Insurance woes

medical

Ok, I don’t like my kids to use the word hate, so I really intensely dislike insurance companies. I view it as legalized gambling. It seems as soon as you have a claim-which in my understanding is the reason you carry insurance — your rates go up. If you don’t make a claim, you just continue to line the pockets of the stockholders, or pay for the claims of others.

More than homeowners or car insurance, however, I really, really intensely dislike medical insurance companies. Ours is just priceless when it comes to paying. When Ben had his cochlear implant surgery they deemed that facial nerve monitoring was considered experimental so they refused to pay that part of the bill. Oh sure…experimental. The facial nerve runs right next to where the dr. needs to drill, but making sure we don’t hit the facial nerve is experimental. Puhhhleeeze. We appealed. They refused. We appealed again. They refused to pay a second time. Exactly one day after the second refusal letter saying our appeal was denied, I got a check in the mail for $900.00 which was the exact amount of the bill. I ran it to the bank that very afternoon and deposited before the right hand of my insurance company figured out what the left hand was doing. Hmmm..my second letter was marked as cc’d to the State Insurance Board even though I didn’t really send it to them. Wonder if that made a difference.

In January, our lovely insurance company shocked me by deeming a new, upgraded external processor for Ben’s implant was medically necessary. This after a simple letter from our audiologist explaining why it was necessary. Understand that usually one letter is never enough with insurance companies. I am convinced they hire someone to open their mail at the medical review department who happily stamps “denied” on every first letter that is sent. From what I have seen, endurance is the name of the game with insurance companies and they hope you burn out before they do when it comes to appeals.

They also make you present new evidence with each appeal, so it becomes a game. Don’t put all your eggs in one basket and send 2 or 3 letters to present your case the first time around. They will just deny it and then you have no ammo left for the next go-round when you need to send an appeal of their denial. I envsion their review department going out to Happy Hour on Fridays, bringing the letters of the foolish people who tried to present their case thoroughly the first time and laughing that these poor suckers now have no hope for an appeal.

Well, after ecstatically ordering my son’s new processor–a huge chunk of change– based on their letter, I got a letter yesterday. Same type of form letter, pretty much identically worded to the January letter. Except…this one stated that “although this is neither an approval or denial it appears that the upgrade is NOT medically necessary.” Alrighty, then…it was medically necessary in January but not in March? Or is it only necessary in months that end in a Y and I should wait to appeal in May or July?

I firmly believe in likening scriptures to my own life, but never knew that 2 Timothy 4:7, “I have fought a good fight, I have finished my course, I have kept the faith” would apply in my life when it came to insurance appeals. After my brief tantrum yesterday, I have tried to pray for a calm, clear thinking head. Knowing that this technology could really improve Ben’s hearing abilities, I have asked my Heavenly Father to guide my thoughts and help me to calm down. The words, “Be still and know that I am God” come to mind, so I am determined to do just that. I’ll do what I can for appeals, but leave the final results in God’s hands. After all, He knows the end from the beginning and has perfect timing. It’s my faith in that process on which I need to work.

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1 Comment

Filed under medical costs, Religion

One response to “Insurance woes

  1. Pingback: Insurance companies make me laugh « Are We Having Fun Yet?

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