Since health insurance is such a big topic on the national scene these days, I thought I'd share my health insurance story. In terms of covering our medical expenses, our health coverage has been fantastic. We belong to an HMO, so our out-of-pocket medical expenses have been extremely low. It's a bit of a hassle to go through the primary care physican to get referrals for specialists, but since everything's computerized, it's not that big a deal. We pay a small co-pay for doctor visits and slightly larger co-pays for surgical procedures and hospital stays. Even with all of that, our bills have been very low. I am glad that we're not in a PPO plan. If we had to pay ten percent of Tim's medical bills, we'd probably be facing bankruptcy.
My only complaint is the way doctor bills are handled. In an HMO, doctor's bills are paid by the medical group unless the bills are for "catastropic care." Hospital bills are by definition catastrophic and go straight to the insurance company, so no problem there. Cancer is definitely catastrophic. So bills for Tim's care are sent from the doctor to the medical group, who marks them catastropic and forwards them to the insurance company. Something always seems to go wrong on the journey from the medical group to the insurance company. The bills get rejected by the insurance company (or not even received) and the doctors wonder why they're not being paid. They start to send me nasty letters. Solving this problem requires REPEATED phone calls to the medical group and to the insurance company. Eventually the bills are properly marked catastrophic, faxed to the right department in the insurance company and paid. I have had this problem every time Tim relapsed with leukemia. My complaint is that every phone call to the insurance company takes close to an hour and requires at least a fifteen minute explanation to the random customer service agent who takes my call. I asked repeatedly for a case manager only to be informed that my insurance company does not assign case managers to individuals.
Several weeks after Tim passed away, I received a condolence card from the insurance company. It was signed by Leah and included her direct line, along with the words, "If you have any questions about Tim's health coverage, please contact me." Well, I decided to see if Leah meant what she said. She did. Leah is now my case manager. She works for the parent company of my insurance company. She has helped me resolve at least three outstanding bills, one of which was for $25,000! So now I know how to get a case manager from my insurance company: die!
Happy Thanksgiving, Dear Ones
8 years ago
Wow! That's fantastic about Leah, the case manager. When my father passed away, my mother had to deal with his med. bills. Because his cancer struck at a small company, they were able to fire him, not offer cobra, and mom's med. insurance had a loop hole about new enrollees subject to $25,o00 limit in first year. I wrote a letter to the chemo doctor and his debt was forgiven. Hang in there, Jennifer!
ReplyDeletebtw: other debts were not forgiven. My mom still wishes she had gone medical bankruptcy . . . but that's just not in her blood or ours .. . But hang in there and if you need, I can clue you in to good insurance lawyers.
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