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Tuesday, August 11, 2009

Insurance (insert expletives here)

It's been over 2 months now since my permanent implant was "installed." As of last week, I hadn't seen the final bill yet. I shouldn't have to pay much since I believe I've reached my maximum out-of-pocket for this calendar year ($5,000). Thank goodness for caps on personal insurance expenditures. Anyway, on Thursday I get a call from the billing department of the hospital where the surgery was done. The lady tells me "you have a very large claim with us pending from June."

"Uh, yeah." (ingenious answer, I know.)

"Well your insurance refuses to pay it until they receive a 'Coordination of Benefits' form from you."

"I have no idea what that is."

"It's a piece of paper telling them that you don't have any other insurance coverage, so they are responsible for the entire claim. I tried to tell them that was the case but they won't listen to me. They said they sent you the form..."

"No, I haven't seen anything like that."

"Well, then we have a problem."

Fantastic. I nearly had a heart attack because the bill was $138,000. I don't have that kind of cash just lying around. In fact, I'm pretty sure I've never had that much cash in my life.

Fast forward to Saturday.

Lo and behold, what comes in the mail but the "Coordination of Benefits" form. All I had to do was check a box on there saying that I don't have any other insurance. Really? They couldn't call and ask me that? They couldn't fax me that? But either way, if they had talked to the lady at the hospital on Thursday, and I just got that in the mail on Saturday, I'm pretty sure they didn't even send it to me before they talked to her!

So, I called her back today, told her I had received the form, and put it back in the mail yesterday. Luckily she was very nice and said she'd just put a note on my file to wait on insurance a little longer.

Here's what gets me: part of the reason I spent four months in Chicago trying to get this figured out was becuase I was waiting on insurance approval for this procedure. Did they approve it and forget? Did they approve it and then decide it ended up costing too much? I really thought all this stuff was figured out months ago so it makes me angry to have to deal with it again.

And people think this country's healthcare system doesn't need a kick in the ass...

7 comments:

WinnyNinny PooPoo said...

Wow $138,000!!! I guess the insurance company was just hoping against hope they wouldn't have to pay all of it, and some other company would have to (thus the coordination of benefits form!!)

Diana Lee said...

They'll do absolutely anything to try to get out of paying even the most legitimate of claims. I can't tell you how many times I've had to fill out that form and another form stating I wasn't in an accident. So frustrating.

I found your blog though No Extended Warranty & I'm so glad I did. I'm currently waiting to see if my insurance will approve an ONS for my chronic migraines & occipital neuralgia. I'm not very optimistic, but you never know, I guess.

Banner said...

Well I'm glad to hear I'm not the only one with insurance woes. I figured I'd hit some bumps in the road somewhere but honestly I thought it would be with the pre-approval. I thought once that was done, the road would be smooth the rest of the way. Guess that was naive!

Diana, welcome! Thanks for reading. I hope you find something useful on my blog. If you have any specific questions, let me know and I'll do my best to answer them. Good luck with your ONS. Can I ask where you are having it done? I don't need specifics but I'm curious as to what state, as I'm trying to get small list together of where ONS's are available.

Cori said...

Thank you for writing this blog. I just found it! My dad had the temporary in late July and is getting the permanent put in on September 24th. I'm sure he will be happy to read this blog. He is always looking for information about it on the internet. You went back to work at 3 weeks? That's good, he thinks he will be out for a full six weeks but maybe not. Thanks again for making all of this information available!

-Cori

Dave said...

Hi,

I had my permanent occiptal implant exactly one week ago (July 18th). I am a bit discoraged as I am getting wierd changes in the pulse with the slightest move of my head. Also going of Lyrica which has left me kinda depressed.

Anyway, it would be awesome if you could email me with some answers to my questions. I live in Philadelphi and had the procedure done here. My email is tuberadio1@gmail.com. Thanks.

Anonymous said...

Does anyone know what insurance will pay for the ONS? I know someone who had the temp placed and it really worked. Then they removed the temp and were going to do the permanent but her insurance would not pay.
Thanks for any help you can provide.

Banner said...

I have Blue Cross Blue Shield and they paid for mine (aside from the few issues I've mentioned). I have never asked anyone else what type of insurance they have.