Today, a representative with my insurance company followed up with me today to let me know that the $222 claim they initially denied would be re-processed and accepted. This dispute with my insurance company marks probably the 15th or so time I have had to call and argue a claim.
When I was first diagnosed with breast cancer, I had little interaction with insurance and its inner workings. I went to the doctor now and then, mostly for sinus problems or my yearly lady check-ups. Hard to believe, but I wasn’t always a professional sickie. After dealing with both a hospital system that routinely messed things up for me and an insurance company that denied claims left after right, I quickly realized that having an extended illness means being your own patient advocate.
The first ridiculous claim that my insurance company denied was a CT scan of my head, which my medical oncologist ordered after I came in with my umpteenth sinus infection. When I opened up my explanation of benefits (EOBs), I was taken aback at their reason for denial: “no referral.”
When I contacted the insurance company, the rep said to me, “You needed a referral for this procedure from your PCP.”
“That cannot be right. My oncologist, who I do have a referral for, ordered this test.”
“Yes, but your PCP needed to order it.”
“That cannot be right. You’re telling me that my medical oncologist, the man responsible for eradicating my cancer, cannot order any tests for me? That I have to go to my PCP for everything?”
“Yes. There’s nothing I can do.”
“I don’t believe that. Look, I have cancer, and I’m off work because of this cancer. I have all the time in the world. I’m not responsible for this $500.”
After two rounds with this representative, she came back and said, “Oh it was just a processing error. We’ll re-process it.”
Sure.
This is just one anecdote out of many anecdotes. My insurance company never processed my last round of chemotherapy, resulting in me receiving a bill from my hospital for $14,000. When I opened that envelope, I came close to fainting. Real close. It took two hours and six phone calls to finally figure out what happened – that was five people who tried to pass me off to someone else.
When you are what I call a professional sickie, you suffer a lot of indignities that normally you could just shrug off when you have good health. Feeling sick and run down because of your medication or the other side effects, it’s a challenge to have to have the same fight over and again with the insurance company. Dealing with an insurance company has felt like a part-time job, without any benefits. Well, I guess the benefit was that if I didn’t stay on top of my EOBs, I would have owed over $17,000, which is thousands of dollars that I don’t have.
Moral of the story: if you think the insurance company is wrong, fight them. Fight, fight, fight. They really hope you don’t pay attention, so the hospital can bill you. Pay close attention.