…even for the tests. I’m very relieved and would like to state that this will hopefully turn out as an example of how people who care, can fix things for you because it is the right thing to do. Sometimes prayers are answered. 🙂
- Infuriation: Healthcare costs (20poorandfabulous.com)
- MLR is only the beginning of the end of private health insurance in America (medcitynews.com)
- Healthcare in Europe and beyond (internationalmanofmystery.typepad.com)
- The need for access to affordable healthcare for all (chronicrants.com)
Laura I am so sorry you are having to deal with this. Insurance sucks beyond the basics.
When I had my gallbladder out last year I had to go to urgent care and the ER because our PCP had no openings for a month. Then I had to schedule an emergency PCP appt (and the doc more than once told me I was not in his schedule for the day and he was on call and in a rush!) so I could schedule a surgery because the military doc get first dibs before I can contact an IN NETWORK provider for the same services that could be done much sooner.
We have had credit bureau issues for an MRI on my deceased child that had been rejected because there had to be a follow up letter stating that he died of natural causes not from intentional injury (WTF!). Oh the store I could tell and all the hours I will never get back from being on hold to figure out yet another glitch.
The best things I can tell you (which I know you know) are to document everything! Write down every person’s name, date and time you called them. I would also ask for you to be assigned a chronic illness case manager. That made our life so much better. There was one person who handled both of the boys’ care (and some of my stuff too!) and I held her accountable. These people are given a specific caseload and they deal with all the billing people at all of the locations you go to. You might have to fight for one but I know several people with private insurance (non military folks) that have also been given a case manager.
Good Luck, it sound like you are at least headed in the right direction!!!
OH dear. I feel for you. We have fought those same battles ourselves. The last thing you should have to deal with when you have a sick child (or sick anyone) who needs extensive healthcare is the redtape BS. I suggest you let me punch you right in the gut super hard so you can go ahead and have that knock-down, drag-out boo-hooing cry. You need that release. I also have a super fun book for Haley about ADHD & dogs. Nicolas loved it. 🙂