Insurance Debacles

When you’re the sick, the last thing you want to do is fight with your insurance company. You’re tired, fatigued. You don’t have the energy to spend thirty minutes to an hour on the phone haggling with someone who doesn’t have the authority to do anything for you anyway. The truly disgusting part is – they count on that.

While at work on Thursday, a notice popped up in my email: You have a timely message waiting for you from Humana.

I assumed it was another routine “we’ve processed a claim for you” email but decided to check it out anyway. The last two weeks had been exceptionally difficult ones for me and I’d seen my neurologist several times before she referred me to both a pain management clinic here in town and a headache specialist in Houston. (My parting impression: she’s run out of ideas and apparently I’m someone else’s problem now.)

Turns out, the message from my dear insurance company was informing me that my last visit to my doctor wasn’t fully covered by my $50 specialist co-pay. While at the office, for lack of anything else to try, she suggested an injection in the back of my head. I agreed since we had already attempted multiple IVs, IM-shots, investigatory blood work and even a cervical X-ray of my neck to no avail. The shot (an occipital nerve block) worked for my newest pain, which had begun at the back of my head in the last month or so, for about 24 hours but did little to touch my original migraine. And now, my insurance company was informing me that the 5 second injection – that one little shot – was a surgical procedure and therefore my $5K deductible applied on top of the $50 office visit co-pay.

Now, I work in health care. I understand the puny reimbursement rates doctors receive from insurance companies if they bill with an injection + drugs type of billing code. But, I never dreamed this type of injection could possibly be considered a surgical procedure.

The bottom line? I’ve spent over $2K on co-pays, Rxs, and an MRI in four months attempting to “break” this migraine cycle. None of this applies to my deductible or my max out of pocket. And, after thirty minutes on the phone, I just didn’t have the strength to argue any more. Makes me wonder though – what’s the point of having insurance?

4 thoughts on “Insurance Debacles

  1. I’m so sorry you’re going thru this. I think they count on these tactics to delay payment as long as possible, even indefinitely. They know sick people (and their families) don’t have the energy to deal with this kind of stuff and count on us giving up.

    I’m going thru a similar situation myself. We’ve been fighting and fighting it for months because altho chiropractic care is covered, they’ve decided it’s not ‘necessary’ for me (despite doctor’s letters) and are taking the money from “wellness dollars”. I was just informed that my wellness dollars are now gone and the claims have been denied. Now I have no way to fight the cervicogenic pain that triggers Migraine attacks and now have no way to get some of the other medical testing I need done because of their underhanded policy of putting some of the testing as “wellness testing” despite the reason for the tests.

    ugh.

    Hang in there. You’re surely not alone!

  2. Oh man would I be appealing that baby! First of all – you were in your doctors office – NOT a sugical setting, which by you working in healthcare, you are aware of.

    Second – I would put it back on the doctors office for not preauthorizing the exam. They should know what needs to be done in their office to get things covered and not come to an “out of pocket” for the patient.

    I work with insurance too – so yeah, they try every trick in the book not to pay. I would keep appealing until the cows come home to get them to pay it. It’s not fair that you should have to pay out of pocket for something like this. Also – as I’m sure you’ve already done – reread your policy….then again, if it’s anything like MY insurance, we don’t even get copies of our policy anymore without requesting it…duh! Of course I’d like that, thank you!!!

    Good luck!

  3. Ellen, I am so sorry to hear of your troubles. I sincerely hope your doctors find a way to help you get the medically necessary treatments your insurance company feels disinclined to pay. It amazes me how an insurance company can believe it knows more about what’s medically necessary than a doctor or a hospital!

    Eileen, I too find it frustrating how difficult it has become to get a copy of one’s own health insurance policy. I had a company once where I requested it four times in two months. It eventually showed up – after I dropped the company and went with someone else!

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