Monday, April 05, 2010

You wonder why people hate insurance companies?

My husband can't breathe.

Early in our marriage, he used to joke that even his breathing was annoying to me....which was kind of true.

You see, I grew up learning to be perfectly silent at the symphony...At 10 years old, I could unwrap a pack of Velamints during Beethoven's 5th without being detected by the snootiest of Arts patrons. So when we were sitting in church, or on the couch, or watching a movie, and I could hear the exhaling or whistling with each breath he took, I might give him and elbow, or a slight head-turn...

He's tried breathe-right strips at night, different sprays and decongestants, steam treatments, and many more things over the years. Recently, one of his doctors suggested fixing a deviated septum that has been restricting the flow of oxygen. Finding a solution to this ongoing issue has been pretty exciting for him, but I'm never excited about more surgeries. Of course, the cost is an issue, as well as the risk, but we went ahead with the next step and called Blue Cross Blue Shield to investigate the coverage.

Here's an exerpt from the letter they sent in response:
"Based on the documentation submitted, 30420 for Rhinoplasty meets medical policy criteria. This plan does provide coverage for this service."

Well, great! That's what we wanted to hear, right?

"However, predetermination of benefits does not guarantee payment. Benefits are always subject to other applicable requirements such as limitations and exclusions..."

Um, you won't cover it? Or you're just not sure? Were you gonna let us know what "limitations and exclusions" might apply to us? Cause that's kinda why we called we would know. But this letter is sort of a non-answer to our question.

Seriously, could they have been any more unhelpful?


Anonymous said...

what? looks like you'll be making another call!

Jill said...

I had issues with Mari's insurance when I changed jobs shortly after bringing her home. Because she had not been covered for 12 months before starting that insurance (you know - cause she was in Ethiopa), she was slapped with a pre-existing clause. Only I wasn't told that until 9 months later when the bills started rolling in....took over 12 months to straighten out - it was a mess!

Anyway, before I knew about the pre-existing, Mari needed ear tubes. She had a PRE-AUTHORIZATION for this. But then they denied her after the fact. When I called, I asked why they gave me a pre-auth if they weren't going to cover it and they said "we can't evaluate the coverage of claims until they are submitted to us." In other words, we opted to have an elective procedure that you pre-approved us for but you didn't tell us that you might not pay for it because my child spent the first 9 months of her life in an orphanage. Thanks Blue Cross!

BTW - Good Luck!

Mamushsky World Headquarters said...

First of all, I meant to comment about how I appreciated your post re: all the healthcare legislation reaction craziness.

This example of the insurance company nonsense is exactly why I support change whether it may be exactly how I desire it or via baby steps that simply apply pressure for even better ideas.

Sorry you are experiencing this! Grrrrrrrrr