Evil — Or Just Incompetent?
Because, of course!
So, of course I need more drama in my life right now…
Just 6 days to go until surgery (and just 2 days before we make the drive), and I got a dreadful email from the hospital in Seattle saying, “I’m sorry but I just received word that your insurance plan denied surgery.”
I’d just barely woken up from a painful “crash” when I read that this afternoon.
I almost had to laugh. Because it’s just one more ridiculous hiccup in this long journey to get past MALS.
10 years to get diagnosed, seeing dozens and dozens of doctors and spending a massive amount of money…
After diagnosis last October, endless hoops to jump through to get a surgeon and surgery date…
A 1,000 mile drive to Los Angeles for surgery last December only to have the surgery cancelled at the last minute. And then 1,000 mile drive back home…
Two more months of jumping through hoops to get a celiac plexus block and a surgery date in Seattle — only to have the finish line move again!
Such a fine line between tragedy and comedy!
I wasn’t too upset about the news. I knew that I’d be going through with the surgery no matter what, insurance be damned. I don’t care if I have to make monthly payments for the rest of my life — I’m getting this surgery!
Doing Their Job For Them
If you know me at all, you know that research is my thing. (In the Myers-Briggs personality type indicator, I’m an INFJ. That means I’m an “extroverted feeler” and an “introverted thinker” — or “Ti” for short. That Ti part of me will chase data analysis and research down the rabbit hole forever for the pure joy of understanding the full picture of a topic.)
So I’d definitely done my insurance homework a long time ago. But to confirm, I called the hospital to ask why surgery was denied. Then I looked up everything on my insurance provider’s listing and — yep, my surgeon and hospital are covered.
Then I called the insurance company and waited on hold while they looked up what I already knew.
“Yes, your surgeon and hospital are covered. But let me pass you to another department to see what’s going on.”
Wait on hold again. Then told by a different person, “Sorry, your insurance doesn’t cover that hospital.”
“Well,” I replied kindly, “yes it does. I called my insurance prior to scheduling my surgery and confirmed it. And the hospital is listed on the provider directory. And the previous person I just talked to on this phone call confirmed that everything is covered.”
“Okay. Please hold and we’ll look again.”
Finally, they came back and apologized. When they looked up my hospital, they were looking only within 100 miles of my home ZIP code. But I’m having to travel to Seattle, which is 175 miles away.
Bottom line: the hospital is still covered. The insurance employees just don’t know how to use their own system. I don’t mean to pat myself on the back, but even I figured out how to remove the distance filter, and I don’t work there.
So, no worries. Surgery is still moving forward and is still covered by insurance!
Lesson Learned: Keep Going
If you’ve ever had significant health issues, I’m sure you’ve probably run into the same types of ridiculous claim denials and what feels like a “run around” sometimes.
Are insurance companies evil or just incompetent? Sometimes it feels like both.
But the people who work there are human, too. I prefer to think that they’re not out to make our lives miserable for patients who are already struggling. But… come on. Help us out a little?
Hopefully, you don’t ever have to play the “insurance denied” game. But if you do, don’t give up too easily!