Monday, November 30, 2009

Feels like I should bend over and say, "Yeah, give it to me right here."

Let me tell you about my hellish morning. I'm really doing this as a public service. If I can save one person from being screwed the way we're being screwed, it will make my frustration worth it. Okay, it really won't make it worth it, but still.

First, some background:

Per our HMO (through Anthem/Blue Cross, apparently the best of the best, for whatever that's worth to you), we have annual out-of-pocket maximums as follows: individual - $2,250, and family - $4,500. We have met our out-of-pocket maximums this year; in fact, we've far exceeded them, and as such, the insurance company now owes us money in reimbursements. We have been going round and round with both the insurance company and our medical group for several weeks now, trying to get this straightened out. The problem is that neither entity has its records up-to-date. Also, there appears to be a complete and utter breakdown in communication between the medical group (which all of our doctors belong to and through which all the billing for office visits, procedures, surgeries, etc. comes) and the insurance company. I don't even know what's going on. The insurance company's records show that we have not met either maximum.

Now, let me stop right there. Let's do a little simple math. We have shelled out $3,000 this year in surgery co-pays - $1,500 for Michael and $1,500 for Finnian. There have been four ER co-pays at $100 a pop. Michael has shelled out over $900 in office visit co-pays just to his oncologist (and his oncologist has a record of this). That brings us, conservatively, to $4,400, $2,700 of that for Michael alone. This isn't even counting co-pays for all the radiation treatments Michael had, any of the other doctors he's seen and made co-pays to (and there have been plenty), pediatrician co-pays, and specialists that Finn has seen throughout the year. I would conservatively tack another $1,000 onto that $4,400.

Some guy with whom Michael has repeatedly been in touch with in the billing department of our medical group seems to finally be acknowledging that yes, it appears that we've exceeded both maximums, but 854 hoops need to be cleared before we can get reimbursed for the overpayment. In the meantime, we are still being asked for co-pays each time one of us has to see a doctor. So that total, that overpayment? It's just supposed to keep growing, and apparently that seems fair to the powers that be.

Which brings me to this morning.

Finn is scheduled to have a minor outpatient procedure tomorrow morning. He has a cyst on the back of his ear that needs to come off. It will require that he be briefly put under general anesthesia, which means it has to be done at the outpatient surgery center. This morning he had a pre-op appointment with the ENT who will be doing the procedure tomorrow morning.

So I get there with Finn and Lilah in tow this morning, I sign Finn in, and the receptionist asks for my $20 co-pay. I explain to her, as nicely as possible, that we have exceeded our out-of-pocket maximum and that I, therefore, will not be shelling any more money out in co-pays. Well, that obviously through a monkey wrench into her morning. She looked a little befuddled for a moment (what to do with this crazy lady?). I just smiled and sat back down. A few minutes later someone else on the staff comes to the front window and beckons me. "Yes?" I ask, sweetly, innocently (see, the truth is, I knew that this was going to become adversarial). "Umm, is this about your co-pay?" she asks. Now I act confused. "Is what about my co-pay?" I ask her. "Well, she" she says, pointing to the receptionist, "says that you don't want to pay your co-pay." So I explain to her again that we have exceeded our out-of-pocket maximum and therefore I should not be required to pay any more co-pays this year. "Well, the thing is, that means that I would have to verify that with your insurance company . . ." she says, seriously coming across as put out. "Umm, okay then," I say, and sit back down.

It's now been about 20 minutes since we first arrived. When we first got there, there was nobody else in the waiting room. Now other patients are coming in, and they're being called back before we are. Now I'm getting mad. I go back up to the front desk and say, "Our appointment was at 9:45. It's now after 10:00, and you're calling people back who arrived after we did. Is my son not going to be seen because of a $20 co-pay? Because he's scheduled for surgery tomorrow morning." She tells me that they're trying to straighten it out with the insurance company, and that, yes, I have to wait.

I'm fuming now.

