Sicko (terrorist)


Health insurance problems here.

Again.

(plant fertilizer)

I’m going to be upfront right away and say that I have absolutely no ideas for solutions.

I’m just a big ole whiner complainer and that's all I got on this.

Well, maybe I’ll rent a boat and sail up the Susquehanna River, yelling through a bullhorn that if I had just given birth in Guantanamo, I might not be singing these insurance blues.

Oh sure, the solitary confinement of high security prison sounds challenging. But at least I’d be able to finish a meal without someone sitting on my lap and poking me in the eye or screaming that they can’t eat when their sister is watching them and making chewing noises.

And the guards do allow inmates to read for extended periods of time at Guantanamo, right? I’m guessing that a prisoner could easily get through the first ten chapters of “Harry Potter and The Deathly Hallows” before lunch and without having to break up a Barbie fight.

And I’m guessing the amount of nagging and verbal beating down that goes on at Guantanamo is nothing compared to living with a 6-year-old who just received a twenty dollar gift card from Toys R Us and who wants to know can we go today? How about today? You said this week. What about today? Today is this week, right? Can we go today?

In fact, the more I think about it, Guantanamo sounds like it would make for a comparatively spa experience for mothers of young children.

And sleep deprivation as torture?

Just try me, sergeant. Let’s see who breaks first.



Aw, ya’ll know I’m just kidding.

I love my sweet babies so much I could eat them.

But cannibalism is a pre-existing condition that would jeopardize my healthcare coverage should my husband change jobs.

Anyway….

(cherry bomb)

Remember I had a baby back last July?



Yeah. Him. Still cute as heck.

Remember my health insurance problem?

This one?

Well, the good new is that thanks to Governor Ed Rendell and his sparkly new No Child Left Behind CHIP Insurance Program - and a homemade double-fudge cheesecake sent to Ed’s home - Little Terzo is now affordably covered booboo-wise thanks to the fine state of Pennsylvania. I pay a mere $40 per month and the boy is good to go for vaccinations and check-ups and snotty ears and waxy noses and bumps on the noggin‘. Isn’t that great? Oh sure, we still have to find out whether CHIP will pay for Terzo's trip to Children’s Hospital in Philadelphia in August for his yearly check-up with the nearest expert on all things biotinidase. But other than that, and truly, I think it only fair that Terzo should have such a low premium since the kid is missing a few biotinidase enzymes, so really, there is less of him to insure in the first place.

Erem.

That’s the good news.

(Eau du Bin Laden)

The bad news is The Birth Date Rule.

Have you heard of The Birth Date Rule?

See, I’d never heard of The Birth Date Rule because up until this past year, either my husband was being covered by my health insurance, or vice versa. We had no need to know about The Birth Date Rule and life was pretty much carefree and we slept easily at night (except for the constant nursing thing), our minds a bit less cluttered for lack of knowledge of The Birth Date Rule.

The Birth Date Rule goes like this:

When you give birth, and when both parents each have a different health insurance carrier, then the baby’s medical expenses are covered for his first 31 days under the insurance of the parent whose birth date falls first in the calendar year.

That was at least a complex sentence and maybe compound-complex. Why don’t I give you a second to read that again. I’ll wait.

(evil doer)

So, through nine months of OB visits and numerous (i.e. approx. 5,364) phone calls to my insurance carrier for one thing or another, I was at one point advised that Act 81 of The Pennsylvania Code provides that for the first 31 days of life, a newborn will be automatically covered under the parents’ health insurance. And I figured that because I could pretty well prove that I was at least one of the parents - what with the roomful of witnesses seeing the kid being pulled out of my stomach - and that I had health insurance that I was paying a good chunk of change for (i.e. COBRA), that my insurance would pick-up the baby bills and life would be easy-peasy-lemon-squeezy except for the anticipated feeling of my post-c-section uterus trying to jump through the incision every time I took a pee.

And, I figured that because during nine months and numerous calls to my insurance company regarding the surgery and hospital details, no one once mentioned The Birth Date Rule to me, then my not knowing about The Birth Date Rule - if I had known about The Birth Date Rule (which I didn’t) - meant that The Birth Date Rule somehow had nothing to do with me.

Confusing and dependent upon parapsychology as that all sounds, I would figure that.

But I would be wrong.

First, it seems that parapsychology is not covered under my policy.

(smoke 'em out)

Second…

Because I delivered Terzo via C-section, there had to be a neonatologist in the operating room as per hospital rule. Fine. Bring in the neonatologist, an efficient, perky woman who - as a warm welcome to the planet - immediately grabbed the slick, complaining Terzo, tossed him around like a meatball and squished his hips in every which direction, and then wrapped him tight like a cabbage halupki and handed him over to my husband. Job well done. Smack hands and high five. Exit the neonatologist.

