Another Health Insurance Debacle

After posting about the problems of finding the identity of an anesthesiologist to confirm the doc was in-network, yesterday we got another scare. Monday afternoon, were at the hospital doing pre-op testing when I checked my phone and found a message from our insurance carrier saying that Randy's upcoming procedure was not pre-certified. I called, and the young lady (who sounded about 12 and said the word 'actually' way to much) told me there had been no pre-certification requested by our doctor's office. Nothing at all was in the system. The surgery absolutely needed to be pre-certified and insurance would pay for nothing if it wasn't. Really? If you have nothing in the system, then how do you know there is a upcoming procedure? She had no idea, and the people I needed to talk to had gone home for the day. Of course they had.

So, next morning, I called my doctor's office and asked to speak to whoever does pre-certification. All the receptionist could do was "send a message over there" and have them give me a call. Please wait 24-48 hours for the call back. I'm still waiting for that call back. I then called the insurance company again. This time, I spoke to a young lady who at least seemed a little more professional. After reviewing whatever it is they put you on hold to review, she told me that there were notes about someone calling about a pre-cert about 3 weeks ago, but no actual pre-cert. And yes, it absolutely needed to be pre-certified, or the insurance company wouldn't pay. She put me on hold and called the doctor's office and spoke to someone. It seems that the surgery is out-patient, even though he will spend 1 night in the hospital, and doesn't require precertification. These people are about to make me go outside my spirit.

All this sounds pretty straight-forward and doesn't take that long to type out, however, I spent about 2 hours on the phone all total, refusing to go away when I got vague, unsatisfactory answers to questions about whether or not insurance was going to pay for this very expensive procedure. (As my grandmother said "I ain't red-headed for nothing")

Here's the point: I wonder how many people give up and don't get needed procedures because of all the non-sense you have to endure to get straight answers from medical/insurance professionals. We're told to be pro-active and to do our due diligence so we can avoid surprise medical bills. I know a lot of folks who would take the word of the first soul they talked to and walk away. Trying to navigate our healthcare system is like have three or four people in a circle. When you ask who is responsible for "A" they all point to the right. When you ask who is responsible for "B" they all point to the left. When you ask who is responsible if the people responsible for "A" and "B" don't do their jobs, they all point at you.

We love the doctor, and we've always felt good about our insurance coverage. But, there has to be a better way. Long Rant Over.

Donna

RandyJoe,

How many people give up and don't have it done? Many,many (that's what they count on, it helps the bottom line that way).

You're right, there has to be a better way. We all have examples of things we, or friends, have gone through. It's no wonder medical bills are the fastest way to bankruptcy in the country--the navigation paths through the system appear to be set up to allow anyone and everyone on the provider/insurer's side to avoid taking responsibility for anything, and the consumer is left holding the bag. When a complaint is raised, the consumer is automatically assumed to be lazy, incompetent, or stupid.

Sky - It sounds like you are advocating for the telecommunication companies to acquire the medical insurance companies for improved efficiency through consolidation of customer service departments

I have a similar story with Comcast that I won't bore everyone with but finally a supervisor lowered my monthly bill (internet only) from $65 to $49.95/mo and increased my speed to 150 Mbps and asked if that would be ok. That was good for a year and I have to work the system every year to keep it from jumping up too much. I am finally back up to $65/mo after a few years but they tell me I have 175 Mpbs now. If you do nothing, it will jump up by a lot every year.

In fairness, many companies still do a good job and bend over backwards to resolve issues the first time through the process. They are generally not insurers and utilities though.

There are better ways, but few and far between in our country. When I read polls finding that a solid majority of Americans are “Satisfied” with their health insurance, I think those respondents have never had a serious medical condition.

When I read polls finding that a solid majority of Americans are “Satisfied” with their health insurance.

LOL that's funny, who might be behind that propaganda BS.

The 30 million uninsured, or the ones with $10,000 deductibles. the ones with health insurance who can't afford to use it(me)
It's a financial racket. dig a little deeper