Five Things I've Learned

In the last six months, I’ve spent a lot of time in doctor’s offices and hospitals. Here’s what I’ve learned.

1. Bring a snack. Bring your patience. And bring a Kindle full of books. Our longest wait was 90 minutes past the appointment time. And then, the insurance billed for an extra-long appointment when we only saw the doctor for 10 minutes max.

2. Layers of clothing. Some rooms are sweltering. Others are icy. One nurse greeted us with blankets and said, “It’s freezing down here and we have no control over the thermostat.” I was thankful I wasn’t the one in a cotton gown.

3. Go to graduate school in math. All the doctors oooh and aaah when they find a patient doing math in grad school—they treat you like they are caring for a brain trust. No one cares when you have a degree in English.

4. University Hospital Parking. Don’t bother looking for a space in level one or two or even six—it’s not worth the time. Head straight for the roof. Be patient with people in front of you who haven’t learned this rule and so waste fifteen minutes meandering through the parking structure while a line of ten cars stretches out behind them. (Also find out who’s the architect for these things and demand that they make it possible to jet straight to the top.)

5. Maintain a well-controlled sense of humor. The doctors and nurses aren’t out to get you—that’s the insurance company’s job. And when you call the insurance company and talk to a rep who says, “I’m so sorry. But I want you to know that we aren’t evil,” don’t laugh.

Image courtesy of Wikimedia Commons.

It's Never Good When the Mail Comes Early

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!!

Senseless Screaming

Is it me or have commercials gotten inane?  We don’t have cable and living on the back of a ridge means an antenna does nothing. (Yes, the children are deprived, but in a good way.) So when we watch a TV program it’s usually streaming with either no commercials or very few.

Last night, we visited my parents and watched Leverage. (BTW, why are they focusing on Sophie and Nate? I’m glad they found each other, but Parker and Hardison are much more interesting. And it’s clear that Eliot is on the show as eye candy since they still haven’t given him an interesting back story. All he gets is tender-hearted tough guy—can you say “cliché?”) Anyway, back to commercials.

So a commercial comes on. Some guy comes on the screen and screams for the entire commercial. And then the name of an insurance company comes up. The problem is that it is unclear why he is screaming. As far I could tell a tornado has not destroyed his house and car. No one has been carried off to Oz. A contractor hasn’t told him that his whole house needs to be rewired/re-plumbed. And he hasn’t had eight major appliances die in a two month period. (Insurance doesn’t cover that anyway—believe me, I know.)

I could only surmise that the guy was sitting in the agent’s office filling out paperwork to get his teenage son added to the family’s insurance policy and had just been given the final bill. And he couldn’t stop screaming because the good student discount barely made a dent in the bill.

When I shared my discovery with Calvin, he said, “That’s our insurance company.” That left me a bit nonplused. All that money and this tripe was the best commercial they could come up with. Maybe I should learn to write advertising script.

N.B. I’m excited to let you all know that this Friday I’ll be participating in an Author Spotlight. I’ll include a link to the site on my Friday post.


ACK. I went to my blogger dashboard and found that all the blogs that I follow have disappeared. I've refreshed and reloaded. They're still gone. Anyone know how to fix this?

Ariflu

Ariel came down with the flu. And, aside from the whole swine flu hysteria, it wouldn’t be a big deal except that she has a Calculus 2 final exam on Monday. So, we had the option of treating it with Tamiflu. It’s supposed to cut down on the number of days you’re sick with the flu.

Being the responsible mother/wife that I am and knowing how little our insurance decides to cover, I called the pharmacy to find out how much this jewel of modern medicine costs.

The pharmacist said, “I can’t tell you without a prescription.”

Now, I’m confused. Then I thought, “Maybe it’s because he can’t be sure how much it will cost us with our particular insurance.” I said, “Can you tell me what the cost price is without insurance?”

Pharmacist: “No.”

Me: “Okay.” I can’t imagine there is a law preventing him from disclosing the cost of medications—so, maybe he doesn’t want me to comparison shop pharmacies. I mean, I completely ignorant of how pharmacies decide what price you pay for things, but comparisons are clearly out of the question. I said, “Thank you.”

Pharmacist: “Yep.”

I called all the numbers listed on the back of my health plan card. Apparently, every office closes at 5 pm, even the call this number before you are admitted to the hospital number. So, I check the insurance formulary on-line. According to the formulary the medication should run $80. In very fine print at the bottom of the page it said, “These prices are only averages and may not reflect the actual price.” Hmm. This does not bode well. What does “reflect” mean? Is it like “mirror twins”—close, but not exactly the same?

I call back the pharmacist, who now had the prescription. He informed me the cost was $120. One hundred and twenty dollars definitely does not reflect $80. Not only are they not “mirror twins,” they’re not even “kissin’ cousins.” They’re more like obscure “second cousins, twice removed.”

We decide not to purchase the medical marvel. And Ariel’s feeling much better today—last night we gave her vitamin C, Tylenol, and raspberry soda. I wonder if we could bottle a mixture of those products, call it Super-Deluxe-Get-Better-In-Time-For-Your-Final-Exam-Miracle-Cure, and market it. No, that’s name too hokey. How about Ariflu? And we could charge $10 and make a killing. No, you’d have to charge at least $80. The more people pay, the more they’re convinced it’ll work—and it’s that whole placebo thing we’re after.