Friday, June 17, 2011

Full Time Job

Through this whole crazy stay in "Hotel Melanoma" I've experienced issues with my insurance company. Almost every time I go see a doctor, which y'all know is often, I have to call my good friends "And.Them." and explain to them that they have my medical records on file, and yes, I am positive my melanoma is not a pre-existing condition.

Normally--after a nice battle--the problem is solved.

Last week I had to call because I had received an updated Explanation of Benefits stating that And.Them had decided to still deny my anesthesia for the surgery I had in January. Here's the best part: they paid for the operation! I guess And.Them thought I should be awake while being cut in 5 areas. When I called the Customer Service Rep, I laughed after I explained my problem. She said, "I see no problem with getting that corrected." I would hope not...

Today I had to call Memorial Sloan Kettering to see why I owed them $1,727 for my office visit on April 22nd. I knew I had not had anything major done that day, it was just a check-up & signing trial papers! When I called MSK this morning, the patient services rep informed me that And.Them had denied my blood work. My first thought was, Wow! A session with the vampires is $1,727..Geeze! Then I got mad. Denying blood work to a cancer patient seems a bit cruel to me. Blood work is extremely important in monitoring my health...especially now where I am possibly receiving Ipi! The claim simply said that the blood work was a "Non Covered Charge." I thanked the not-very-helpful girl and hung up the phone.

On to my next phone call...When I was initially connected to the very nice customer rep at And.Them she could not find the claim for the service date April 22nd. After some hunting, she found it, and informed me that the provider had already been paid. When I explained that I had just talked to the hospital, she pulled up the details, and said that And.Them had paid MSK $1,600 for service date April 22, 2011. She explained that the claim had been denied at first, but that it had been reprocessed and the provider should have received payment by now. I thanked her for being the friendliest And.Them rep. I have encountered and  I hung up.

Time to call MSK again...I received a much more helpful patient rep. who informed me that they had not received payment from And.Them yet but to give it time. He noted my account, and told me someone would be in touch.

Now we wait...Did And.Them pay? Time will tell.

*I say this after every rant against my insurance company, but I honestly do not know how they get away with the things they do. I got lucky this time. The problem had already (hopefully) been fixed prior to my phone call. But what about all the patients who are too ill to call and fight for themselves? What about the folks who would rather pay thousands of dollars towards medical bills that should have been paid than argue with their company? I just hate that so many people are taken advantage of simply because they can be. I understand that it is intimidating to fight for yourself. Those people get paid to make you feel like an idiot. But we have insuance for a reason! It infuriates me, but what can I do about it? Nothing.

Rant against And.Them is over for today...

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