July 22, 2008

Insurance Company Rules!!

I don't know much of anything about the organization/website that created this "commercial" so I can't vouch for them, but I have to say that this pretty much sums up how I feel about our health insurance company right now:

A couple of weeks ago we got a call from the ob's office informing us that UC Irvine, the medical center, had cancelled their contract with Aetna, our insurance company, and therefore my doctor and care was no longer covered. By law they're supposed to give us 60 days notice in writing, but since everyone plays by Insurance Company Rules (see above) we had to pay for our genetics appointment (which was the following day) out of pocket with the hope of getting reimbursed from Aetna. The good news is that there's a "continuity of care" clause in the state law that says that if you have certain conditions (pregnancy being one, a terminal illness being another) your insurance company has to continue to pay for your care even if their contracts change. We applied (and were approved with remarkable speed, all things considering) for continuity of care so I can continue seeing my specialist at UCI and will be able to deliver there. So that's good.

But this just opens the door for all kinds of other battles. Our experience over the last 8 years has been that insurance companies (and I'd like to pick on Aetna, but everyone else we've had has done it too) like to quibble over small specifics and deny care or payment at in-network levels seemingly randomly. Much like trumping four aces with a pair of nunchucks. We have also found over the years that as we meet our deductible and out of pocket limits for the year, the insurance company tends to make a lot more "mistakes" in billing. The result is that we have to pore over every statement and bill and pretty much fight for half of the charges, usually over a prolonged period of time.

Perfect example of Insurance Company Rules? Several months ago I passed out at work and was taken to the hospital by ambulance (turned out to be no big deal--this was before I was pregnant). Kevin is still going back and forth with the insurance company because I had the audacity to be picked up by an out-of-network ambulance carrier. They've finally decided to pay most of the bill, but they won't pay for the oxygen that was administered to me because it's an "incidental." That and the little bottle of rum I took from the mini-bar. I guess next time I have a medical emergency I'll call 911 and have them call around to find an in-network ambulance company and go ahead and pass on the supplemental oxygen since my insurance company will probably decide later that I didn't need it.

Posted by Shelby at July 22, 2008 07:45 PM

Oooo...I've beeen there! When I accidentally broke my ankle in 8 places and dislocated it, the ambulance that picked me up took me 10 miles to the Kaiser Hospital in Panorama city. They passed 6 hospitals on the way (one of them Kaiser too). This is a BIG deal when they can't administer pain meds and your foot is on sideways!

Posted by: Sherri at July 23, 2008 05:20 PM

I'm with you on the insurance issues - I was in a car accident two days ago driving for work. I was in Allentown, PA and the EMTs and the firefighers all said that if I felt okay to drive the hour home I should do that and go to my own hospital. Becuase if I got in the ambulance I'd have to go to an Allentown hospital and they didn't recommend that.

Posted by: Mary at July 24, 2008 06:07 AM

Yes, I've been there too. I also had the audacity to have an "out of network" ambulence pick me up a few times as well as an "out of network" Dr. review my x-rays at the radiology center.

Honestly, I think the Canadian system of Socialised (sic) medicine is the way to go (call me unpatriotic.) It's all about profit. The American health care system really takes the "care" out of healthcare.

Posted by: Katrina at July 24, 2008 05:06 PM
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