Friday, January 21, 2011

Insurance Claims R Us

If there is one thing I have gotten really good at, it is filing and following up on insurance claims. No one has less patience than I do for the whole process. I have a system for handling all this mishigas, and in the last five plus years I am still learning.

After the premature birth of our triplets I became keenly aware of how utterly bogus the whole insurance industry has become. We had three babies in the NICU at the same time and some of the charges and coverage for the exact same services were different. It was an eye opening experience for me. I took notes, filed EOB sheets, documented who I talked to and got written confirmations on anything and everything. It became like a full time job.

Now, five years after the triplets and many hundreds of claims later, I still spend way too much time dealing with the idiotic paperwork associated with health insurance claims and payments. I can press one for this and two for that like the next moron, but actually dealing with and getting resolution takes some skill.

This week alone I have dealt with a bill collector on the Synagis shots from the triplets first RSV season. Of course our shots were pre-authorized and ordered from an in network pharmacy. We received the vials of Synagis for December 2005 and January 2006 via the mail order process. Somehow, our pharmacy changed participation in 2006 and our coverage was considered out of network for January, unbeknownst to us. After hours of research it turns out this was the only pharmacy that could deliver our medication and the insurance company allowed them to fill the order as if they were in network. Can you smell the disaster yet?

Here we are five years later and the collection agency has an unpaid balance of $4533.29 for Natalie. Only Natalie. This means that our insurance company paid the correct portions for two of the three patients. I have all the documentation and files upon files of paperwork relating to this matter. At this point, I do not have the time or inclination to spend any energy pleading my case. I am done. I have filed complaints with the insurance commission and I refuse to pay a dime for something we do not owe. It is crazy.

The whole matter just makes me furious. If that was not enough to ruffle my feathers this week, I also discovered a mistake on our prescription claims for 2010 with Amanda. Now, I have to retroactively file reimbursement claims for every single prescription she had filled. The only bright side is that we are owed about $1500.00 for medicines we paid out of pocket when there was coverage had the information been correct in the system.

In order to process the forms for our money, I had to request copies of all the receipts for the filled drugs. I did get a smile from the sight of the pharmacy stubs. Every time I see SLUT in mass quantity, I laugh. This four letter abbreviation is my motivation.

I am not really laughing, but I am thinking of opening a new business called INSURANCE CLAIMS R US. Just press one if you are a doctor and marke dos para Espanol.


Sid@ FĂȘte Foreign said...

Speaking from a land of subsidized health care I really feel your pain but at the same time I'm glad you have such a great sense of humour about it!

Edward said...

LOL. I am still fighting with my insurance over our girls time in the NICU. Total cost in India was ~$4k. TOTAL for 12 days! They are refusing to pay because it was outside of the United States but would have happily paid 10x (or more) the cost if we were stateside?!?!
They also keep insisting that I haven't proved that my children's care was necessary. Do you know anyone who elects to stay in the NICU?!?!?!
You may have a good business model if you can successfully deal with the paper pushers!!!

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