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Customer Service is Dead – Installment #2 (Part 1)

October 2, 2007

We have pretty good insurance. In today’s world, you really have to, just to get by. It’s so important that when I shop for employment, I do so primarily by the kind of insurance I’ll end up with, rather than the old salary standby of days past. My current position ended up providing me with both, so I generally feel blessed. Our family NEEDS insurance. We’re not the 30-something’s with a kid or two, primarily healthy, just the basics, preventative medicine kind of folk. No, no, no.

My hubby alone has enough issues and ailments to bankrupt us in 30 days flat, with no insurance. And the kiddos? They seem to break something, swallow something, bang something, clobber something, inhale something, or become allergic to something with the regularity of underwear changing. We’re on a first-name basis with the ER, the Urgent Care, the pediatrician, the allergist, the therapist, and our regular old family doc. Thank God for good insurance. That’s all I can say.

So back in May we had the youngest tested for allergies. He’s done the skin-test routine before. He’s been on (insert strong inhaled steroid here) before. He’s taken allergy meds, decongestants, inhalers of all shapes and sizes. He’s run the gamut of all things that can be done for a kid with tender lungs. He had RSV as a very little one and his lungs have never recovered. For several years, he went to the hospital annually, like clockwork, with pneumonia. Our goal in life has been to get his asthma and reactive airway issues under control. It’s a big deal. Blue lips and coughing until you puke are NOT fun.

Our current allergist suggested that we put the young one on allergy shots, in the hope of increasing his tolerance to the seasonal junk that seems to float around and irritate his lungs. We thought it was a stellar idea. We seconded that motion when the eldest stepdaughter tested positive for multiple allergens as well. Even better? Our insurance company would cover those shots at 100%. No copay.

No copay? It was as if the heavens themselves had opened and the angels were singing. For a family already paying 1 billion copays per week for allergy meds, well-checks, therapy appointments, glasses, dental work, strep throat, tonsillitis, and every other thing on the planet, it was like a gift… wrapped up with a pretty bow.

That very week we started shots. That was in July. Both kiddos have received approximately two shots per week since then–sometimes more, sometimes less because, you know, their Egg Donor refuses to EVER take them to anything. Regardless, it has now been a LOT of shots received, all with the pretty, wrapped gift of no copay. Imagine my shock when the bill from our provider showed up and suddenly we owe a copay for every single time they’ve received a shot since July. Even at just $15 (which is pretty good) it added up fast. Four visits per week at $15 is $60. Four weeks in a month for 3 months now and we already owe around $700.

Yikes!

I almost passed out. I went through all of the normal stages… denial, anger, and the rest. Then I just decided I would call the billing folks the next morning and straighten this whole ugly thing out. I mean, really, with as much as we’re forking over to our attorney for court, $700 is just NOT possible. And the allergist’s office checked with our insurance company before we ever started allergy shots. And we’ve been doing them now for three months. How is it possible that they’re just now billing us for all of these copays? It smacked of a simple bookkeeping error to me.

The next morning I called. I got Cindy on the phone. Cindy sounded like she just hadn’t had a cup of coffee yet. She didn’t quite understand what it was that I was saying. To give her the benefit of the doubt, I was driving to work, calling on my cell phone, and it’s entirely possible that there was road noise, or static or something. But I really thought the issue was quite simple.

“Did you call your insurance company?” she asked in a tone that sounded knowingly annoyed.

“No, I sure didn’t,” I replied. “I thought that this had all been verified by the doctor’s office on the front end.”

“Yes, well…,” she responded, in the nasally tone to which I’m unfortunately becoming accustomed, “it’s not actually set in stone until the benefits are paid out. If they changed their policy in between now and then there’s not much I can do.”

I asked if she could possibly call the insurance company. It is my perception, although perhaps it’s a flawed perception, that it is the job of these billing folks to act as the liaison between the doctor’s office and the insurance company–to get the doctor his cash and stick the patient for the least amount possible, since said patient is covered under the aforementioned insurance. She grudgingly agreed to call the insurance company and actually took the time to jot down my work number so she could call me back after she had resolved more pressing matters (I guess). I then asked if she could also call Jennifer, the very nice gal at the doctor’s office who had initially gotten this whole “no copay” info from my insurance company.

“I don’t know what good THAT would do,” she said, with a huff and a sigh.

I explained that perhaps Jennifer had maintained some notes on the person that had approved the “no copay” thing–like maybe the procedure code, or other information that might help us resolve this little issue.

“Well, if I get a no from the insurance company, then I’ll call Jennifer,” she said. “But I can’t guarantee anything. You’ll probably end up calling them yourself.”

To Be Continued…

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4 Comments leave one →
  1. October 3, 2007 7:25 am

    This ranks in my top two or three instant high blood pressure, steel band around the forhead, road rage kinds of infuriating issues to deal with. How do you do it, girl?

  2. October 3, 2007 9:29 am

    Wow – I’m shocked there would be no co-pay. That’s just unheard of. I think Jennifer made a mistake and now you’re getting stuck with the bill. We have Anthem BCBS and our copays are like $15 for our GP and $30 for Specialists. Check your card — it might have a separate amount for Specialists (well, obviously, $15 per your post!). I think Jennifer misled you — even in an HMO there are office copays (especially for specialists).

    We’ve also had our share of medical nightmares with Ruby’s growth hormone issue. It is incredibly frustrating. But once you can navigate the waters of our American Health Care system you’ll find smooth sailing.

    Hope things get better and they’ll work with you on the copay issue.

  3. tulips4me permalink
    October 3, 2007 10:26 am

    In many cases, there is no co-pay for the injection, but you get hit with a co-pay for the office visit that is required to administer the injection.

  4. October 3, 2007 2:50 pm

    Grrrrrrrrrrr…….indeed!

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