Tuesday, February 3, 2009

my insurance sucks.


seeing as how i had to take an entire afternoon to come home, call insurance companies, hospitals, dr's, undereducated telephone operators and fight while pacing back and forth and stomp around through the house i need to rant.....

just a disclaimer: this is really long and maybe offensive to some. and for the record, as crappy as it is- i am still very thankful to have any insurance at all. i know many people don't.

i became pregnant at the end of may. i went to the dr for the first time during june. at the drs appointment i was told that i would be responsible for a $350 portion of the maternity dr apt and delivery package. the grand total being around $3000( and not included lab work, ultra sounds, hospital stay blah. blah. blah....the end actual cost for a routine full blown healthy pregnancy/delivery is around $10,000... we should end up being responsible for about $1000.) i was totally prepared for this and figured we'd end up paying around 10% of the total cost. so i paid and they sent the balance to the insurance.

i've also been getting little bills here and there for our 10%ish portion of things that the insurance hasn't covered: lab work, ultra sounds (and those other pre mentioned things.) i've been doing exactly what i am asked to do by both my insurance and the medical billing people.
today, at my nearly 37 week appointment, i am given all of the information to preregister at the hospital and to contact our pediatrican about coming to check & release the baby from the hospital.

so i call my insurance and find out that i was suppose to call in and register for some kind of babytime program with them, which would have waived all deductibles and covered an additional $500 of the babys health care for the dirst year. this was suppose to be done by the 16th week of pregnancy, but this is the first freaking time i've even been informed of it. (even though the insurance is well aware that i am pregnant and have been paying my deductibles all along.) if we owe any health providers money, we hear about it right away. but when they have information that we should have been informed of, they wait until Jupiter is properly aligned with Mars before getting it to us. it seriously reminds me of the scene out of the incredibles when mr. incredible is working for the shady insurance company.

so basically, since i no longer qualify for babytime, all the insurance is willing to cover for the new baby once she is born, is one well child check per year. if you've had an infant, you understand that you take the baby to the pediatricain at 2 weeks, 2 months, 4 months, 6months on and on... and every time their eyes cross or they're poop smells funny for check ups, immunizations etc. to make it even worse, when the pediatrican does show up after the baby is born to check and release her from the hospital, that will be considered the once yearly check up they cover. thats right. and she will qualify for a second pediatrician visit again...in about a year. so any visit after that will be our responsibility 100%. unless of course, we claim that she has a cold or tempeture or sore throat or any other kind of ailment. we basically have to lie about what we are taking her in for to have it covered. because preventative medicine/check ups will not be covered. unfortunatly, we just didn't sign up for the babytime-program-we-had-no-clue-about in time.
we already pay a fortune for our insurance every year. its expensive and we pay the deductibles and left over differences and balances. the rates go up and up every year while the coverage gets crappier and crappier. we are healthy people who rarely have to go to the dr..... we don't go to the dr at the drop of a cold or flu symptom, we try to avoid a careless self-incfliting-disease lifestyle, we exercise and take vitamins, we don't smoke and get lung cancer, we aren't obese and cause issues like heart conditions and diabetes (i understand that some people get these for other reasons as well, but we do our best to avoid causing them)..... we basically just need insurance for obvious reasons like emergencies, having babies and preventative yearly check ups.

what cracks me up is that our dental coverage is amazing! we hardly ever pay a dime and the insurance is willing to pay for 2 full blown check ups and xrays ever year! along with any fillings, root canals, whitening, etc, etc.

...and this is why i can't stand insurance and it makes me irrate to see so many morons free loading off of the government while i get to pay for my own insurance AND theirs and my families not even getting proper health care!!!! (..anybody see the movie idiocracy? you really should.) and why is it that people on state and federal welfare programs aren't responsible for some kind of copay or deductibe?!?!?! i'm not a fan of universal health care. the theory sounds great, but i don't see how it would work. but this is ridiculous. maybe our baby will end up unimmunized simply due to the fact that it's freaking expensive and uncovered. i guess i'll do some research on the benefits of that.

despite hours upon hours upon hours of calling, nothing seems to be resolved. i seriously must have talked to about 15 different people. one of them just hung up on me and another one suggested i just take the newborn down to the state welfare clinic where the visits are a bargain at around $90 + the cost of each and every immunization, for her 2 wk, 2month, 4month, etc. checkups. hmmm, ummmmm, no thanks.

some nice lady from premera named dee, after putting me on hold for 5 minutes, promised me she would see what she could do and call me back this afternoon. honestly, i seriously doubt i will be hearing from her again.

you should be ashamed of yourselves premera blue cross.
i am now mentally exhausted from thinking about this bull-caca, and i have gained nothing from it. :(

this is just a crying shame...
but this cracks me up.
some genius wrote it and i highly reccomend you read it:

CEO: Jenkins here has a proposal for us on how we can increase profits this year.

