As you may recall, I began revealing my poop test woes yesterday.
Friday afternoon, I called my ex health insurance company. Oh, yeah. Maybe I didn't mention that the school switched plans on July 1. But don't you worry about Mrs. Hillbilly Mom. She was fully covered by this company in May, the date of the poop test claim. Good thing I always hang onto the old insurance ID cards for six months or so...
The InsRep tried to make me jump through all the hoops that PoopCoRep prepared me for.
"How can I help you?"
"My poop test claim was denied."
"How do you know that?"
"Because I got a bill for $649 from the Poop Company, showing DENIED by the insurance portion. And also a statement of benefits from insurance showing a payment of ZERO for the claim, which seems to me to be a denial."
"Well, this provider was OUT OF NETWORK, so we applied the charges to your deductible."
"This is the ONLY provider in the world who does this test. So there can't be an IN NETWORK provider."
"Yes, there is no IN NETWORK provider that does this test. The $203.55 applied to your deductible is the allowed amount."
"Allowed by who?"
"By us. The insurance."
"I don't know how you got that amount from $649. There is NO CONTRACT between you and the provider, according to the Poop Company."
"Well, that's because they're OUT OF NETWORK."
"But there is no company IN NETWORK that does this test."
"That is correct."
"So there's no way I could have had this test with an IN NETWORK provider."
"That's right."
"But according to the Affordable Care Act, I have the right to choose whether I want THIS test, or a colonoscopy that might include general anesthesia. Which I didn't want."
"Yes, you have that right. But it is OUT OF NETWORK."
"Yet there was no provider IN NETWORK that could give me this test."
"Correct."
"So if there's no IN NETWORK provider, how can there be an OUT OF NETWORK provider? You can't deny me the only company that can give me this test. According to the Affordable Care Act."
I heard a lot of keyboard clicking and sighing during our conversation. And several interjections of "Oh, come on!" Though I think they were directed at InsRep's computer system, and not at me. He had been polite, in an obstinate kind of way. He was shining me on, blowing me off, poo-pooing my poop test problems. As if trying to shut down my own talking points, while roundaboutly repeating his own. Like he was trying to get rid of me, per policy, by explaining in several different ways, the concept of, 'That's just the way it is.'
I, too, was polite. But I used my stern teacher's voice. You know, the one that says I mean business, I'm not backing down, and I think you're full of...um...poop. I was like a snapping turtle that wouldn't let go, with no thunder on the horizon.
Oh, he was good. I'm pretty sure he caught on that I was voicing the PoopCo talking points from their website. It was an epic battle, worthy of a cheering and jeering crowd in The Colosseum. Perhaps InsRep has a quota to meet each day. He finally heaved one last sigh, and said,
"I will have this claim re-processed at the IN NETWORK level. You will get a written determination within 30 days."
You bet you will. Or deal with a supervisor when I call back. I have your name.
Bob.
Seriously. The worst that can happen is that the insurance company still pays nothing, and I file an appeal off the template on PoopCo's website. Which may or may not help. In which case I would end up paying that $649 anyway. Although PoopCoRep says they work out payment plans, and/or reduce the amount for individuals. It's not like this will break my budget, and make me sell the Mansion and live in a wanker truck down by the creek.
It's the principle of the matter.
I'm pretty sure that the insurance company is none too fond of bandying words with teachers on all their claims for school district clients.
6 comments:
I'm still positive you"ll (probably) win!!
I hate dealing with insurance companies. I feel like they should be working FOR me, since I am paying them. Doesn't work that way. An ambulance took me from my doctor's office because my EKG was abnormal. As you can imagine, there are not an abundance of hospitals to choose from close by, so they took me to the one that could handle a cardiac event that was closest. Because it was out of network, my part of the bill was $40,000. Yes, you read that right. My argument was that, no matter that it was out of network, I still fulfilled my $10,000 deductible and therefore should only owe 20% of the remaining $30,000. They still kept saying "out of network". I suppose they thought they could out-talk me and I would tire, hang up and write a check for the 40 grand and go on about my business. I assured the person on the phone that I would stay on the line all day if necessary and would call back if they chose to hang up on me. I won. My bill was reduced to $16,000 and the hospital settled for half that. It was still a huge amount to have to come up with considering I had insurance.
I think you'll win this one and I also think if enough people do what you have done, there will one day be an IN Network provider for insurance purposes.
fishducky,
I still appreciate your confidence in my vindication!
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Kathy,
That is outrageous. I thought the whole premise of OUT of network was that you pay 80%. That's what it always was on my insurances. You're right, they must have a policy to try to wear people down to pay it all.
Many years ago, Farmer H had a metal plate put in his neck, and with our incompetent mail delivery, I never got the bill until it was 30 days past due and I received the second notice. I called them that day, explaining that we didn't get the bill, and tried to make arrangements to pay over the phone by credit card (which we pay off every month anyway).
That gal CUT THE BILL IN HALF because I was paying right then! The amount escapes me, but I know she took off more than a thousand dollars. She was babbling about how they know it's hard for some people to pay, and they'd take that lesser amount because I was willing to pay THAT DAY.
I told Farmer H that I was insulted, with them acting like we were paupers, and he said, "I don't give a crap! They cut off a thousand dollars!"
You are a very PERSUASIVE negotiator! I'm glad you got through to them. I agree that costs are outrageous, especially after paying those insurance premiums. That's because we're paying for the people who don't have insurance and don't pay.
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River,
My insurance rep found out that PoopCo has since contracted with the insurance company, effect this month, so now they ARE in-network. Not that it helps me, since it's too late, and we don't even have that insurance company any more.
In that case, check with your new insurance company to see if you are covered for your next poop test and for anything else you can think of. Best to know up front and get them to put it in writing with the date on it. And they should let you know if any of that changes for any reason.
River,
I feel like I'm caught in the middle of the insurance company not wanting to pay, and PoopCo having a monopoly on this kind of poop test, and wanting to prove a point to this insurance company. Since there are so many cases of the denial that PoopCo has info on their website helping people appeal.
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