A few minutes later, the other girl comes back to the front desk and she has some figures written down on a piece of paper. "Your insurance company says that you have not met either out-of-pocket maximum," she tells me. "They're wrong," I say. "We're actually in the process of trying to get it straightened out with them, but I can tell you that my husband was diagnosed with cancer in February and has seen at least one doctor every single week since then, so you can imagine how many co-pays we've made." She wasn't budging. I told her, "Fine, bill me for the co-pay then, because I'm not paying it today, I'm just not."

All the while, I'm texting Michael and telling him what's going on. Finally, he calls this doctor's office himself and somehow sweet talks them into . . . I don't know what. Letting the issue of the co-pay go for today, I guess. Because finally a few minutes later, Finn gets called back.

The doctor looks him over, gives me pre-op instructions for tonight and tomorrow morning, and then I'm told I have to go pre-register him at the hospital. Ugh. Which I should have known since we've been through this drill before.

So I haul Finn and Lilah over to the surgery center to pre-register him. There are about 30 people ahead of me - no kidding - and everyone is being required to take a number. I ask how long the wait is and am told cheerfully, "Oh, about 20 minutes, I'd say." Okay, fine. I take a number and have a seat. We wait. And wait. And wait. For about 40 minutes. I finally go back to the front desk and ask how much longer it's going to be. "Ohhh, it's going to be a while," she says (a much different story than the one I got 40 minutes earlier!). I told her I had kids to pick up from school and that I would have to come back later. And we were on our way.

As a final insult, I had to pay $2.50 for parking when we left - and for what? Nobody even saw us, and I got nothing accomplished. Screwed again.

And now I have to go back there later today!

I am so absolutely frustrated and angry - especially about the insurance part. Everyone wants their money - the doctors do, the medical group does, the insurance company does, that's for sure. But who is looking out for us, the patients? Not the doctors. Not the medical group. Not the insurance company. How many people have been reamed this way - by overpaying their annual out-of-pocket max - and don't even realize it? This smells like bad faith to me. There is something very, very flawed with how the whole system is set up.


Alex and Kristi said...

I swear, insurance companies are such a PAIN!! I just went through this with my OB/GYN. I guess some people might not have a clue if they have met their deductable but I KNOW that I have met mine and obviously you know you have met yours! Such a pain...I wish the left hand would talk to the right hand!!!

Raymond said...

I had this same issue when I was pregnant with matt - we met our deductible and yet they wanted me to pre-pay the birth/hospital fees and said they'd reimburse me at the end of it all once the insurance portion was figured out and I refused and refused until one day they refused to see me at the OBs office - I was PISSED and did the same song and dance with the billing and insurance company - finally getting insurance company to agree I HAD met my deductible but I could not get the dingbat in billing at Dr office to accept it and in the end I gave up and I think they got $500 extra from me but I could not stand the fight any longer - it SUCKS for certain! As an aside, I am glad to hear Michael is home and hope you can come to Karyn's for awhile tonight :) Lisa

Kristin said...

That sucks! I am currently battling my Doc over a bill I am refusing to pay since insurance should have covered it. What a bunch of crap. Hope you get your money ASAP. Hugs to Finn

Heidi said...

Oh, I HATE insurance companies! I reached my max OOP last year. But I was still asked to pay a co-pay. The issue is still not resolved. I finally gave in and paid the fucking money. Sad thing is that the insurance I have is the only insurance that will take me.


Cate said...

oh sheesh. that's just wrong.

Abby has an ortho appt later this week and the hospital keeps calling me to preregister (which, now that I've read your tale, I'll stop being irritated about.) Anyway, is that an option, to preregister by phone? It really sucks to make you do it in person.

Tricia said...

Lisa. Geezum Crow! That SUCKS! I am so furious for you! We have always pre-registered for surgeries by phone. If that is an option and they didn't give it to you I would be even MORE livid. It's robbery. It really is. Especially if you tend to just trust the system (which I used to do). TERRIBLE! SO SO SO sorry.