The dark side of having a child with a lot of medical history is the inevitable insurance issues. Over all our insurance has been superb. Tyler is rather close to being a 3/4 of a million dollar baby and we haven't had to pay much at all in the grand scheme of things.
Today we get a call about a bill for the breast pump. Our insurance has denied claim to it because it was made out in Tyler's name and not mine. I now have to figure out how to get a new prescription for the pump in my name dated 8 months ago as well as a doctor's note on my condition for needing the pump. Anthem policies based in the state of New Hampshire wants the pump to be in the name of the child. While in California, Anthem wants the pump to be under the mother's name. Technically the provider and the doctor here filled out all the information correctly for the NH Anthem. We have Anthem based in California because that is where Ben works. The California Anthem is not happy about the paperwork and is refusing payment because it's not to their policy. I called California Anthem to try to figure out this problem and was rudely explained that this was my fault and they will not do anything until the claim is in my name. This is a case of too many standards for a industry that shouldn't be for profit in the first place. The providers and the doctors can not keep track of all the different procedures to file claims for all the insurance companies. In our case, it's hard to know what the procedure is for different state branches of the same insurance company. Another notch in my "The health insurance of this country needs major reform" stick.
The state medicaid program isn't much better either. They have graciously decided to back date and pay for claims up to August 17. What I now have to do is call every single provider and get a list of charges that I paid, match it up to my receipts, get doctor's approvals for all these past visits and send all this paperwork in separately to one lone lady who works only in reimbursements for the whole medicaid program for the state and wait close to a year before I get an answer. Another lesson, when a hospital say fill this paperwork out and get it in to start the process, listen. We waited primarily because Tyler went back in for surgery in August and then September and time was rather short.
Again in the grand scheme of life this is all minor inconviences. The worst part of it is the annoyance of dealing with it instead of other things.
1 comment:
Oh man does that suck.
Have you tried calling the hospital and asking them to handle this for you? I know that Childrens has dealt with a lot of these technical issues for us and even filed appeals for us on wacky issues like names and waht is 'medically necessary'.
Since they are the pros in the insurance world and are also the ones that will be sending you nasty letters for fees, I would try them first.
Gib
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