Monday, January 27, 2014

How will Obama Care compare to traditional health care? Something has to change, I am stuck in an Insurance Nightmare right now...

Its Monday the start of a new week and even though I hate to say goodbye to the weekend I always enjoy the start of a new week. Its like a clean canvas, and you are the artist... What are you going to make of your week? I think my goal this week is to start my Valentines projects research. Which means I will be hitting Pinterest pretty hard this week.

This is also my week to hopefully get some medical insurance 'junk' squared away. You see the last 3 months I have been living in a medical insurance nightmare. To make matters worse about three weeks ago I was hit with another piece of insurance 'junk' and then this last Saturday I was thrown yet another blow... Let me explain...

Last August I made a trip to the ER. In case you were wondering some people have kidney stones, apparently I get stones in my ears...If you are wondering what it feels like, imagine trying to pass a kidney stone while dealing with Vertigo. It came on so fast, I honestly thought I was dying. Hubby and I had gotten up and made breakfast (I was feeling great), shortly after breakfast I told my hubby that something wasn't right. Everything was starting to move in slow motion. Within about 90 minutes I was completely down. Everything was spinning and it didn't matter if my eyes were open or closed. We made the decision to go to an Urgent Care (because nothing says its the weekend, like a trip to the Urgent Care) and the car ride almost did me in. When we walked (technically not sure you can classify it as walking, but I did make it through the door) in, the woman behind the counter immediately said, "You aren't feeling well, what do you need, a blanket, water, a bag?" If the room had not been spinning so horribly, and I could have seen her I would have probably tried to have a conversation with her. Instead in my sick stupor I think I said, "oh, I am o.k."...Ya, because healthy o.k. people are at the Urgent Care on Saturdays... Long story short, the Doctor was concerned that I was having a serious medical issue that warranted the ER. So, one shot to my 'Bum' and off to the Hospital we went. Prior to leaving the Urgent Care, we called our Insurance to make sure we went to an approved ER, and sure enough we were. So by the time we got to the Hospital the meds were starting to work. I was seen by Dr. McDreamy (I am sure it was the meds that made him look like Pierce Brosnan, but whatever) and was told that I was probably passing a stone in my ear. Here is the funny part, he also said if it worsens then I might actually be having a stroke... Really? Isn't there a way to figure that out now? There is, but that is another story. So Dr. Dreamy then proceeded to tell me I was Peri menopausal and fat... Somewhere around that moment he went from Dr. Dreamy to Dr. Jekyll...

Then October came and all of bills from that day started to roll in, all but his. His did not come till the very beginning of November. The bill was for the full amount, minus a community discount. Meaning this poor person has no insurance so we will throw them a bone and take off $40.00. Do they really think if someone does not have insurance, that a $40.00 discount will really help? Anyway, it didn't bother me because I figured they forgot to bill my insurance. I quickly called them and gave them my insurance information. Fast forward three months.... and probably 50 telephone calls between my insurance company and the company that the Doctor uses for billing later. The Doctor is still coming after me for a lot of money. The insurance company is saying that I saw an Out of Network Doctor. Here is where we enter the 'cat chasing its tale' part of the story. I went to an Approved In Network Hospital Emergency Room. Unfortunately the Emergency Room Doctor was Out Of Network. How in the world would I have ever known that. It is not as if you know who you are going to see once you are at the ER. If you ask me, if the ER is approved then EVERYONE who bills you once you are admitted should be approved. The Doctor is giving me until February 1 to pay, or they are turning it over to a collections agency. My insurance is telling me that they cut them a partial check, and that my Co-Pay is $15.15... and not to pay a dollar more. The Doctor is saying that they did receive a payment but that I still owe the remainder... The remainder is still Hundreds of Dollars. It has been a nightmare...

Then around three weeks ago I received a bill from a Laboratory we used when JayJay was sick back in December. Not just a little bill we are talking a $600 bill. Again I was not worried because it showed no Insurance status. So I called them up, and found out that they typed in her insurance number incorrectly. So I filed the incorrect bill and thought we were good, until I received the same bill last week. So I called them up and they told me that insurance was saying that JayJay was not eligible for insurance... WHAT?!?!?!!! After a few (try to keep your cool) phone calls we think the problem was that they were spelling her name wrong.. I am in the keeping my fingers crossed stage that we might have cleared that one up.

Now for the icing on the cake. Last Monday I called in Ademans prescription for his reflux. It is so very important that he takes this medicine, since he no longer has his feeding tube. Long story, just know that feeding Ademan is like walking a tight rope. So last week with all of the commotion of our dog Sammie becoming sick, I forgot to pick up his meds. So, Saturday when I realized we were on his last pill I called the Pharmacy to make sure that it was filled and still sitting on the shelf. That is when I was told that his insurance is denying it. WHAT?!?!?! He has been on this pill for at least a year, and now they are denying it? You should have heard the desperation in my voice when talking to the Pharmacist. We came up with an over the counter concoction until I can see his Doctor. I guess at that point we will have to find a new approved medication.

I am so over Insurance companies. I would love to say, well maybe we just have a bad Insurance company, but the sad thing is that my kids and I don't even have the same Insurance companies. Which tells me that this kind of stupidity is widespread throughout the Insurance industry.  I wonder how Obama Care will stack up against traditional Insurance. I will be upset if it ends up being hassle free for people. I wouldn't be upset for the people who can sign up for it. I will be upset that I can't since we are eligible for Insurance through work.

Anyway, that is what my Monday holds for me. Telephone calls that will probably cause my blood pressure to rise. At least I will have my Pinterest browsing to look forward to, and to help me calm down.

3 comments:

  1. Oh Meri, as tho you don't have enough on your plate. I used to work for a visiting nurse association. The billing is what drove everyone nuts. Has your insurance changed? As far as the ER doc, I agree. I just found this out myself. So it seems if you are dying and go to the ER, the first thing you have to ask the doc is: are you in or out of network. That is just nuts. Love, Aunt Linda

    ReplyDelete
  2. Our Insurance has been the same for two years. As for our kiddos they have State/Medicaid through Adoption support. They have had the same policies since they were in Foster Care. Our Insurance company has a policy that if you go to an In Network ER, but the Doctor is out of network, you will not have to pay. Unfortunately I am 3 months into begging them to pay up. I guess it goes through a third party who negotiates the final price and that is were the hang up is. I had my Monday call this morning and it is still not paid, not only that, it got bounced back to my Insurance company and has been sitting on someones desk since last week, not getting processed. So they resubmitted again today, and told me to call back on Friday. if it wasn't for the fact that it will hurt our credit if it goes to Collections, I would so who cares let it go....

    ReplyDelete

We Love Hearing From You!