Monday, December 27, 2010

And I believed her!

Some of this post might be considered an overshare, so don't read if you are sensitive to that sort of thing. Also, I realize that this will automatically repost on Tyler's Facebook page so Note: this is Amanda typing.

I've asked my mom, mother of 7, why she had so many children. At different times in my life, I've received different answers. One time, she said, "I just couldn't turn it off. Every time I turned around, I was pregnant again." I think I was a teenager, or maybe in my early 20's because I answered, "you know mom, they have things that you can do to take care of that problem."

And now, here I am, 3 kids in 4 years later because I just couldn't turn it off. Something had to be done, so I decided to get an IUD. My doctor, whom I know and love, told me that her office no longer stocks Mirena because they cost $800 and they were losing too much money on them. So, if I wanted one, I would have to buy it myself, have it shipped to her office, and they would put it in. She made it seem like no big deal. I called Blue Cross to see if such a thing were possible, and the lady on the phone actually said, "Oh Yeah! That's FINE. Just go online and fill out forms X, Y, and Z and send in a copy of such and such paper and we'll send you a check." I was apprehensive because it seemed all too easy, but she was so confident that this would be no problem; she knew which papers to fill out, what to photo copy, she used sentences like, "ask your provider for a copy of the superbill." Surely this woman knew which way was up.

I called CVS/Caremark and ordered the thing, had it sent to the office, they put it in. I filled out form X, Y, and Z, made the appropriate photo copies, and sent it all in. I waited. And waited. Meanwhile, CVS/Caremark was deducting $35 a month from my account and would continue doing so until I paid them $800. I received a notice from Blue Cross stating that my claim was denied. Excuse me?

I called and an hour on the phone later, got it all sorted out. Did I mention that this was in September?

Since then, I've received notices, placed phone calls, and made more copies. I called again today to get a status update.

"My records show that we sent you a check for $326 on November blah-bi-di-blah."
"Yeah, I never got that. Did you send it to blee-bi-di-bloo?"
"Yes. Well, because it was never cashed, I'll just put on a stop payment and send you a new check."
"Great. What about the other 400-some-odd dollars?"
"I'm sorry?"
"The device (this is what you have to call it when you call in, so you know) cost me $800."
"Well, Blue Cross only allows 500-blah-blah dollars, your deductible was met so we'll pay 80%, leaving you to pay 200-blee-bloo dollars."
"Um... what?"
"[Starts to explain allowances]"
"No, no. I get that. What you're saying is that I'm stuck with paying not $200, but actually almost $500."
"Um.... Right... well [starts in on some lame explanation about pharmacy benefits vs durable hardware benefits]."
"[Enter a rant about how I CALLED and MADE SURE that this would work and the woman said it would be NO PROBLEM and now I'm stuck paying what may as well be the full price for something that IS COVERED and HOW IRRITATED I am and that I HATE Blue Cross.]"
"[Clearly flustered] I'm sorry ma'am. That does sound irritating. You're more than welcome to appeal."
"YOU AND I BOTH KNOW THAT WON'T WORK! I'll get a nicely worded letter about how I am ultimately responsible for knowing my coverage and that I have a copy of the plan, and that they have no record of me ever even calling in, and that it says in article B section 13 that I shouldn't base my insurance coverage decisions on what the insurance-coverage specialists say."
"Is there anything else I can help you with?"

I apologized to the woman on the phone because she didn't do this to me. I probably will send out an appeal, but really, it probably won't work.

On one end of the customer service spectrum is Costco. I once took back some Cuties because they tasted a little funny, and they gave me cash back, no questions asked. In the middle is Target, where they require a receipt, a picture of you buying the item, and your first-born child before they'll give you cash back. And then way way down at the other end of the spectrum is the insurance company, who doesn't even give money to people who deserve it who are dying. Why would they give me my money back?


Myriah Cohen said...

That sucks. I was wondering about that whole thing, actually. Good to know that the system is working exactly as I left it. Fabulous. I hate change.

Allison said...

I have two words... Sqeaky wheel. Be that. Call again. Ask to speak to a supervisor. Fill out an appeal. Call a million times. It's like when you go to the DMV, sometimes you need the pink form that you didn't get signed by someone not with you, and sometimes they just let it go. Depends on who you get at the window. Did you by any chance get the name of the lady you originally talked to? I think you can win this one if you push it.

Caitlin said...

Welcome. To. My. Life.

Jenn said...

Hey Amanda,
Not sure how I found your blog...anyway. You should have my husband write your appeal. He wrote one for us when UMC botched Emma's MRI and we just got word that our appeal was approved and a refund is on the way. He is really good at sounding very official. Good luck! :) --Jenn Vaterlaus

Bridget said...

Ooooohhhhh that sucks. I agree with others who say to appeal and call over and over again. What happened to you is just not right.

Steph said...

Solution... keep having babies. hahahaha. You know you are already going to the "that family" in the ward who has 10 kids and is under 45. Just accept it.
Or try the appeal thing. Or find a new Dr or gyno that does supply them and see if that is an easier route.

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