Tuesday, April 27, 2010

Insurance Shminsurance

I think I would have better luck if I simply put all the money I pay towards premiums into a sock and then paid cash for Doctor visits and services.

After Susannah was born I called our insurance company and spoke with a customer service rep. (hereby called "lady #1"). I told her I'd just had a baby and needed to add her to my policy. I didn't know what all I needed to do so I asked the lady "What do I need to do to have her covered?" The lady said "send a fax requesting Susannah to be added to your policy." So I did.

After her next Dr. visit I received one of those nice "explanation of benefits" informing me that her well visit isn't covered under my policy. What!??! I called the Dr's office and they said that all her "sick" visits (weight checks) had been covered but her well visit had not. Weird. I don't like the sound of this. Not to mention that at her 8 week visit she'll get some shots and that Dr. visit will cost me $500-some if insurance won't cover it. YIKES!!

I call the insurance office. I speak with a different lady (now called "lady #2") and ask her what in the world is going on because I had added Susannah to my policy just like the lady said I needed to. Lo and behold, Susannah was added only as a "dependant." And as a dependant only sick visits are covered. Well visits and vaccines are not. As a dependant it costs me a whoppin' amount each month. To have her well visits covered I need to spend another $40 a month and add the Well Child Rider. I'm afraid I, uh, might've sounded a bit very upset on the phone when I learned all this. Lady #1 NEVER mentioned the Well Child Rider. I said as much to lady #2 and asked if there was any way it could be back-added to cover her visit. Nope. Not a chance. I have to pay for that visit out of my pocket. But she was very helpful (at least acted like it) and told me what I needed to do to add the Well Child Rider. I also talked to her in more detail about 2 claims that had been denied (for Susannah's newborn stuff at the hospital). She said she was going to call that Dr's office and get it straightened out for me. And she was going to call me back "next week" - which is now LAST WEEK.

Yesterday, having given her ALL WEEK to call me back like she said she would, I called and asked to speak to lady #2. I got her voicemail. I left her a nice (really, I was polite) message asking her to call me back to let me know what's going on with the 2 claims. Have I heard from her yet? Nope. Not a chance.

Today, having given her a nice grace period of 24 hours, I called again. Uh-oh, I got lady #1. The lady that didn't tell me about the Well Child Rider. I bit my tongue, as much as I wanted to let her know I didn't appreciate her costing me a Dr's visit of money. I was calm, cool and collected, and asked about the Well Child Rider. It had not been added to my policy. She didn't even see the fax I sent in the system anywhere. The fax # I'd sent it to was one of their fax numbers. So we agreed that I would re-fax the request, attention to lady #1 this time. Then I asked her about the 2 denied claims that lady #2 was supposed to call me about. She said the system showed the lady is "working on it" and "is going to call you about it."

I'm waiting by the phone waiting for it to ring any second. NOT.

So I faxed the original fax AGAIN, with a note on it that it was the second time I was faxing it, so on and so forth. Lady #1 said she was going to call me back if she didn't get it. The phone hasn't rung yet. I'm going to give her a day or two to get THAT straightened out and I'm going to call again. The squeaky wheel gets the grease, and this wheel's squeak is going to get a whole lot louder if I don't get some serious grease here soon.

This has been a recording. Thank you. Goodnight.


Candi said... [Reply to comment]

I really don't like insurance. I think it's because I don't really understand it. I know they pay for a great deal but there's a WHOLE BUNCH taken out of my hubby's check every week for insurance related things...oh well, hopefully you'll get it straightened out. Just keep notes about who you spoke to and when. That helps alot. (I used to do collections before mommyhood.)

Amanda said... [Reply to comment]

I agree that insurance is the worst thing to deal with. Luckily when I had my daughter in November, my work added her to my policy for me, so I didn't have to deal with all that rig-a-ma-roll...

Stay positive and know that it is just money and Susannah is worth every penny!

Meghan said... [Reply to comment]

Sounds like you are doing everything right and that is probably the most frustrating thing of all. Keep calling and hopefully you will get some answers maybe try speaking to a supervisor.

Cate said... [Reply to comment]

How infuriating!! I would definitely ask to speak to a supervisor if it isn't resolved soon (and maybe send the company a polite but firm letter naming names), since it's costing you money in the interim. So annoying!

gina said... [Reply to comment]

I don't know if your county does this but when my kids were little they got their shots at the Health Department. You just make a donation. It really helped and they are usually very nice Moms just like we are. Also, if you continue to have problems, you can contact the Division of Insurance for your state and report a problem. After that, they act pretty quickly! Sounds like you got scammed and I wouldn't let it go. Once, my then 3 year old daughter had a cattle panel fall on her. Her e-room visit was denied and when I called our company the receptionist told me "oh, they deny everything the first time, just make an appeal!" I did and they paid, but WHAT A SCAM THAT WAS!

Heather @ Fabulous Finds said... [Reply to comment]

I despise dealing with insurance, as it is never an easy process. Found you through another website. :)

A family at our Wits End... said... [Reply to comment]

Miriam, take her to the Health Department for immunizations! You have already paid for them with your tax dollars! The actual office visit when she is well shouldn't be more that $40 or $50, but the shots can be anywhere from $10- $80 each!!

Anonymous said... [Reply to comment]

i know the feeling. that is the beauty of ins. through work. i dont worry about anything anymore. i love it! but believe me before when we had our own ins. it was a monthly battle and took many hours on the phone a a few court summons!