Healthcare Headache

January 18, 2019 12:30am
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At the beginning of 2019, we changed health insurance providers through my job.

I’ve pretty much had the same insurance back as far as when I first got it on my own (circa 2004?), so I’ve never had to deal with the special kind of hell that comes with changing insurance and making sure all of your doctors are still covered…

…and getting new pre-authorizations…

So said headache that we’ve been enduring for about three weeks now is due to issues that we’ve been experiencing with therapy for one of the kids. I’ll talk about it more in another post, but basically Christopher has been doing ABA therapy for autism at home since last summer and it’s been really awesome for him … and damn, has it been a pain in the ass getting the insurance coverage transitioned for it.

🙁

Case in point – today was literally his first session this year, and we still don’t entirely have everything worked out yet!

We tried contacting the new insurance company for information about the pre-authorization back in December, but they didn’t even know we were going to have insurance with them yet.

When we finally got the new cards and gave them to our therapy provider, first the paperwork was sent to the wrong company … because our insurance network is one company, but it’s being provided by another company and customer care is handled by a third company!

Because there aren’t already enough middlemen involved with providing healthcare in this country… 😛

Once the paperwork finally got sent to the right place, it turns out that the wrong codes were used … whatever that means.

And then the right codes got submitted, and it sat on somebody’s desk with the insurance company for two days, even though at this point Christopher had been without service for two weeks.

When they finally reviewed and approved it, it took another two days to get it back to our therapy provider because the department’s voicemail box was full for the two people who process these things.

Oh yeah, and when they got the approved documents back, someone discovered that the insurance company had somehow approved 2.5 hours PER YEAR instead of 4 – 6 hours a day FOR THE YEAR.

Grrrrrr…

And guess who got stuck playing connect the dots throughout this whole, entire cherade?!

Sara and I were joking earlier that we didn’t realize we’d be learning about medical billing this week, and quite frankly – we shouldn’t fucking have to!!!

Someone else on either side of this transaction should’ve picked up the ball and ran until not only it was done, but done correctly, too. It kills me that neither party looked at that approval and said, “Wait a minute … 2.5 hours??? That doesn’t sound right!”

By the way, did I mention that we’ve also got my company’s HR department amending the new insurance policy because it wasn’t clear what the limits are for # of sessions allowed in a calendar year???

As I type this right now, I think we’re now on the right track to getting this resolved, but it’s really been wearing the both of us thin. Healthcare is important, and no one should have to jump through this many hoops to ensure that they can get medically necessary treatments for their children.

And all of this was after having to ask the old insurance company to even cover it because it had been omitted from the policy and wasn’t legally required due to a regulatory loophole in how the policy was setup.

I hope that someone in my lifetime fixes this mess … American healthcare in general, that is.

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