About Me and My Insurance

I am a single woman who is independently employed who pays a whopping $560 per month to have access to health insurance.  Many times people have asked me why I don't drop it.  What is happening to me now is exactly why.

My insurance sucks.  I have a high ($3000) in-network deductible, and even higher ($6000) out-of-network one.  I go online to find the right doctors from their network, and constantly call my insurance company to find out information, and am always battling them in terms of things that should be paid, but haven't been.  There is almost always some sort of situation that requires my efforts.

When I recently went for a cat scan I was on the phone ahead of time.  I had to find out if my insurance paid for it, or if I would.  I learned a few years ago that one person could tell me one thing, but then someone else would say something else, so I was prepared to call back more than once.

Before I go on with the current situation, let me share with you about my previous one - just in case it would be helpful to anyone who might be reading this.  My doctor had sent me for a large amount of blood work.  I needed to know where to go.  I called my insurance company and was told that I could go anywhere that was considered in-network.  So I found a place, and I went.

Well!  I got socked with a $2000! blood work bill.  Aghast, I called my insurance company - several times - and go no where, but annoyed, fast.  There was no reason I should have to pay the bill.  But everyone was insisting it was MY responsibility.  I was on the verge of surrendering when I asked a key question, "What do I need to do next time to avoid this?" "You need to go to -----" DING DING DING!  So, why didn't someone tell me that in the first place?  Well that gave me the ammo I needed.  I had to write to the company and explain my case, and ultimately they realized I, as the consumer, wasn't explained things correctly.  So they paid the bill.

It was this memory that I took with me when I called about the cat scan.

First person told me that it was a part of my deductible and copay.  

Second person told me that as long as it was unattached to a hospital, and not a hospital, it would be covered by my insurance.

Sure, I liked that answer, and I could have left it there.  However, I wanted someone to validate the info.  It would be quite a costly error, if she was wrong.

Third person adamantly claimed that the first person was correct.

Fourth person, too.

I called again, and got lucky, I got person number 2 on the phone.  It's not like I didn't trust her, but I needed validation.  She was so certain.  She had me hold, got validation, and returned.  I asked her to make a note in my account specific to her findings, which she did.

*Whew*

So about 10 days later I called again.  There was something else I needed to ask that I couldn't remember the answer, or if I had asked.  In the process of doing this, I decided to have the person make a note that based on the information that was provided, and the research I had done, I was going to go have a ct scan with the full expectation of it being covered.

In the interest of this person being helpful, she tells me that it will be a part of my deductible, despite what the note/other person said.  I was more than annoyed.  I couldn't leave things like that now.  If I went for the test, and the last thing I was told was that I would have to pay for it, then I likely would be responsible.  I waited forever for her to come back to me, only to be told that she had to have her supervisor contact me - in 24-48 hours.  WHAT?  No way was that acceptable.  But it was all she was giving me.  I then asked to SPEAK to the supervisor, and just as I heard his voice after a long hold, our call was disconnected.

I called back again, and went straight to the supervisor who ultimately confirmed that what was in the note was correct.

*Dang insurance company*

Why can't they train their employees on how to properly assess someone's plan?  I most assuredly cannot be the only person who has gone through this kind of thing!  I certainly never need the aggravation, and even less so when not feeling well.

I had also found a doctor on their site who was supposed to take my plan.  When I got to his office, I found out, after being there an hour, that he only takes it, if the insurance plan is locally based.  Why aren't these things spelled out somewhere?  This person may or may not be your doctor, it all depends on which way the wind blows.

I realize that is an extreme statement, and silly, but why is our system so convoluted and complicated?  What kind of incredible monster have we created around an industry that is supposed to be taking care of people?  Instead it seems to do a good job of taking them for a ride.  

I remember hearing something once about how a lot of creditors will be happy to give you an umbrella when the sun is out, but the minute it rains, are more than happy to take it away.  It seems as though our health insurance industry is also like that.  So many people who need the coverage are either denied or in some cases, their insurance taken away.  I am not going to say that government is the answer, but there has to be an answer that somehow is better than the one we currently have.   I just wish someone would come up with it.

Of course, you may think if it was that simple, then I could be that someone.  Well, maybe I could be.  The problem is we all have our things and limitations in life, and right now as much as this makes me very frustrated, it isn't a hill I can currently climb.  At the same time, if insurance companies could at least be more consumer friendly, it would certainly be a start.