Venting: Fun with Health Insurance

citizens, doctors and dentists, pet peeves

Illustration from iStockPhoto

I’m self-employed. Therefore, I’m self-insured.

I’m pretty healthy, thankfully. I visit a GP once a year for a “wellness” exam, and while I should see a dermatologist every 6 months, I go less frequently than that. I’m pretty adept at avoiding colds, but landed a nasty bronchial bug last winter that included a trip to the doctor’s office for some super-strength cough medicine. My blood pressure is fine, as are my cholesterol levels and whatnot. I carry insurance as, well, insurance. Against the possibility of an Unusual and Drastic Scenario.*

When I started buying my own insurance, back in 2008, my monthly premium was $144, with a rather ridiculous $2000 deductible. Each year, the premium and deductible crept higher. The price of doing business. I wasn’t happy about it, but it was understandable. In November of this year, I noticed that my premium had skyrocketed to $246, so I called to find out what was going on. Surely, I thought, this was some clerical error.

“Ah yes, I see here that we sent you the paperwork regarding new plans, but it was returned. We must have an incorrect address for you.” Well that’s funny, seeing as how my address hasn’t changed the entire time I’ve been doing business with you. I find out that the plan I’m on is no longer “current” and my high premium is a result of being “grandfathered” in to an outdated plan. The rep will transfer me to a Plan Expert who can help me choose a new plan. The helpful Expert and I discuss a few plans, a few prices quotes, and I decide on the $157/month plan for a $4000 deductible. He emails the appropriate Plan Change Request Form, with the instruction to check one particular box, sign, date, and return. And I do, that very afternoon.

A few days later, I receive a voicemail that some information is missing from the Plan Change Request Form. I am to refer to the mailed paperwork (that I never received, if you recall) and call back with the information. I call back, only to get their own voicemail system, telling me that all Experts are in a staff meeting. I leave a message with two phone numbers at which I can be reached, and wait for a return call.

More days go by, and now I receive a letter in the mail (oh look! my address is correct!) that they “have been unable to” reach me, and the missing information is still missing. I call again, speaking this time with a very nice woman who, it turns out, is in a different department. She attempts to connect me through but…all Experts are in a staff meeting. She promises to make a personal plea on my behalf, and I leave another voicemail.

In the meantime, another billing cycle has gone by, and another $246 premium is billed.

Woo, I get a call back! Actually, three in one day. Apparently, their log system doesn’t indicate that anyone has already spoken to me. Or the helpful woman I last spoke with left personal notes on a few desks. Anyway, I explain my story to a new Expert, she explains the missing information, quotes me a slightly higher premium than the previous Expert, and sends me to a web page for more information. The web page spits back at me the same $157 quote as the first Expert, so I fill out the confounded missing information, and return the form. Again. All is well, right?

Today, I received an email with the official “offer” for my new plan. This time, for an outrageous $315.50 per month. There’s something on the documentation about a claim processed for cervicalgia, which seems to be the culprit behind the price hike. Once again, I call.

I explain that I’ve been trying to change my plan since late November. I have lost all patience. I explain that I don’t have cervicalgia, I don’t know what cervicalgia is, and will they please re-review the documents and get. this. straightened. out. Well, they tell me, cervicalgia is quite serious, and it’s right there on my medical records that I was seen for it back in July. July? Why yes, I did see a doctor in July. I pulled a muscle and Advil wasn’t doing the trick. The folks in the office where I was working were very concerned, and had me in a panic with their horror stories of spinal injuries. I saw a doctor, who told me it was nothing serious; to apply heat, rest, and to take a prescribed muscle relaxer for a few days. I don’t think I took it for more than a night or two. “It sounds like it’s probably a coding error,” the insurance people say. I’ll need to request a copy of my medical records from my doctor, and send them in along with my own statement of what took place, and wait for re-evaluation.

Jiminy Christmas!

I call the Records department at my doctor’s office. I get a recording. It suggests I try another phone number, which I do. I get a recording. I look up “cervicalgia” and find out it’s medicalese for “neck pain.” Nothing drastic or serious about it. WebMD doesn’t even bother with a listing for it, and Wikipedia says that 2/3 of adults have it. My insurance company, however, is deeming it serious enough to warrant doubling my insurance premium, so I know that I’m going to need to speak with my doctor one-on-one.

I call the main desk at the doctor’s office, and get a recording. This time, I eventually am transferred to a human being. She tells me that the staff is at lunch, and doesn’t accept messages. I have to call back after 2pm.

::head desk:: ::head desk:: ::head desk::

_____________________________

*Back  in 2003, I was on the receiving end of a nasty car accident. My medical bills were in the thousands, and while the other person’s insurance eventually covered it, they legally have three years to pay out. If my own employer-subsidized health insurance hadn’t covered me in the interim, I’d have been financially destroyed in no time at all.

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