Yesterday, the mail came early. It was not a good thing. There was a letter from my health insurance company in the stack of mail. I swallowed, took a breath, whispered a prayer that it wasn’t bad news, and opened the letter.
Of course, it was bad news. About three paragraphs into the letter, my insurance company announced they weren’t going to cover my recent surgery. My blood ran cold. Blue Cross claimed that there hadn’t been proper prior authorization. Now I broke out in a hot sweat. What had I missed? I’d made phone calls—I talked to the insurance company, the doctor’s office, I even talked to the hospital intake staff and each one verified that I was good to go. And now the insurance company said I wasn’t. (If I’d been five, I would’ve shouted, “Liar, liar, pants on fire!”)
I called the insurance company. A woman answered. I explained that I’d gotten a letter saying that Blue Cross refused to cover my surgery. Actually, it never said that. It only said that it refused to cover a recent procedure—I only guessed it was my surgery because of a date in the corner.
The “helpful” agent at Blue Cross reminded me that I signed paperwork before surgery making myself financially obligated should there be any payment problem. She asked me if I remembered that. “Um, yeah,” I said. This wasn’t going the way I’d hoped. So I explained my situation—that I’d double-checked everything. She put me on hold so she could read a copy of the letter that had been sent to me. I waited a long time.
When she came back, she said, “That was a very confusing letter. (Uh, yeah.) But one of your procedures wasn’t preauthorized, so we won’t cover it.”
I was stymied. I did sign paperwork right before I was wheeled into surgery. Maybe I shouldn’t have signed it? Maybe the “happy juice” they put in my IV made me lose my vigilance.
But the doctor didn’t know what I’d need until he started the surgery. I explained this to the BC agent. She murmured that it was too bad—to be fair, I think she was sincere. Sort of. She informed me that I could appeal Blue Cross’s decision. Blue Cross’s letter also told me that I could appeal. It also mentioned my right to consult a lawyer for help in crafting the appeal. (Gulp.)
Then, the agent mentioned that the doctor’s office could appeal because it was actually their fault because the missing paperwork could only be filed by the doctor’s office anyway. I had a moment of sunshine—I didn’t screw this up. It wasn’t my fault. We might have medical debt for the rest of our lives, but at least it wasn’t my fault. Still, I wasn’t sure when the doctor’s office was supposed to do this. I asked her, politely, if Blue Cross required doctors to call during the middle of surgeries to get prior approval if things turned out differently than expected. (I can see an interesting comedy skit developing from this.). She merely restated that either doctor’s office or I could appeal. Then, she said, “Have a nice day.”
So I called the doctor’s office, which, of course, was closed on Wednesdays. I left a message. I called again Thursday. They didn’t pick up. I left another message. Just when I thought that they might be avoiding me, the doctor’s office called. The woman in charge of billing talked to me. You know, sometimes it’s nice to talk to someone who knows what’s really going on and actually cares about you. She assured me that I had no financial obligations in this case. That the hospital blew it by not filing the paperwork and that she had been on them since the Friday afternoon when my surgery happened. (I’m guessing that the billing people were too eager to start their weekend.) She assured me that she’d deal with the insurance company—she explained how they work, which is not too different than what you see in The Incredibles. Finally, she assured me that she would take care of everything. I could almost hear her cracking her knuckles. And she even promised to call me when she had everything “taken care of.”
Thank you, insurance-billing-lady!!