Monday, April 23, 2007

Dodging the Big One (and Doing the Happy Dance With My Muse)

The topic to follow is hardly writerly, and yet, on second thought, maybe it is given how heavily it weighed on my muse until it was resolved.

A little over 14 months ago, our middle daughter E underwent surgery to correct a brain aneurysm. This surgery came on the heels of a lengthy recovery from an actual rupture in July 2001 that required months in the hospital, and years of rehab to relearn how to be herself again.

Fast forward to 2007. E's doing fantastic, having a fab time in 8th grade, planning what to wear for her graduation dance, and embracing life.

With the most recent surgery over a 15 months ago, you'd think all bills for said event would be paid up by now. Think again.

For months now we've been living under a perpetual rain cloud of sorts, wrestling with medical providers and insurance to get certain bills paid. Navigating the insurance system, especially the medical billing part of it, is a bit like navigating an elaborate maze, one I firmly believe changes monthly, if not weekly.

The option of paying off a small balance because it's easier to do so rather than argue about it with the Powers that Be isn't an option. First of all, there's the principle of it. Secondly, both surgeries left us with more than a half million dollars worth of medical bills from the dozens of medical providers who made up our teams. So paying off each $10 argument rather than following-up with it until they get it right is problematic and too expensive.

Our most recent battle with Mr. Insurance Man was over a bill from the latest surgery, one that required timely attention because of the lateness of the date, and the number of zeros associated with it:

1. For reasons we have yet to grok, one-half of E's surgical team neglected to bill insurance for his part in the February 2006 surgery until 14 months later. 14 months. We weren't talking chump change here. The bill neared $20,000.

2. Finally, after much hounding on our parts (because there's no way we could afford to pay the amount due on our own, because we worried that the insurance company would have every right to refuse to pay based on the fact that the bill came in so late, and because we're the responsible party in the end), the surgeon's office managed to bill us.

3. You'd think this would be the end of it.

4. Think again.

5. Shortly after the paperwork in #2 went through, the insurance company informed us that the surgeon was out of network, and thus we were responsible for the entire amount, minus the appropriate deductibles.

6. After we punched the wall a few times, we called Mr. Insurance Company, and said in a good way:

"Excuse me? Way back before the surgery, we arranged for this surgeon to be included at the in-network rate. In fact YOU called us to say everything was good."

7. Unfortunately, turnover is rampant in the medical insurance world, and the person you talk to today will likely not be the person you talk with next week. And because we've been burned one time too many by reps who neglected to log dates and details of our conversations and agreements, we've learned to take detailed notes about every phone call, including names, dates, decisions, etc. to use when disputes occur.

8. Late last week, after weeks of phone calls and emails (because we have nothing better to do than spend our lives waiting on hold listening to the Stones on Musak, and because we refuse to roll over and let Mr. I-man get away with the shell game), we learned the bill will be paid in full.

Doing the Happy Dance, and intending to channel the relief my muse is feeling into continuing revisions to KM.

edited 4:40 p.m.


Carol B. said...

And who says we don't need health care reform?

Kim Winters said...
This comment has been removed by the author.
Kim Winters said...

Don't even get me started...unless someone knows a Senator looking for someone to testify in committee on this very subject.