Tuesday, July 17, 2012

Insurance-land Ain't for Wimps Ya'll!

Dealing with medical insurance companies is just exhausting.  Over my years of medical drama, I have really learned how to maximize insurance benefits, but let me tell you, when it breaks, look out!  Due to a surgery I had about 3.5 years ago, I needed some physical therapy to regain the use of my right arm.  I was in PT for about a year and a half - doing really well.  And them BAM, received a letter from my insurance company telling me that all of my visits from the date of the letter back six months had been denied.  Nice. 

Their reasoning was that I didn't show any progression or decline because of the treatment based on the documentation submitted by my physical therapist (aka terrorist.)  SO, because the physical terrorist didn't submit adequate documentation, my insurance company wouldn't pay for it.

Naturally, I appealed, and then appealed again...(rinse repeat) and 4 appeals later, I was denied.  BUT, in glorious fine print in the letter I received was the following verbiage:

"Please be advised, that although these claims have been denied for payment, you are only responsible for any applicable co-payment and you are not responsible for any outstanding balances.  The denied claims are the provider's responsibility. "

I was shocked...really...that after four appeals, they said I wasn't responsible for the balance after all???  OMG!  What a waste of energy and stress.  So, the PT's office would just 'write it off' per my PT and we'll call it a day. 

SO NOT reality.  I'm so naive sometimes. Nothing is easy in insurance-land.  I've called and emailed and called and emailed.  It's now over two years later, and it's been sent to a collections agency...who can't do anything or get any response from the PT's billing people either.  I've been in one big limbo for way too long.  It's a lot of money people - I'd like to know if I have to start selling my shoes to pay for it or if they are going to do as they said and 'write it off.'  Speaking as a compliance geek (which I am) their books must be really loosely managed to have a balance from 2 years ago just sitting there....being ignored.

I love that the government is going to force everyone to have insurance.  I think it's a great idea - but who the heck is going to manage the influx of people who show up to be treated?  They can't manage the patients they have right now my people.  I'd advise any college bound students to think seriously about a medically related degree....there will be a huge need going forward. They will also need lots and lots of accounting types.   People who can actually answer phones and return emails....it's a dream world that I'm talking about I know....but a girl can hope.

For now I'll just call my insurance company at least once a month, (sometimes more often) and hope that before my insurance changes - God forbid...that they straighten out this mess.  Should we start a pool to see when they will actually return a phone call?  I'm choosing 11/13/13 - seems like a nice round number....until then, do yourself a favor and be diligent about what your insurance company is doing.  Check your bills and make sure they are actually yours and that they are being paid.  Be proactive and call your physician to let them know when things are in limbo and aren't being processed. 

You'll thank yourself in the long run. 

Happy Tuesday Ya'll!

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