Some insurance lady...
...is probably very uncomfortable right now.We are swimming in medical bills right now. $25,000 so far this year. The usual ones for my son's prosthetic leg ($10,000), plus a bunch of other stuff, (2 broken bones, 5 x-rays, 2 CT scans, and on and on.) Mr. Broken-Jaw's medical bills are already over $10,000, and he hasn't yet even had the surgery to take the bars OFF his mouth.
God was really watching out for us, though. My husband's boss switched everyone over to new insurance in January, and it turns out it is EXCELLENT insurance-- it pays 90%, with a max out-of-pocket for the family of $2,000. We just got an $8,000 bill in the mail today, of which we need to pay $50. It's incredible.
But there's a snag: our flexible spending account.
When they sent us a debit card to use to pay medical bills, I was delighted. In the past, we've paid things out of pocket, then filled out a claim form and got reimbursed months later. How nice, I thought, to just pay with a card.
Not nice. You see, every time you use the card, they ask for a ton of documentation. The documentation I sent on my son's leg was apparently lost. I sent it again via mail AND I faxed the info. Issue resolved? No. We got a second notice, threatening to freeze our account unless we provided an explanation of benefits form.
Now let me explain the moronic stupidity of this. The flexible spending account and the insurance is THE. SAME. COMPANY. All they had to do was look in their computers to get our EOB forms. And now they are saying they will suspend our card if we don't send an EOB.
Nevermind that we'd tried to give them what they'd asked 3 different times. Nevermind that THEY generated the EOB form in the first place!!
I called and tried to talk some logic into some lady this morning, pleading with her to look up the EOB, or to make some note on our file till I could send our copy of the EOB. She stonewalled me repeatedly, saying she wasn't authorized to stop our account from being frozen, and on and on. It was so stupid. I suggested several different ways she could resolve this. But at every turn she was spouting some company line about how she really was trying to help me but that policy was... blah, blah, blah.
And here I am with all these medical bills that I'm planning to pay very soon, because insurance has finally paid their portion and I finally know exactly what we owe. This is NOT the time to have a frozen card!
The conversation ended with me being very impolite and hanging up in tears, which is a reflection on her, not me, thank-you-very-much. I cry like 3 times a year, maybe, and I get mad at strangers even less often. She was just NASTY, even implying we may be trying to wrongfully spend the money in our flexible spending account.
Anyway, I called FearlessHubby at work, spouting the whole sad tale, and gave him NastyLady's name and number. He was righteously offended, and believe you me, he is not a man you want to have angry at you. I am certain NastyLady is having a difficult time as I write this, which fact is causing me immense satisfaction.
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Update: FearlessHubby called and talked to NastyLady's boss, who informed him that the issue has been resolved and that the account is no longer in danger of being frozen.
As long as we can substantiate the next round of bills within 42 days, that is.
Proving that you end up paying one way or another....
posted by owlhaven @ 1:28 PM
13 Comments:
Mary I am so sorry, I HATE insurance! Ever since our HMO was switched to Healthnet we've had nothing but trouble ourselves. It's ridiculous!
I hope everything gets ironed out.
My mom had the same trouble with her flex account--she ended up sending everything in by certified mail--which doesn't make them any happier! Hope it all works out...
I really really dislike insurance companies. I had a c-section for my very large at birth son and the insurance company denied the anesthesia saying it wasn't medically necessary....eventually we won and it was paid but come on? This isn't the stone age.....so I feel for you.....May God enlighten the freaks they get to work there.......
We swim in medical bills here too, and I tell hubby I am sure our insurance company just loves to see our name pop up because I also go over everythign and argue if they are off at all until they make it right.
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How frustrating!!
Wow, it sounds like you have an interesting family. May God continue to bless you for welcoming these children into you home.
Gloryland-- God HAS blessed us, by giving us these kids! (despite the insurance headaches, lol)
Mary
Wow! You have a very small out of pocket max!
As a side note, I assume your son gets a new leg every year? As he grows? I am just wondering since my DH has one and we are starting to look at getting it replaced (it's 7 years old). I don't have the first clue as to how to get insurance to cover it since he wants one a little better than the one he has now. We are worried that they will deny the whole thing, even though it should have been replaced at 3-4 years old.
HATE insurance. Glad yours changed to 90% every bit helps.
I hate it when companies respond to "the husband" but not to "the wife." In this day and age,... really! But it is a sad reality, as is health insurance. Grrr. Glad you got it resolved, anyway.
He has an above the knee amputation. They tried awfully hard to save the knee, 3 actual amputation surgeries just so they could try. The last one was one the one where they realized they wouldn't save it and cut way above the infection just to make sure it was all gone. I think I will have him talk to his prosthetic doctor to see about a prescription. Thank you for the help. :)
Here's a tip: Hubster is a Chiropractor, so I FEEL you pain. It's gotten so bad for doctors, we started sending ALL documentation and bills via Certified Mail WITH Return Reciept Requested. They still try and pull the "We never got that!" with us, but they change tones REAL fast when I say, "Oh, really? I have so-and-so's signature on this little green card that says you did!" Any further problems, you need only bring up that you are tired of their garbage and are going to call your state insurance commissioner and get them involved. As consumers, we've GOT to demand better service from insurance carriers because more and more doctors are wanting to stop accepting insurance at all! I'm so glad you've got decent coverage though, what a blessing!
American medical bills frighten me to no end.
We've been fortunate to not need anything major, although given that we live in Canada and have universal health care, it could be that my idea of major is different. None of my kids cost me anything to give birth to - not even when I was in hospital for 15 days.
How amazing that you have such comprehensive insurance. I hope it all gets sorted out quickly. I hate dealing with insurance companies.
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