Friday, February 20, 2009

The awful truth

This is a typical occurrence following every. single. bloody. appointment. I've had thus far:

1) Letter from husband's insurance comes in the mail. Letter says as far as they know I have my own health insurance and to please provide them with further information. (I have called them and provided them with said information at least eight or nine times, and they have been covering my prescriptions without a question since last June, when my own health insurance was no more.)

2) I call the insurance company. I try not to be pissy and probably fail in tone of voice, but say please and thank you and have all my information conveniently at hand. I have to speak slowly and clearly into the clown's mouth to get routed to the proper agent, who may or may not route me to one or more agents or divisions, who may feign surprise, make reassuring yet noncommittal sounds I am convinced they send them to training specifically to learn, apologize, or not. It's a white-knuckle rollercoaster ride of fun and frolic, let me tell you! (Is this kind of unbridled excitement why people love to gamble? I like my money too much to ever let go of it long enough to find out.) I always wonder if I'm *really* being recorded or monitored for quality assurance.

3) Every single solitary time the claim I am calling about has been a covered service. I don't go to out-of-network providers; at least 95% of the time I check ahead of time that things are going to be covered.

Today's wrinkle is that they are trying to bill me for the psych eval that they required prior to this surgery. I specifically went to the only provider they covered at the wellness center because he was the one they covered; if I'd had my choice, I would have gone to a female practitioner, because that's just the way I roll.

So I call the behavioral/mental health division and tell them what's up. They tell me it's a medical claim because it's relating to the bariatric surgery. They also try to tell me the provider isn't in network, and I cut them off at the pass. They transfer me to the medical division.

The medical division listens to the situation and tries to send me back to behavioral/mental health and I say no, this evaluation was ONLY performed because it was a required step prior to bariatric surgery. They hem and haw, put me on hold to research it, and then come back on and say they will have to research it further and then call me back. So now I get to wait for them to call me back.

(Fittingly, I bought a copy of Michael Moore's movie "Sicko" the other day; I am a big fan of his films in general, but have a feeling this one's going to be my favorite. I will never forget when he had his TV show "The Awful Truth" on Bravo--the most memorable episode for me featured a man--the father of a small child, and he may have been her only surviving parent, if I recall correctly--whose health insurance provider refused to pay for an organ transplant that would save the man's life. Moore staged an elaborate mock funeral for the man on the lawn of corporate headquarters, complete with casket, pallbearers, the works. Following this, the insurance company paid for the gentleman's transplant.)

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This blog focuses largely on a personal journey to and through weight-loss surgery. It's also about reading, writing, animals, photography, love, humor, music, thinking out loud, and memes. In other
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