With all the joys that come in having children, the silver lining is, of course, dealing with the insurance company. After having a premature baby, we hoped our last concern would be how to pay for his care. instead many quite hilarious situations have entailed in our insurance dealings.
Firstly, we received a bill shortly after this whole experience for the transportation of our son from the hospital he was born in, to the children's hospital where he was being cared for. This bill was near $1,000, and the note on the bill said our insurance had denied coverage because it was not a medical necessity. So, I guess it really was our fault that we didn't try to plug the incubator into the cigarette lighter of our car first. Since, it has been appealed and covered.
Since our plan is a bargain plan that they give to college students, they expect that we first go to the on campus health center for all our health needs. Since we lived in a different state than the university at the time this happened, we hardly had a choice to go to the health center. So we are being held accountable for not buying an expensive plane ticket across the country every time we needed to take our son to the doctor, which was a lot.
Especially in the topic of immunizations, we needed to get them at the pediatrician's office. Then we were told they weren't covered because they weren't given at the on campus health center. So, now we have moved back on campus and I took my son to the school health center for him to get updated on his shots. Would you believe that they don't even give immunizations at the health center?
So, I asked the insurance company if they ever actually communicate with the health center before they write their policies. So you understand that we are paying out of our pocket because we didn't go where the insurance wanted us to go get his shots, when they don't even give shots anyway. Are you appreciating the hilarity of this ignorance? I hope so.
Another conundrum follows a pretty substantial bill we received from the Neonatal doctor's office that saw my son daily in the NICU at the hospital. We talked with the insurance when this first happened and they assured us that the hospital was covered and would be no problem. So why did we get a bill for the doctor that treated him there?
Apparently they cover the hospital, but not the doctors that work there. Because it is an option to go to the hospital without seeing a doctor. That totally defeats the purpose of going to the hospital doesn't it? So, I'm at a loss to how this policy makes any sense.
It is naturally being appealed for the lack of sense it makes along with the lack of options we had once he was admitted into the hospital. Especially since I was still in the hospital when he was admitted. A small band was put on his ankle as a safety precaution that kept us or anyone else from taking the baby even to the elevators. Aside from those excuses, we wanted the best care our three pound son who needed help with the simple task of breathing without having a second thought about what the insurance was going to do.
The insurance company must employ a man somewhere in their crevices that has never been to the doctor in his life, and he is the one assigned to write the policies of how it is to be done. It seems that all the employees at these companies must miraculously be free from needing any sort of medical attention, or else they would be more aware of the problems that exist in their policy. No wonder it was frequently a topic of debate for our last election.
Luckily, the insurance company has people in it that also see the problems in the system and are trying to help. The key is to find those people and ask if they will personally help you in all your claims for the future. Get their personal extensions and emails so that you don't have to deal with the phone center customer service know-nothings that will just hand you the standardized statements of policy. I have found this to be useful.
Their is always an appeals process to anything going on that you know is incorrect, so don't be intimidated to use your rights as their client. Before you pay a bill, contact the insurance so they can check the system and insure they have done all they are required to do for that particular claim. Then, check again with the doctor's bills to keep them from charging you over the agreed rate they made with your insurance, without you knowing it. Make note of things the insurance company tells you so that if it comes to a misunderstanding, you have a clear recollection of what you were told.
In reality these are just people doing a job, and it might help them if we show them how they can improve. It is just a fact that dealing with the insurance is part of getting healthcare. The only way to avoid it, well, don't get sick.
Firstly, we received a bill shortly after this whole experience for the transportation of our son from the hospital he was born in, to the children's hospital where he was being cared for. This bill was near $1,000, and the note on the bill said our insurance had denied coverage because it was not a medical necessity. So, I guess it really was our fault that we didn't try to plug the incubator into the cigarette lighter of our car first. Since, it has been appealed and covered.
Since our plan is a bargain plan that they give to college students, they expect that we first go to the on campus health center for all our health needs. Since we lived in a different state than the university at the time this happened, we hardly had a choice to go to the health center. So we are being held accountable for not buying an expensive plane ticket across the country every time we needed to take our son to the doctor, which was a lot.
Especially in the topic of immunizations, we needed to get them at the pediatrician's office. Then we were told they weren't covered because they weren't given at the on campus health center. So, now we have moved back on campus and I took my son to the school health center for him to get updated on his shots. Would you believe that they don't even give immunizations at the health center?
So, I asked the insurance company if they ever actually communicate with the health center before they write their policies. So you understand that we are paying out of our pocket because we didn't go where the insurance wanted us to go get his shots, when they don't even give shots anyway. Are you appreciating the hilarity of this ignorance? I hope so.
Another conundrum follows a pretty substantial bill we received from the Neonatal doctor's office that saw my son daily in the NICU at the hospital. We talked with the insurance when this first happened and they assured us that the hospital was covered and would be no problem. So why did we get a bill for the doctor that treated him there?
Apparently they cover the hospital, but not the doctors that work there. Because it is an option to go to the hospital without seeing a doctor. That totally defeats the purpose of going to the hospital doesn't it? So, I'm at a loss to how this policy makes any sense.
It is naturally being appealed for the lack of sense it makes along with the lack of options we had once he was admitted into the hospital. Especially since I was still in the hospital when he was admitted. A small band was put on his ankle as a safety precaution that kept us or anyone else from taking the baby even to the elevators. Aside from those excuses, we wanted the best care our three pound son who needed help with the simple task of breathing without having a second thought about what the insurance was going to do.
The insurance company must employ a man somewhere in their crevices that has never been to the doctor in his life, and he is the one assigned to write the policies of how it is to be done. It seems that all the employees at these companies must miraculously be free from needing any sort of medical attention, or else they would be more aware of the problems that exist in their policy. No wonder it was frequently a topic of debate for our last election.
Luckily, the insurance company has people in it that also see the problems in the system and are trying to help. The key is to find those people and ask if they will personally help you in all your claims for the future. Get their personal extensions and emails so that you don't have to deal with the phone center customer service know-nothings that will just hand you the standardized statements of policy. I have found this to be useful.
Their is always an appeals process to anything going on that you know is incorrect, so don't be intimidated to use your rights as their client. Before you pay a bill, contact the insurance so they can check the system and insure they have done all they are required to do for that particular claim. Then, check again with the doctor's bills to keep them from charging you over the agreed rate they made with your insurance, without you knowing it. Make note of things the insurance company tells you so that if it comes to a misunderstanding, you have a clear recollection of what you were told.
In reality these are just people doing a job, and it might help them if we show them how they can improve. It is just a fact that dealing with the insurance is part of getting healthcare. The only way to avoid it, well, don't get sick.
About the Author:
Haylee Landford is the mother of a premature baby with another on the way. She frequently writes articles for Land For Sale as a guest author.
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