Wednesday, February 21, 2007

The One Where I Rant!!

There are many things to like about my job and working for a big innercity hospital, but one of my favorites is that I have nothing to do with insurance. We take all comers and someone else deals with insurance. Now as a patient, I am having to deal with insurance and it STINKS! Before going to Sloan Kettering for any of my evaluations, I had to call to make sure that insurance would cover it. I had three phone conversations with three different insurance people who all said different things, but the jist was the same- they are contracted with the parent company for my insurance so it should be no problem in the big picture but the out of pocket maximum might be different. I was OK with these facts so we proceeded, and I even made it through the private hospitals wallet biopsy. So no problem, right, WRONG. We got a notice from the insurance my dad had when he was working (he retired years ago) under which I was covered until 1995, (Yes, folks 1995, ie. over a decade ago, not to mention that I have had about 4 insurance carriers since then) saying that they have rejected the bill for my hospitalization. Hello people. How did they even get this information and better yet why are all of the doctors bills proceeding correctly. Strange- So, I am now spending countless hours trying to figure this out. The really weird part is that the hospital seems to have no record of sending bills to this company and can't even match the amounts. I have gotten all of this information with only 2 hours on the phone. I can hardly wait to see how many hours it will take before this is fixed. Help!!

5 comments:

Bob said...

I read your post about your hospital bills. What caught my eye was your statement about passing the hospital's "wallet biopsy". I don't normally send info like this over a block, but thought you might appreciate a pair of items my company sells:

http://www.cafepress.com/bobmccarty/2276655

http://www.cafepress.com/bobmccarty/2276852

Enjoy and good luck with your bills, doc.

Anonymous said...

Good luck to you with the insurance. YOu need to be sure to keep all of your fact documented, like I am sure you have. These companie are programmed to spew out rejections. I had to jump through every hoop and quote note after note, and finally sited state statute (that fortunately I had worked on) to get Jackson's birth covered. I am sure I told you the delimna of mom on one insurance, baby on dad's and dad's insurance change in the middle of the hospital state. Not fun, but in the end, I won, and only had to pay the 1 pediatrician visit because his pediatrician is on the NEW insurance, and she came to see him on his second day of life, the LAST day on the OLD insurance. I finally got the docs office to submit the bills separately, so new insurance paid visit 2 & 3, and I paid visit 1.

My grandmother fought with MEdicare for 3 years on her cancer of the mouth surgery because they insisted it was "dental". The irony was that if it had been more invasive, they would have paid it all with out question. She won. Three years later.

I ramble because I am so tired.....

suz

Anonymous said...

Dear Lisa:
Keep after these folks. After Bard's anuerysm surgery and then massive stroke in the recovery room, our insurance decided not to pay. In the midst of our agony over our destroyed future, the hospital notified me that they were putting a lien on on our home! The CEO of the hospital had a daughter who was in Bard's high school history class at the time, so I called him for help. He said, "not to worry" and we never heard another word from anyone ever again.
So, call in all your markers and go to the top for help.
Mary Jane

Dolores and Harvey said...

Lisa,

Here is a suggestion that might solve your insurance issues, although I have never tried it myself. INDENTITY THEFT! The next time you go to a Starbucks with your dad, leave your social security card on the table. Someone will come along and take it, steal your identity and inherit all your bills. Is that thinking "outside of the box" or what?
Harvey (Dolores gets no credit for this one.)

Lisa said...

I love the identity theft comment,Harvey. It made me literally laugh out loud. I'm not sure if I'm that desparate yet, but it is something to keep in mind.