I'd be more shocked

that Kelsey's eye surgery for Thursday has been canceled, but let's just call it par for the course, at least for our family.  I am so used to mishaps on the part of anyone and everyone having anything to do with our medical care (to include payments for such care), that I am now surprised when things go the way they should.  Oh, the eye surgery?

Yes, not so much, at least not this week.  Well, I guess it could be Friday, but no one will call us back. Apparently, it was not realized until today that Kelsey could not have her eye surgery in Virginia, as our insurance won't cover it.  Nope, they won't cover us doing an outpatient procedure at the office minutes from our house.  What will they cover?  Apparently, shlepping downtown to Michigan Avenue to the main hospital.  So forget all of our careful planning and coughing ahead of time, we now are waiting to hear when the surgery will be performed.

Kelsey is annoyed as she was hoping to have two days off this week.  Peter is perturbed as once he sets his schedule, he generally needs to keep it as is.  I'm a tad bothered as now I have to figure out all new arrangements for Nick for surgery day, but don't have any dates to plan around.  On the other hand, I suppose at least they let us know before the surgery took place.  I don't want to think about how livid I would be had they waited until the day of surgery or worse, after it was all said and done and a huge (and not covered) bill awaited us.

Now, it would be in keeping with our other insurance/medical billing mishaps, but the mistake would likely have eaten up our entire FSAFEDs account. By some miracle, we have only used $50 thus far this year (Seriously, pinch me, I'm dreaming!).  If you remember, last year we hit our cap by mid-August.  So much for refiling those dental claims.  

This doesn't mean we won't use all of our money (we darn well better), but I'd like it to be a bit more spread out this year.  I had a brief upset when the first claims coming from my plastic surgeon were in the $34K range (no deductible, just a $6K co-insurance).  Then I calmed down, as I noticed that neither the insurance company nor the hospitals or doctors could seem to get anything right billing wise.  One minute a claim is being paid, the next minute it's rejected.  Well, I'm still a teeny bit nervous, but trying not to show it.

Claims are still bouncing back and forth, insurance isn't paying half of what the hospital requested (special rates and all) and no one seems to care.  Peter even called the anesthesia people (who tried to stress me out with a $5K bill) and they said to ignore it for now.  The insurance rejected it, of course (cause it's fun to be awake for an 8 hour procedure?), but okayed my post-surgical anesthesiologist visits (to check how much morphine I wasn't using...not even half of what was recommended, thank you very much).

In fact, one hospital, that will remain unnamed, isn't even billing the insurance for the corrrect person for a procedure from last April.  They have refiled the same claim THREE TIMES.  Each time it is rejected for "the correct diagnosis for sex" (which just makes me giggle) and Peter has to call them and explain that if they continue to put claims for my treatment in his name, they will never get paid.  They promise they will fix it, then they ignore said advice, and 6 weeks later, we get another explanation of benefits that has been rejected because they didn't listen to us.  It's like a little game now.  In fact, I'm not really sure anything since 2010 has been completely resolved, but you know what?

I just don't care anymore.  At this point, as long as we are not receiving random bills for $3,095 or $17K (or so) in the mail, I just don't care.  I am so over this whole mess and wondering if maybe I shouldn't consider being some sort of insurance specialist in my next career.  Just as long as I am the person that gets to put the notation about the diagnosis for sex....

 

 

 

 

 

Comments

[Alex]

Yikes. So sorry you're dealing with all of this. Healthcare in our country is so evil and broken right now, in my opinion. I will never forget the headache I went through when I fell running and knocked out a few teeth shortly after entering the adult working world. I'm convinced that the default is for insurance companies to just deny coverage people some people miss it or don't realize it could be challenged. I had like 25 different bills for a not very complicated procedure, and it was like a second full-time job negotiating between my insurance and the hospital to get them all paid. Makes me mad just thinking about it. Ugh. Well, I hope you get a new surgery date set soon.