OVERPAID SYCOPHANT: Why do we need to increase profits? We're already up fifty percent from last year.

CFO: Last week we voted to increase our bonuses by seventy-five percent, so we're actually in the hole.

OP: I see. Then it makes sense.

CEO: Jenkins?

JENKINS: A careful review of claims paid on prescription medications last year shows that several hundred people got approved for antihistamine eye-drops, which cost about a hundred dollars a bottle and last roughly three months.

OP: So it's about $33 a month?

JENKINS: That's right.

OP: And how much does the average claimant pay us every month?

JENKINS: The family plans are about $1,800 a month.
OP: So we're making a ton.

CFO: Pay attention, boy.

JENKINS: As I was saying, if we deny all these claims, our revenue increases substantially.

OP: I'm sorry. I'm not getting this. How can we justify denying the claims?

JENKINS: We issue a statement that we strongly recommend the use of over-the-counter eye drops for this condition. Of course, since we don't cover any over-the-counter meds, it costs us nothing.

OP: Do the over-the-counter drops work?

JENKINS: Mm ... no.

OP: Not at all?

JENKINS: Well, they work at least as well as plain water, so that's a plus.

OP: How can we get away with that?

CEO: Actually we can't, but we can create such massive obstacles almost no one will be able to figure out how to file. Is that right, Jenkins?

JENKINS: On the nose, boss. Here's how it works. When a pharmacy calls to find out if the eye-drops are covered, we don't say yes or no. We simply say, "Anthem recommends the use of over-the-counter medication for this condition." About fifty percent of all pharmacists will take this at face value and break the news to the customer, who will either buy the over-the-counter drops ...


OP: Which don't work?

JENKINS: (continues) Or decide to pay the full price for the prescription with their own money.

CFO: And the other fifty percent?

JENKINS: The other fifty percent will call us.OP: And then we'll approve?(Laughter all around the table.)

JENKINS: Hardly. Our operators will be instructed to tell the pharmacist that the claimant has to phone us directly to get an override.(More laughter.)


OP: What's so funny?

CEO: There is no such thing as an override!

JENKINS: That's right. But again, about fifty percent of the claimants who call will hang up in disgust before finding that out, because we'll keep them on hold for twenty-five minutes.

CFO: Is that long enough?

JENKINS: Usually. Those who hang on for the full time will be told their doctor has to call.

CEO: Brilliant!

JENKINS: But wait. It gets better. The doctor has to call a special division at Anthem called the Prior Authorization Unit.

CFO: Prior Authorization Unit? I don't know, Jenkins. How much would it cost to set up something like that?

JENKINS: That's the beauty part. All calls to the Prior Authorization Unit will be routed to Tina in accounting.

OP: Who's Tina?

CFO: She's the redhead who works for the brunette who works for Bob, Jack Greed's assistant.

CEO: No she's not. She's the blonde who sits behind the redhead.

JENKINS: Actually, she's the girl who sits next to the blonde who sits behind the redhead who works for the brunette who works for Jack Greed's assistant, Bob.

OP: And what will Tina say when she fields these calls from the eye doctors?

JENKINS: We doubt anyone will ever get that far.

OP: But if they do?

JENKINS: They'll be put on hold.

the end.

7 comments:

Arah said...

Ah, that SUCKS!
We are looking for health insurance, I will avoid Premera.
Also, thanks for the extra things to add to my list, for some reason, it published when I wasn't even done with it. It's finished now.

Josh n Betsie said...

man you need a new health insurance. We have cigna and its great

Forever Young said...

Absolutely sick, disgusting, and sadly true.

Kera said...

its like when I asked my doctor if there was something I could take for my morning sickness because I was throwing up 10 times a day and she gave me the complete run around!! eventually writing a prescription for the stuff SHE took her whole pregnancy which saved her life... later she tells me insurance companies don't like her recommending that one because its more expensive. gag. its all messed up it really is. people who don't work get full coverage and people who do have to take it up the rear.

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Anonymous said...

premera blue cross sucks. They don't care about anything but the bottom line, avoice them at all costs. go to Regence or any othe rinsurance company