Health insurance problems here.
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.
Remember I had a baby back last July?
Yeah. Him. Still cute as heck.
Remember my health insurance problem?
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.
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.
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)
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.
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?
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.
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."
"Uhhh...maybe. Yeah, probably. I think. Wait a second....Oh yeah....she has it.”
“How do you know she has it?”
“I don’t know.”
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.
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.