I suspect that my daughter and I are growing too costly and inconvenient for my health plan’s customer profile. They are genius (and stealthy) in their tactics to exhaust me financially, emotionally and physically. The company manuals must contain strategies for this, cleverly disguised as “working together.”
I have tried to be patient and cooperative. I pay the premiums for my top-tier PPO plan on time. I have accepted the fact I must cover a sizable deductible, copays, and coinsurance. It’s harder to swallow the exorbitant “out of pocket maximums” we are required to pay before a health plan will cover at 100%. Not many people hit that mark, and are likely bankrupt by then.
Looking at this logically, it was silly of me to believe the health plan when it said it wanted to help me or my family. After all, this is strictly business for the company, and businesses must make money. It’s nothing personal — unless we die.
I learned the hard way how to survive in this wild world. It entails reading the fine print, contending with confusing website portals, and enduring astonishingly long wait times while being serenaded by repetitive jazz when attempting to reach a live person.
Based on my decades-long journey, it appears that a health plan’s modus operandi is: When in doubt, deny. Unfortunately, at times I discover that a claim has been denied only after being contacted by a collections agency. Why? Because insurance approval or denial decisions can be delayed while providers are grilled for “more information” to justify their treatment plans, and bills deemed delinquent are routinely sent to collections.
Claims are typically rejected for one or more of these reasons:
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Preauthorization forms or superbills are not submitted properly.
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The facility or doctor is not in network.
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The treatment is not medically necessary. (That one is my all-time favorite.)
First, dealing with paperwork and shifting protocols during a crisis doesn’t help anyone’s well-being. This, coupled with the medical field’s reluctance to share digital files (citing privacy issues despite encryption solutions), means we are sent on a scavenger hunt for hard copies of our medical records, or must play digital hopscotch with external sites trying to transfer data into our insurance portals — which frequently malfunction. I believe these portals are programmed to crash multiple times a day. Once documents are submitted successfully, they aren’t always expedited to address urgent situations.
It’s mysterious how information I work so hard to obtain seems to vanish into black holes. During my quest for records from a hospital that failed to help my child, I had to revisit the scene of our trauma. Despite being sent to the wrong buildings twice, I persisted and asked another orderly for help. Without breaking stride, she rattled off complicated instructions. She might as well have directed me to follow the yellow brick road, veer left to pass a magic tree house, and then descend floating stairs, all while reciting Hail Marys and clicking my heels three times to reach the golden door.
Eventually, I found a dank basement office that matched my mood and the receptionist’s. I then faxed, emailed and even visited a local post office to ensure the copious paperwork reached a grievance coordinator.
Trying to call this aggrieved individual was even more challenging. As I cannot get the same person on the phone twice, I find myself reliving the darkest hours of my life repeatedly with each new person, who inevitably offers different instructions than the last.
One such encounter went like this:
Me: “Hi. I’m calling about my daughter’s ambulance and hospital charges. I haven’t been able to reach my grievance coordinator about the appeal.”
Representative: “I can help you.”
Me: (Genuinely excited.) “Great!”
Representative: “Oh, I see your daughter turned 18. I can’t discuss her information with you.”
Me: “I sent a release of information form by mail, fax and email. I also faxed our conservatorship papers.”
Representative: “I’m sorry, it’s not on file. What office did you send it to?”
Me: (I give the information.)
Representative: “That’s the wrong fax number. Let me give you the correct one.”
Me: “I’m not inventing numbers out of the ether. This is the third new fax number I’ve been given. Are the address and email inaccurate too?”
Representative: “I’m sorry, but I can’t discuss your daughter’s claims with you without this information. Can you put her on the phone to give verbal consent?”
Me: “I can’t put her on the phone. She’s currently in a treatment center and has no access to a phone, which is why I have a conservatorship to help with her medical care.”
Representative:My Health Insurance Company Is Trying To Kill Me