A few months later, I get a bill from her practice that, evidently, my insurance has denied.

See, cause even though I was in a hospital within my insurance plan, the neonatologist - who I had no choice in no matter how well she folded halupkis - was not covered by my insurance plan. In fact, according to a woman I spoke to in hospital billing, this group of neonatologist (the only group that serves the hospital) only accepts a few forms of medical insurance. Bob's U-Save Insurance is one. I can't remember the others.

“Oh yes, we have this problem all the time,” said the woman in hospital billing. “Almost nobody’s insurance plan is accepted by these neonatologists.”

My OB’s office confirmed that, yes, this was a problem that happened all the time:

New mom and dad, finally home and slightly harried with newborn bundle of joy, aglow with sleeplessness, slightly puzzled trying to reckon the spitting end from the pooping end of the new love of their life, have now have to spend eleventy-thirty-two-thousand-hundred hours on the telephone punching in numbers off their insurance card in an attempt to talk to a live human being who will give them the number of a lady named Pat who might know the name of the person who can tell them again that they’ve reached the wrong number.

(Anthrax: Fistful of Metal)

I call my insurance. When I finally do talk to a real live human being, she tells me that maybe they'll pay, maybe they won't. But that if I write a letter and ask real nice, maybe my insurance will pay the bill.

Or maybe not.

I write to the insurance asking them nicely to please pay for the baby squishing specialist.

My insurance sends me a partial check.

I write again and beg some more, and then I call my OB/GYN and ask them to convince the insurance that I absolutely needed the baby-squisher lady and it wasn’t even my idea to have a baby-squisher and that I even asked to have fewer people in the room staring at my tripey bits (I'm funny that way) but that the hospital insisted on the neonatologist. The insurance said that I should have had a referral; that even though the hospital is covered by my insurance plan, many of the doctors given access to the hospital might not be covered by my plan and it's up to me to make sure that every doctor who sees me while in the hospital accepts my insurance.

It's a good thing I wasn't in a coma.

But okay. My bad.

(I’ve since learned from the hospital that anesthesiologists and some ER doctors are notorious for not accepting many insurance plans.)

(Ahiida Burqini™ Swimsuits)

The insurance sends me another check for a total of $522. I send the check to the neonatologist. God’s in his heaven and all’s right with the world.

Then two months ago, I receive a letter from my insurance company asking for all their $522.00 back.

And they want their $522.00 back because my husband was born in March and I was born in August and there may have been something about him owning Dark Side of the Moon on CD before I did and not eating fish on Friday.

See, because of The Birth Date Rule, all of the baby's medical bills for the first 31 days should have been charged to my husband’s insurance, not mine.

Oh.

That's good to know. Because there's nothing I love more than spending my mornings on the phone talking to doctors and convincing them to send me $522.00.

The neonatologist practice says that they'll give me the money back when they've been paid by the other insurance, but that they can't submit a claim to the other insurance because I don't currently have an account open with a balance.

You see the problem here?

Yeah?

(Freedom Fries)

Well, it took the billing gal a few slow explanations and a coffee break before the Catch-522 became evident.

Are you following?

Because, I know I’m barely hanging on and I’ve got an entire room with a white board diagram and Powerpoint presentation to help me keep track of just who I need to call next to get this problem sorted out.

  • Twice the neonatologists have faxed the claim to the insurance company.
  • Twice the insurance company says they haven't received the claim yet.
  • One person at the insurance company told me that they don't accept faxed claims.
  • Another gave me the fax number to send the claim to.
A lady at the neonatologist office told me that she faxed the claim to the insurance company and that some mysterious person named "Gwen (of the Fairy Realm)" received the fax and Gwen said that the claim was good to go.

I call back the insurance office to confirm this

"OooooOOOOOOOhhhh! Gwen! Oh yeah...yeah okay...she has the claim."

"You sure she has the claim?"

"Oh yeah. Sure. Uh-huh."

"Really?"

"MM-hmm."

"Really really?"

"Uhhh...maybe. Yeah, probably. I think. Wait a second....Oh yeah....she has it.”

“How do you know she has it?”

“Has what?”

“What?

“Who?

"What?"

“I don’t know.”

“Third base!”


So at this point, who knows.

I have until July 31 to make sure the claim is in the hands of my husband's insurance.

After that, it’s pony-up the $522, bitch, or else…or else what? Maybe the insurance company sends a slack-jawed, muscle-headed neonatologist around to my house to unsquish the baby and tell me that they take back all the good things they said about his hips.

More likely, I'll receive a bill (in triplicate) for $522.00 from the neonatologist, another bill (in quadruplicate) from my insurance asking for their $522.00, and a postcard with a picture of an 80-year-old hooker on it from Gwen saying that she took the $522.00 and went to Vegas and blew it all on lap dances.


