Wednesday, January 12, 2011

Insurance Sucks. No Insurance Probably Sucks More.

I have never had to pay too much attention to what insurance we had and the details of our policies. Before this weird pregnancy that is treated like a rare and dangerous disease, I could count on one hand the number of doctor appointments I had been to in the last several years. Most of those were for ringworm that my dirty but delicious students continually gave me no matter how much I avoided them when they were infected. Anyway, now I get to bask and bathe in the details of not only our medical insurance but also short-term disability. Firstly, insurance for a family is like insanely expensive each month. Even after your employer pitches in. So that's cool. Back in December when we switched insurance companies I called to find out just how much these aliens inside me were gonna cost. First she told me that all my prenatal appointments would be free of co-pays. Then after we talked more she realized I was seeing a specialist because of my "high risk" pregnancy, and changed her tune to me paying 40 bucks every time I go. Okay, I go to the doctor AT LEAST once a week. Are you kidding me? She kept saying how if it were a regular pregnancy it would all be free. Thanks. Yeah. You should keep rubbing that in. This makes no sense to me. I certainly didn't opt for having a high risk pregnancy. They make it seem like I had 2 choices and went for the more deluxe option. Good grief. Supposedly, our in-patient hospital yearly max is 1200 but I feel like they lie. Often. So, I guess we'll see.

Then, there's the short-term disability a-holes. My hatred for them is on a Shakespearean level. A triplet pregnancy is incredibly risky. Let me guess, you probably put that together. I'm going to tell you anyway because all I want to do is rant and piss and moan. This bit won't be funny so you should probably skip it and then just tell me that you read it, even though you didn't. So, 91% of triplet pregnancies have at least one antenatal complication, 80% go into pre-term labor, the average gestational age at delivery is 32 weeks (So only half even make it there), and the prenatal mortality rate is 10x higher than with a normal pregnancy. Given these "challenges" one of the precautions that pretty much all doctors take and anyone can read about in various medical journals, is to modify maternal activity. Considering the entire medical establishment seems to think this is the way to go, you'd think that when my doctor told me it was time to stop working and go on low-activity leave that the insurance company would understand and pay my short-term disability. I mean, they have to follow established treatments or at least know how to read, right? You would be wrong. You would be so so wrong. I know how you feel. I was also so so wrong. I got a call from the company and the lady says they had to deny my claim because the information from the doctor said I had no restrictions or complications. She said she even called the doctor's office to get more information but that they had said there was no reason for me to be out of work. Huh, my doc had said something completely different. Weird. Well, its clearly just a misunderstanding. I'm no communication expert but I'll get it cleared up. I was extremely confused so, of course, I call the doctor's office to find out what's going on. Predictably, the insurance company called the day before Christmas Eve so the doctor wouldn't be back until the 29th. I think they did that just to be funny. Those rascals. When I can finally call on the 28th the doctor's office tells me that is not at all what they said. They had told the insurance company that I was on low activity restriction because of the inherent risks of having three hungry fetuses taking over my body. They said they had reiterated this to the insurance company many times. I call the insurance company back and, of course, they won't let me speak to the agent who actually knows about my claim. They just keep reading me parts of this very non-specific letter they sent about why I was denied. Every time I ask a specific question about what the doctor told them they say "Oh, well, I wasn't the one who spoke to them." Then I say, "Ok, great, can I speak to that person?" and they get a little quiet and then just start reading the letter again. There must be some sort of regulation that the call center workers have to panic easily and not make any sense at any time.

 The next day I went to my regular doctor appointment and my cervix had shortened significantly so I had my first trip to labor and delivery. Luckily, they just monitored me for a couple of hours and sent me on my merry way (we'll discuss this whole thing in the next post, promise, pinkie swear). The next day I asked the doctor to send in the information about my cervix to the insurance company so they could re-consider me. They did and I called after 4 days (the company has 5 days to review new documentation). The lady made a note for my claim agent to call me when they had reached a decision. I thought fine, they'll call today or tomorrow. Well, of course no one called so I called two days later and the person who answered said that her notes showed that what the doctor had sent in wasn't sufficient and blah blah blah. I asked to PLEASE speak to the claim agent. Of course, she was unavailable and would call me back. A miracle occurred and she actually called me back before the end of the day. Okay, remember how she had said all the problems with the claim were because the doctor hadn't given any restrictions or reasons to be out of work? I remember that. I remembered it so well that I stayed awake at nights thinking about what else I could have sent to them to make them understand, including researching medical journal articles about standard management of triplet pregnancies. Oh, well, her tune is completely changed now. Apparently, the doctor DID say all of that. So, I wasted countless hours mulling over this situation and now you tell me that what you said was just completely untrue. No, that makes sense to me. No worries. We're cool. Apparently, the doctor's reason just wasn't a good enough reason for them. They need a complication to actually occur before they feel you should be out of work and since no complication had actually occurred yet, that is why I was denied. Fine. Forget you, but fine. However, the paper that the doctor's office sent over, despite what the notes I was read said, was sufficient and though they couldn't approve me for the December 1-28 period, they could approve me starting the 29th when my cervix actually shortened. Now, why the other lady had told me something completely different five minutes ago about the info not being sufficient is beyond me. Probably goes back to that regulation of only hiring people who make no sense. Fine. Great. Goodbye. I hope to never have to speak to any of you again. Ever.

Epilogue: Just the other day I saw a commercial for a lawyer, specifically citing that if you had been denied short term disability by this exact company you should call this lawyer because they are being repeatedly sued for wrongfully denying claims. I am obviously not the kind of person that would do that but it seriously put a smile deep, deep in my soul just to hear that.

Update: When my short-term disability was turned over to their long-term disability department the agent reviewing my claim called and told my that I absolutely should have been approved from the very beginning and when I got my check for long-term, the money I missed out on during the period for which I was denied was included.  I love that claim agent for having a brain.

1 comment: