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Health Care Issues Hitting Home

First, it's the Pookie's 2 month birthday! Things are finally feeling pretty good from my perspective, I hope he feels the same. I'll write more about how we are doing later, but I don't know how long my internet connection will last right now. So this will probably be short. Instead of complaining about the cable company and/or my lame computer, I will touch on my frustration with my insurance company.

When the Pumpkin was born, I had registered for the hospital online before her birth, even receiving a confirmation email. Of course, after she was born, they didn't have my registration information. And the couple of times they came by my recovery room to get the insurance information, Londo was out of the room getting food or something. Londo had the insurance card, and I was in the new mother overwhelmed stage.

The hospital ended up sending the full bill to a collection company instead of following up with us for the insurance information. Because we weren't busy or feeling crazy with our first brand new baby. When I was finally feeling coherent enough to deal with it, I figured out what had happened by talking with a very nice and helpful guy at the collection company. He was instrumental in helping me figure out why the insurance wasn't charged and how to get it run through the insurance. We had to send in a check for the amount of the birth (crazy expensive!!!), but we got reimbursed by the insurance company. Eventually.

This time, I made sure they had our registration and insurance information ahead of time. I didn't want to go through all that again. But of course it didn't go smoothly. Just this morning I had to call the insurance to find out why they weren't covering all of the anesthesia costs that they should be covering. It turns out that the claims for anesthesia were submitted incorrectly. They were submitted as a hospital visit, not under maternity. Huh? Whatever. They are going to resubmit them and pay more on them.

But that got me wondering about the doctor's charges (separate from the anesthesia charge) that we paid as we left the hospital (again to avoid having to deal with all we went through before). I'm guessing that those claims were submitted wrong, too. I am now going to have to call the insurance company again to check the doctor's claims too.

Is this their job? To submit claims correctly? To double check that the claims are correct? To cover our medical bills with as little hassle as possible? Isn't this why we and my company pay so much each month to them? We don't have the money to keep paying out of pocket things they should be covering!

I'm so frustrated, and I'm a little busy taking care of my newborn. Isn't insurance great? Urg!


Anonymous said…
is it the hospital who is submitting bills to the insurance company for reimbursement incorrectly or is it the insurance company? From what you described it sounds like the hospital's fault
caramama said…
Hmmm. It does sound like the issues were on the hospital side--for both deliveries! You'd think the hospital didn't deliver dozens of babies every few days, and submit claims for them. Maybe it's some larger conspiracy...
Cloud said…
What a pain.

I had a really surreal experience when I decided to start trying to get pregnant with Pumpkin. My doctor switched my asthma meds to something safer for pregnancy, but my insurance wouldn't cover it because I wasn't pregnant. I'd explain that I didn't know when I would get pregnant, and my doctor had recommended I switch to the different inhaler as soon as I went off birth control. And the insurance people would tell me that they couldn't cover it because it was only on the formulary for pregnant women. I would explain that I was trying to become a pregnant woman. And they would say I could call back when I got pregnant.

I eventually gave up and paid for the prescription out of pocket until I got pregnant.

This is the sort of thing that makes me look at people who are worried we'll "break" our health care system with reform. I think it is already pretty dysfunctional.
Shellie said…
Don't get me started.... Health care reform has GOT to involve insurance reform. They are as bad as any government agency.
-goofydaddy said…
all health care should be run like Kaiser Permanente.
Becoming Mommy said…
Sounds like your hospital's billing office is seriously screwing up.

As for insurance, don't get me started. It's aweful, they do anything they can to NOT pay, and if only you could successfully sue them, I'd get $K's back from a little hospitalization they said was "unnecessary"

I had a 106F fever, blood poisoning, and my bp was so low that they had to put me on a tilt table to measure it.

No...I was fine to wait a week for a GP appt. ::roll::
caramama said…
I had Kaiser Permanente for most of my life, and the thing about them was that they were great as long as you were healthy. Once I had a problem that was difficult to diagnose (with my hip), they were a PIA. So I'm not sure I'd be happy if all health care was run like them, since I've had other problems since then.
ImpostorMom said…
holy crap you had to pay out of pocket for the Pumpkin's birth?!! I am impressed. I've seen the bills I got from Boog's birth and there ain't no way I could have written a check for that, reimbursement or not.

Overall, insurance does suck, especially the bureaucracy of it all. When Boog was 1 month old and colicky I went to get a prescription filled for Zantac for him and I was informed that he wasn't covered on my insurance. Talk about flipping out. I knew good and well that I had mailed the paperwork AND the premium to my office 3 days after we were home. I knew this because the trip to the mailbox was a momentous occasion seeing as it was the first time I'd been out of the house in 3 days.

The problem with that was with my office. All that lovely paperwork was sitting on someone's desk at our home office. Argh, I had words with them. Post-partum, sleep deprived, colicky baby words. They were not pretty.
Hua said…
You would think that for what we pay, these insurance companies would step up their game. Reimbursement is such a headache.
I became an expert in dealing with billing nightmares for insurance after matthew was born. I spent probably a couple of hours a week on the phone with someone or another.
Calling the insurance to find out what when wrong and what should have happened then calling the dr. to tell them what to do, then following up with EVERYONE! I had to know our coverage inside and out and fight for each visit including the hospital.
It is a bit better now, we have slightly better insurance but I still end up calling and making sure everyone is doing their job properly.
What I learned was each time to make sure there was a crying baby in the background (lots of sympathy) and always act like you KNOW it is the other person's (hospital if you are on the insurance) fault but you are just trying to help things along.

But yeah I could go for a single payer plan... at least it wouldn't be so much WORK all of the time!

So sorry you had to go through that AGAIN!

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