So yeah. The Birth Date Rule.

I’m sure that there is a very good reason for it.

(Jane Fonda)

And in the grand scheme of dastardly deeds on the part of insurance companies, my story is small potatoes.

To be fair, I probably should have read the small print somewhere or other that would have clearly told me that all newborns should be, of course, put under the coverage of the parent who was born first and who wears the higher sunscreen number and who says “pop” instead of “soda”.

Aw darn...there I go again, being an whiney, complaining, spoiled-rotten American.

The insurance companies, of course, need rules to ensure that evil-doing parents of newborns aren’t spending their scads of free time figuring out ways to double-dip their insurance claims during the first 31 days after the birth of their child.

We need rules.

Of course we need rules.

However, I wonder whether this rule, in this situation, didn’t add-up to man hours, phone calls, paperwork, and additional Xanax prescriptions all equaling about eleventy-thirty-two-thousand-hundred dollars.




If you see Gwen in Nevada, tell her to at least tip big.

Meanwhile, I’ll be at home, waiting on hold with the insurance company, typing suspicious "high hit" words and phrases over and over again until a Google from Homeland Security lands me much-needed vacation on a Caribbean island.


(al Qaeda)

(Pop Rocks)

(Blast-Ended Skrewt)

27 comments:

kgirl said...

So, as a Canadian, there is a lot (a lot) about this that I cannot even fathom, but the thing that has me blinking in absolute disbelief is - THE DOCTORS GET TO PICK WHICH INSURANCE THEY'LL ACCEPT?

Oh. My. God.

Good luck sister, sounds like you are going to need it.

mothergoosemouse said...

I had to giggle at kgirl's incredulity. Hells yeah, they get to choose. And it can change at any time. And some of those bastards don't accept jack shit.

Ahem.

Righteously indignant on your behalf, Jozet. It should not be this difficult to navigate health care, nor should a woman crouched over to receive an epidural prior to having her belly sliced open be concerned in the least about which friggin' MDs are in the room and why and what friggin' insurance they take.

Anonymous said...

I'm with kgirl. How can doctors possibly decide which insurance they'll accept? My garage doesn't care who insures my car. As a Brit I've said this before but I'll say it again: thank God for the NHS!

Hope you get this sorted soon Jozet.

Queen Karana said...

Oh my. I thought our insurance problems were difficult - but no, oh no, I'm afraid you have it much worse than we ever did. You have my sympathies. I hope it all gets worked out soon. It seems to me that the insurance companies should battle it out themselves.

Julie Pippert said...

Insurance sucks.

HMO/PPO health care sucks.

Doctors opting out of most insurance or any insurance and requiring cash---while understandable from their POV---sucks.

My mom's town finally built a hospital! Private. No insurance allowed.

Dude, do what we did: catastrophic plus HSA.

Now I can go anywhere, just pay out of the savings and when we hit $3000 as a family, 100% covered.

Again, socialized medicine ROCKS!

Sorry for all of your troubles. Insurance is a full-time job, isn't it.

slouching mom said...

First of all, look at that adorable redhead!

OK, now to insurance:

We went through a similar three- or four-year ordeal with regard to a payment of $422.89 (well, of course I remember the amount; I must have recited it over a thousand times) we were told we owed for -- get this -- a pediatrician visit for Ben with a date of service when WE WERE NO LONGER IN THE STATE.

I spent two years trying to work this out with a nice guy named Bob. Nice he was, but ineffectual.

And in the third year? The office had some kind of mass firing and rehiring, and all of a sudden NO ONE HAD HEARD OF BOB.

I cried.

I am so sorry for your troubles. I understand.

anne said...

Wait...I got confused. Were you dealing with a health insurance company or Penn DOT.

Because it sounds like it could be either.

I've always said, when I finally decide to blow up a building, it will be an insurance office.

There. That ought to get you noticed by Big Brudder.

Momish said...

Wow, you have been through hell and high water over this, my sympathies. My cousin had a similar experience with her birth that a year later is still going on despite the fact that she has already paid out over 10,000 dollars! Mind you, she does have insurance through her employer, which she pays a huge amount for out of her paycheck each month - let's not forget about the fact that is stuff we actually PAY FOR.

But, like you said, she doesn't have blue eyes and ate at McDonald's more than once before she met her husband and three times in her life went abroad and was born a Sag. Such stupid clauses abound, it's amazing anyone can get anything done. I never heard of the Birthday Rule, but then again, my husband's Birthday is in Dec. so that is why it never came up. Otherwise...

But, I have to hand it to you, if I was going through all those hoops, I would not have been able to write such a coherent and funny post about it.

Best of luck!

wordgirl said...

