Monday, March 27, 2006

The Biggest Scam Going

Health Insurance (which is an oxy-moron, if you ask me.)

So, I've been having insurance issues for several months now. I changed jobs back in October, and thus changed insurance providers (of course). Once I received my new insurance cards, I called my girly-doctor to make sure that they took my new insurance and to schedule my annual exam. They assured me that yes, indeed, they took my insurance, and I made an appointment for 6 weeks away (the earliest she could see me--after all, her priority appts. go to the preggos, which is fine with me). The was late Nov., the week after Thanksgiving. I go, everything's cool, I pay my co-pay, and even have some lab work done. I get the Explanation of Benefits (EOB) for what I think is my exam, but what turns out to be my lab work. No biggie, it does not surprise me that the hospital my Dr. is affiliated with is slower than the private lab they send everything to.

So then I get an EOB in January from my OLD insurance, stating that they did not pay the $265 because I was no longer covered by them. Duh! Still haven't gotten an EOB from my new insurance for my exam, and then I get a bill from my Dr. in the amount of $265. I realize what has happened....my Dr.'s office (and the extremely competent people that work there....note the sarcasm) filed the claim with the wrong insurance, even though I gave them my new card and information, and they even have it on file! I call the dr.'s office to clear it up, and the lady said they would promptly file with my correct insurance, so don't pay the bill you just got. Great, I wasn't planning on it anyway!

Fast forward to last week, when I finally receive the EOB from my NEW insurance (confusing, isn't it?), stating that my dr. is out-of-network and they won't cover my $265 bill, but that it will apply to my deductible. MWHA? This can not be the case! I have a strict In-Network-Only policy (luckily I don't really have an special doctor's I have to go to and I'm not really that picky), so if, when I called my dr. back in the fall, I was told that she was not in-network, I would have simply changed doctors. So I call the insurance company today, and sure enough it was listed as out-of-network. I assured the woman with the insurance company that my doctor was in-network, I even looked up her status today on the provider's website. She was very polite, said she would place an inquiry with the plan provider and call me back this afternoon with more information. (I still don't understand how you can have a plan administrator, who I called today, that is different from the plan provider, the people who actually pay your doctor when a claim is filed. It's all very strange to me, and seems like an absolute waste of time, paper, trees, people, and money. But anyway....) I appreciate her responsiveness, but still. I am going to be really pissed if my dr.'s 'network status' changed and the website just isn't updated. Because then I have to pay $265 for an exam that is completely routine and falls under the category of 'Annual Physical,' which my insurance clearly covers under their policy statement. Provided I'm In-Network. URG!!!!!

Health Insurance is a SCAM!!! Dealing with it is enough to drive you to the mental institution! Which, of course, isn't covered under your plan.

3 comments:

Wes Raine said...

And yet some people still insist that if the government ran health care it would be better! If a private company has this much red tape can you imagine if you put it into the hands of professional bureaucrats?!?

Eddie said...

Ugh. Just ugh. This sucks--sorry you have to go through it!

Bubba's Sis said...

You are so right - insurance is a racket!! Keep fighting them - you'll come out ahead!