My Mortal Enemy

Is it just me, or does the medical insurance industry drive everyone else to the brink of insanity??? Years ago I worked for a health insurance company, who shall remain nameless, and previous to that, I really had no dealings with health insurance at all. I was young and single, no longer a dependent of my parents, and perfectly healthy to my knowlege, and so I figured I had no need for medical coverage. (Did I mention I was YOUNG?) Anywho, I received medical coverage as a benefit for working for the company, which we later discovered was one of the greatest miracles and blessings ever granted to us. But my experieces with that company and learning the industry have helped me on more ocassions that I can count. And although there were some claims that weren't processed smoothly, and there were a number of people calling with complaints about their claims, I must admit, the majority of claims were handled with no problems at all.

I've come to realize that a perfectly processed claim (one that is processed and paid at 100%) is far from the norm. I won't get into details, simply because it would take me a year to go through them all, but the births of my girls have caused me literal nightmares when it comes to dealing with the insurance company and getting those claims paid. If I were to conservatively guess, I would have to say I've spent more than a month of my life (that's a WHOLE month, 24 hours a day for 31 days) on the phone being the "go between" for the insurance company and the doctor's office or the hospital, trying to resolve the issues of getting my medical claims paid.

And each time we have another baby, we have new insurance, which claims to be so great, and I figure "This time there won't be any problems." At least with the last two, the problems didn't start until AFTER the births.

So yesterday I decided to call up my perinatologist's office to get in for an appointment. I didn't bother calling a regular OB since I don't see one through my entire pregnancy, and last time I did what the insurance asked (get a referral from your regular OB before going to a specialist), and it ended up being a huge mess, so the perinatologist told me, "Next time don't go there first. Just come straight to me." Sounded good to me!

After talking with the lady in scheduling about how this would be my third baby to be delievered by the doctor, and that we have new insurance, and how he had told me to come straight to him instead of getting a referral first, she told me she'd have to call the insurance just to make sure. Well, I could have told her what they would say. "Oh, no. You MUST get a referral to see a specialist. Sorry, those are the rules." Fine. Whatever.

I proceeded to start calling the OB doctors who are covered under our new insurance. "Hello? I need to schedule an appointment. I'll see whichever doctor can get me in the soonest."

"Are you a new patient?"

"Yes. But I just need a referral to my perinatologist. The insurance company requires one for me to see him."

"Oh, we're not taking new patients until November."

November!!! What the crap?!? "Thanks. I'll try someone else."

After numerous phone calls with responses such as, "We're not taking new patients" and "We don't accept that insurance anymore" or "The doctor only sees new patients at his office in Southern Hills" (which happens to be like a 50-minute drive for me), I gave up and called my doctor again, hoping against all hope that Rosa the Receptionist would take pity on me and find a way to get around the whole referral thing.

No such luck. She offered a few other clinics that weren't in my provider directory, but assured me that they did accept my insurance. I then spent the next 37 minutes on hold, waiting to see if I could get an appointment. THIRTY-SEVEN FREAKING MINUTES!!!! And the best part? They never answered the phone. Oh, no, I got to leave them a message. And to top that off, the recording let me know they would get back to me ... within FOUR business days. Can I swear now? No, no. I can do this without profanity.

So here we are, a new day, and I have to start again with the phone calls. I wonder how much of my time will be wasted before this child is actually given life. Forget it. We're freaking moving to Canada.