Tuesday, June 17, 2008

Insurance hell

In April our insurance company sent us a letter that they had approved my spine surgery. Yesterday, they sent us a letter saying my surgery had never been approved. Today they sent us an account summary denying most charges for my surgery and sticking us with $20,000, although our out-of-pocket limit starting in 2008 is supposed to be $7500 (this doesn't include all the items they regularly decide not to cover or deny absolutely, such as the scooter and lift, medicines, therapies for son's autism, denied claims for regular appointments and labwork, etc., which accounts for our other $7500 a year). Hubby's been on the phone trying to get them to work out the contradictions, and that he hold both contradictory letters in his hand. My job is to try not to freak out too much in the meantime. The day before surgery, we were told we owed $2000; the day of, $2700. A large way from $20,000. We really have to call his employer and complain about what assholes (no apologies for the language) the people at this insurance company are.

And they claim work is not a medical necessity (thus no scooter). If we're stuck even with a small percentage of this bill, I can't get medical care the rest of this year and would consider filing for bankruptcy. Forget it. Disability is way better than financial ruin.

I would never have had the surgery, despite loss of bladder function and increasing sensory/nerve issues in my hand and arm, neurological lesions, pain, etc. if I'd known this.

That's just the surgeons'/doctors' portion. They also turned down the $32,000 bill for the surgery center and said that wasn't preapproved. The insurance company says I won't owe for that either, but if they don't pay, I'm certain the surgery center will attempt to charge us. I guess I was supposed to have surgery in my backyard or the kitchen table or something. Yes, the surgery center also preapproved it with the insurance company!

Also, the roof is leaking again. Grrr. I forgot to tell my daughter to hold her hand flat to feed horses before she went to Girl Scout Camp, though I emphasized drinking lots and lots of water. I guess if her fingers had been nipped off, I would have heard about it already. You can't stop a mama from worrying.

Over to friends' tonight, a needed break.

If there's a hell, insurance company executives belong there. That is all.


Elizabeth McClung said...

OH MY GOD - I hate this, and yes, these people should be put in some sort of hell - you sure you don't want to give me the number and see if I can't put the fear of Elizabeth into them. Becuase I know what you mean, having to choose between your health and your family stability; you would choose family - the insurance company says, "Hey, go ahead and have it" - you are recovering and enjoying a better quality of life when WHAMMO, the ulcer bridgade decend! I am so sorry, and if I HAD however many thousand I would give you some. But I am here and I am hoping you get positive resolution SOON. And that you sleep tonight! Take a pill, stop thinking about it.

And I am pretty sure she will come back with all fingers! But then some days I can't sleep until Linda arrives because I am convinced she is in a bike accident - I think stress and worry like has been dumped on you makes the world look a even more dangerous place

Elizabeth McClung said...

Linda says to get "prepaid legal" or another group where you pay like $400 (a year) and then you get a group lawyer who will write letters for you - since you HAVE the letter, you have the evidence or rather, get the lawyer gun to do the firing off of salvos with the evidence - she isn't trying to be bossy in case that comes off that way, she is just concerned about you.

We have it and have used it a couple times including our beloved landlord. It is always nice to HAVE a lawyer and at those threats of financies...I wish I had passed the bar.

FridaWrites said...

Prepaid legal isn't something I knew about at all and that definitely isn't bossy--I am definitely going to look into this right away. Even if the doctor's office let us off the hook partially (one can hope), we want the best outcome for them as well. I do envy that the Canadian system is free, even though I can see that the lack of specialists and the lengthy waiting procedures for you are huge, huge problems for those with a lot of illness.

I'm sure my daughter is fine. Concern for them is always present, and that's probably prevented some of the issues others have had. At the same time, I realized that my son is overcautious of electrical appliances sometimes (he wasn't cautious enough as a toddler).