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Wednesday, November 11, 2009

Insurance Stupidity Take 283,456

I swear. I could spend all day telling you all stories of the idiocy that I experience dealing with insurance companies. It seems that they try and find ways to make things difficult for us parents of medically involved children. Most parents would not expose their children to radiation just for kicks. Obviously, if a doctor ordered an x-ray, it was medically necessary. Must we submit a million pages of documentation to prove that?

But I digress. I have an actually amusing (well other special needs people will find it amusing. The rest of you will be perplexed) story to tell you all.

Correct me if I'm wrong, but if I'm not mistaken, the statute of limitations to bill someone for medical procedures is two years. Keep that in mind.

On October 17, 2007, Dovi broke his tibia (remember the six month stint of ongoing broken legs?). How do I know that very specific date, now, over two years later?

Well, my readers, that's because I received a bill from the orthopedist who saw Dovi in the emergency room. In September of 2009. For the date of service October 17, 2007. And I had never received any correspondence from the orthopedists' office before.

Hmmmm who do you think was auditing their accounts and realized that they didn't collect from the insurance company and decided to try and do something about it?

So I called the orthopedist practice in September and informed them that there was absolutely no chance of them seeing a penny of the $431 they were billing me. I don't even have that insurance anymore, but I knew that the policy covered emergency services at 100% coverage after a $50 co-pay. Which I paid. So heck if I was giving them $431. And had they contacted me, say, 18-24 months ago, I would have been happy to contact my then-insurance company to work it out, but this was soooooo not my problem anymore. I believe I might have ever so slightly slammed the phone down after informing them of said facts.

Well, they sent me another bill in October. I called them again. The "sweet" woman I spoke to informed me that I could say it wasn't my problem as much as I wanted, but if I didn't pay the bill they'd take me to collections. And they had been corresponding with my then-insurance company for the past two years but had been unsuccessful in collecting the account. I believe I hung up on her.

I then rethought the issue and decided that it was to my benefit to get it taken care of before the bill collectors came a-calling.

So I called them back and informed them that since I was a very reasonable person (I actually SAID that! I'm gutsy), I would call the insurance company ONE TIME and try and deal with it. And by the way, can I please have my ID number and group number because I haven't had this insurance in almost two years thankyouverymuch?

So I called. Got a very lovely guy on the phone.

Want to know why they denied the claim over and over? Well it seems that the orthopedists' office was billing the claim as an inpatient service when Dovi had never been admitted! And since there was no inpatient authorization on file, the claim was denied.

Ooh was I pleased to hear it was the orthopedists' fault.

So I asked the guy if we could conference the orthopedists' office on the line. He was happy to oblige.

We called the previously condescending snooty woman. She was all "we've been submitting, you keep denying, she needs to pay" etc

Then the insurance guy told her how they'd screwed up. Let me tell you, she was silent. But she never admitted she was wrong! She just got the fax information and said she'd fax over the claim and hung up sooooo fast.


But today, I had a message on my answering machine from the insurance guy telling me that he had not yet received the corrected claim from the orthopedists' office. Now I need to call them again. Drat.

6 comments:

Anonymous said...

Speaking of statutes of limitations...

When I was almost two I needed to see an ENT. My mom was 6 mos along, but she shlepped me down to UIC.
A month later my mom receives a bill for a chest x-ray. She calls up hospital billing and informs them that I saw on ENT -- no chest x-ray. She's informed that sometimes parents aren't aware of the exact procedures doctors perform, but since she's on bedrest, they don't want to cause her anxiety and they'll call her back. They never call.

Fast forward to 2007. I'm 20 years old and as a UIC collegiate, I join UIC health insurance. I call to make a doc appointment with them for the first time and give my social--- I am informed that I have an outstanding bill --- yep, for a chest x-ray.

That would be an EIGHTEEN YEAR BILL that they wanted me to 'deal with'!!

-TC

Stephanie said...

Yes, I was still getting NICU bills on Amelia's 3rd birthday. Needless to say, I didn't pay them.
And I have written to the state insurance regulators more than once to argue charges. When Mary had surgery, we got bills from out of network anesthesiologists at our in network hospital. What was she supposed to do? Wake up mid-surgery to ask if the dr was in or out of network?
It's a racket.
Insurance companies are out for profit - THAT is what makes our current health care system different from any other country's.
Oh no. You got me started.

Rach said...

oh my goodness, thats crazy

Shira said...

That IS crazy. I had an insurance issue today that perhaps I'll blog about. But first I have to call Y's pediatrician and try to work it out. I hope I can work it out so my blog post has a happy ending.

Rocheyl said...

I had mt delivery denied cause it was yup you guessed it AN ELECTIVE PROCEDURE... Now I guess you could say getting pregnant was elective, but not the delivery...
On my second pregnancy I had the baby's nursery charges denied cause they were not yup you gueesed it again preauthorized... HA HA what was I supposed to do, call when I was 6 cent dialated?? And to top that one off my delivery was fully preauthorized and covered...

Heidi @ Tayterjaq's Rebels said...

Yikes....lots of crazy insurance woes out there. It makes my (very) small problem seem even smaller but I'll share anyhow. We received a bill from hubby's doctor for 12.50. Not really sure what for since everything but the copay($20) is supposed to be fully covered but I figured, whatever, and sent them a check. Two months later I receive a check for...12.50 that I "overpaid". Can you guess what my husband received from the office next time he went for an appointment? A notice telling him he owed 12.50!!! Are you kidding me?!?!? Someone is sooo not communicating in that billing office.
See...pretty small potatoes compared to everyone else's stories but annoying nonetheless.