Sweet Mother of Pearl! This is ridiculous! Insurance is a scam! A drunk monkey could devise a better health-care system than this. Do you think Dick Cheney had this much of a problem with insurance companies to process his claim after he shot that guy in the face? Do ya? Huh? Huh? I'll be that took some fancy explaining. I'm blaming him for this mess because it makes me feel better. I'm also thinking that today sounds like an excellent day to go to Target. They sell wine there, right?

Kelly said...

Oh. My. Fucking. Lawd.

And I get all out of sorts when I receive a dermatologist bill because my PCP didn't get the referral over in time. Usually takes a single phone call to sort that out.

This country? Oh, we got a whole lot of work to do yet. So sorry this ordeal has to keep you up at night. The all-night nursing, at least, is for a good cause.

evil columnist said...

I hate these people too. Hate them. Hate them, I do. But I'm sorry. You are the funniest darn writer, so I have to laugh. Out loud. Laugh out loud when I read that some evil company doesn't want to pay up for the care of that sweet, adorable boy whose smile lights up the room.
So yeah, I'm mad. Really mad. But I'm laughing like a mad cow.

lildb said...

just as soon as I scoop my eyeballs up from my desktop and squish 'em back into my head I'll have a decent comment that satisfactorily details my stupor over your situation.

ye. gads.

sognatrice said...

So ridiculous. Imagine the insanity of just applying whichever insurance actually covers something. I'm so glad I don't have to deal with that stuff anymore. There are (many) things left to be desired in Italy's health care system, but at least I know that I don't have to go into debt should something happen.

Best of luck.

mamatulip said...

Also being a Canadian, there is a lot of this that just absolutely blows my mind. Like, there are bits of my mind on the keyboard.

So sorry. Seriously. This is bullshit.

Siuan said...

Seriously, wow! Another Canadian here, baffled! I hope it all works out in the end and quickly for you.

Anonymous said...

Want me to cruise the strip for Gwen? I have a bullhorn.

Birthdate Rule difficulties here too- wtf decided that was a good idea????
(GWB)
(fuckers)

kaliroz said...

That's about the most ridiculous, innane piece of bullshit legislation I've ever read.

Really.

Maybe I can give Gwen a lapdance and get your money back for you?

miss bliss said...

I totally went through this with the anethesiologist's office after my first baby was born 4 days before Hurricane Katrina near New Orleans. I was dealing with the dr, insurance, and creditors since we didn't get the bill in the mail...you know, since they weren't even delivering mail.

I agree, you need a spreadsheet or diagram of who called whom and documents the name of anyone who sounded fairly competent, or gave an answer you liked. Good luck.

Ernest said...

J

Seriously, you ought to tone it down before the IRS shows up or you end up with a black van parked in front of your house.

and Anne you obviously forgot that we live in America and your not allowed to talk like that here.

Lisa b said...

I'm so sorry you have to deal with this
but its sooo funny the way you tell it
good luck w the vacation plans.

jchevais said...

As a Canadian who now lives in France... I'm dumbstruck.

Your healthcare system makes absolutely no fucking sense.

pardon my french...

Mom101 said...

This makes me want to scream and yell and vomit on someone then scream some more and maybe vomit on them again. After which it makes me think that Montreal is a lovely city with a great many reasons we might be happy living there.

I wish you luck resolving this. It's all sickening.

Moobs said...

All insurance companies are evil. I had one as ac lient recently and they told me that they usually ignore (or deny they have received) the first two written attempts to claim as statistics show that the majority of claimants then give up.

Mommy off the Record said...

Oh my goodness! This is just horrible.

I hope it gets resolved for you. Considering the time and energy you are putting into it, they should be paying YOU an extra $522.

Bock the Robber said...

Woo! Those crazy Americans.

But at least they're bringing freedom and democracy to the world.

Thanks, guys.

Anonymous said...

Am I missing something here, or did your post say you had COBRA? Isn't this govt issued insurance rather than private? Can you see the ridiculousness of govt run insurance?? Do we really want socialized health care where you have to wait in line to see (maybe) a doctor or have the govt tell us whether we really need/deserve/qualify for medical care for our specific malady....and when that may be? Our health care system needs improvement, but handing it over to the govt is the last thing it needs.

Jozet at Halushki said...

COBRA is not government insurance.

And frankly, I'm waiting in lines now to see a doctor, maybe, that I can't afford even with insurance. That things could be worse with some other imaginary system is no excuse for not trying to find some other system in which large numbers of people are making decisions between eating or buying their medication.

And actually, my kids are on CHIP right now and my husband has state paid health insurance. They work beautifully. Everyone should have this insurance. Meanwhile, I have private insurance and I'm the only member of the family who needs to put off doctor visits because i can't afford the co-pays.

Blog Ping