I'm tired baby. Tired of the insurance run around.
When I saw Michael Moore's movie "Sicko" a couple of months ago, I had no idea I would soon be embroiled in my own insurance battles. Scratch that, I had a feeling. Still, things have been frustrating. My surgery was set, cancelled, set again, and then cancelled again. The first surgery was cancelled due to a bad cold I contracted that left me with a cough. The anesthesiologist wouldn't have it, I had to be symptom free for four weeks.
So, I rescheduled for August. The date was quickly approaching when I got a phone call from the surgeon's office. Poor sweet Pat had to break the news that my insurance had denied coverage because the surgeon I chose was out of network.
Let me clarify, "out of network" does not mean that my insurance doesn't cover this surgeon, just that within the greater insurance network there are apparently multiple networks, and my surgeon and general practitioner were not in the same network.
Ok, so I asked how much it would be if I paid for the surgery myself (some generous friends and family had offered to help me out with this). Pat told me that she would contact the finance department and get back to me with a figure. An hour later, her voice was a little softer, more hesitant.
"Um, you can't pay for the surgery yourself."
Moment of stunned silence.
"So, if my insurance denies coverage, I can't pay for the surgery either?"
"That's right."
"I don't understand."
"I know, neither do we. Apparently your insurance company and the hospital have some kind of contract...(awkward silence)."
"I see. That doesn't make any sense, does it?"
So now I'm pondering the idea of bringing a lawsuit against...well, that's the question isn't it?
Who exactly is responsible for this? The insurance company? The hospital?
Or, I could go to a surgeon in my network. Start the process over.
2 comments:
Ridiculous- and disheartening, especially since so many other surgeries of sometimes questionable medical necessity- are often covered w/much more ease. Not to mention illegal immigrants who specifically come to this country JUST to have babies and try to get citizenship by virtue of having ‘anchor babies’ get FREE medical care.
I’m on the other side of the fence- can’t get insurance w/surgery coverage b/c it’s deemed a pre-existing condition; can’t get most doctors to talk to me b/c I’m NOT insured (those that will talk to me want me to pay HIGH consult fees- which I can’t really afford to go to many consults b/c I do NOT have insurance); and have had hospitals say that I’d have to pay MORE for surgery BECAUSE I’m uninsured. It’s a catch 22 for people w/strabismus it seems. The US medical system is really messed up and makes us seem far less ‘advanced’ than most other nations.
Have you thought of taking your battle w/the insurance co./hospitals public? It would seem like it’s an issue that deserves attention.
ps other cross-eyed celebs (supposedly- i don't really see it in them and many have had surgeries)- paris hilton, jessica alba, matt leinart, wynona ryder, and some others i forget the names of.
Winona Ryder? Definitely don't see it. Paris Hilton I heard had more of a droopy eyelid problem.
Anyway, I haven't considered taking the problem public, well...anymore public than a blog! But I have thought about pursuing a lawsuit. Whatever I decide to do, I need to hop to it!
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