I don’t want to spend my time blogging about this. I much rather spread the message of hope to others about Luna's speedy recovery from the Fontan. But once again The Health Insurance Company has hijacked our time, money and good spirits.
So here I am, blogging in attempt to get the corrupt ways out to the masses. One, because I need to document the sheer hell that Insurance Corp puts us through, and two, I dream of testifying against all of the Big-wigs at the Insurance Companies on the floor of congress one day. I will do my small part to change the way American runs its health insurance program. In my dreams, patients who were denied treatments from their insurance carrier, who as a result died, like this little girl here, will at least not die in vein. In this country, even an accidental death can result in second degree murder. So, why should these Health Insurance Companies, who very concertedly deny coverage to people (kids, even!), be shielded from serving a term for nothing short of murder?
So, you’re not going to believe this. Here goes the latest round with Big Insurance.
While I was in the hospital with Luna-getting her through her third and hopefully last open heart surgery, The Architect called to say there are insurance problems again.
Can we just stop right here. Let me repeat: a mother in the hospital with her two-year-old, trying to get her girl through surgery, and I have Insurance issues to worry about.
Ok, moving on.
The Architect went on to explain that the latest statements had two erroneous charges on them. The total out of pocket charges on the statements? Nearly $14,000. But for now, we’ll focus on just one of them.
One charge was for $4065, in which The Insurance company states I am the consumer, and apparently on 4/14/10 I had some type of service done at UMass Memorial Health center.
That’s funny. I’ve never even been to the place. And on that date I was with photographer Greg West touring the Boston Residential Design & Contruction Show.
This is where it get’s stranger than fiction.
Paul, aka, The Architect decides to call my primary care physicians to try to make some sense of the claim.
The receptionist, a young man took Paul’s call: and explained that he too has (insert big Insurance Provider here) and got a statement with the same exact charge, also from UMass Memorial Health center.
Can’t make this stuff up folks.
Nick, the receptionist explained that when he called to contest the charges, Big Insurance responded saying, “Oh, we know what happened, there is another man with your name and same birthday, that must be it”.
Well, guess what? With this little invention called the internet, it’s pretty easy to look up to see who has your name. There is no other Nick (insert unusual last name here), with his exact birthday; month, day and year.
And that really doesn’t explain why I got the same charges. Does Big Insurance want to tell me that there is another Sabrina Velandry out there?
Nick, works in health, and his parent company, concerned and bothered by the claim, and the Insurance Company's rebuttal to it, has taken up to investigating the case. I faxed over my statement, which will be part of this investigation.
When I called Big Insurance, the woman I spoke with Beth K. actually said to me: “well, this is not the fault of (Insert name of Big Insurance carrier here)”.
Let’s just stop here to reflect upon the dysfunctional culture of the entire company. First, can you think of another company where employees do not release their last names? Tells ya something, doesn’t it. Secondly, if this was your company, and you were alerted to such an error, would you not make it priority to stop whatever fraudulent behavior was stemming from your corporation?
Stay tuned folks; something tells me this is just the tip of the iceberg.
Showing posts with label Health Insurance Issues. Show all posts
Showing posts with label Health Insurance Issues. Show all posts
Saturday, June 5, 2010
Thursday, March 4, 2010
Synagis Follow-up
Yesterday I posted a blog about, how Luna and I were treated like circus animals (as described brilliantly by one of my friends)-all in our quest to get our two year old a much-needed and time-sensitive shot called Synagis.
Just after I posted my blog about the Synagis/Anthem/Precision RX heist, I sent the post, along with an email to the aforementioned parties.
By 6pm when I heard nothing from any of the three, I have to say, I was feeling flat-out depressed and started contemplating how I could get my family out of this country, and into a more civilized nation; one where healthcare runs smoothly and affordably-and one where half the population isn't crying government takeover (a very clever and carefully crafted message to instill the very outcome it's generated).
Finally, last evening I checked my email around 7:30pm and a rep from Anthem had written to say "thank you for the note" and asked me what state we were in-to which I replied immediately: New Hampshire.
About a half hour ago, Precision RX, the suppliers of Synagis, the shot that Luna is now about 3 weeks over due for; called to follow-up.
This is what the very kind (and really, the reps-all women-are truly nice, it's the system that is maddening) said:
"Renata from the pharmacy solutions department at Anthem called to say that your co-pay for the drug would be $1825.13, and to go ahead and process it immediately".
This new figure of $1825.13 is indeed wonderful news, a vast improvement over the original $2791.64 that was due.
And somehow (as in it took a day of blogging, tweeting, emails and phone calls) everyone is perfectly fine with billing the balance after the $800 down payment into monthly payments of $512.57
I asked the Precision Rep why the co-pay dropped nearly $1000, and she could not answer.
Footnote: I actually had a few angry commentors to my previous post, one in particular called me, "full of crap". I think the most diplomatic rebuttal is to say, I love business, and if you are selling hand bags, furniture, jeans, paper clips and even coffee; by all means, sell for the highest you can!
But when it comes to lifesaving drugs, medicines, and medical treatment for kids (and adults); shouldn't we be a bit more transparent with the cost and yes, fixed with the fees for these services?
Just after I posted my blog about the Synagis/Anthem/Precision RX heist, I sent the post, along with an email to the aforementioned parties.
By 6pm when I heard nothing from any of the three, I have to say, I was feeling flat-out depressed and started contemplating how I could get my family out of this country, and into a more civilized nation; one where healthcare runs smoothly and affordably-and one where half the population isn't crying government takeover (a very clever and carefully crafted message to instill the very outcome it's generated).
Finally, last evening I checked my email around 7:30pm and a rep from Anthem had written to say "thank you for the note" and asked me what state we were in-to which I replied immediately: New Hampshire.
About a half hour ago, Precision RX, the suppliers of Synagis, the shot that Luna is now about 3 weeks over due for; called to follow-up.
This is what the very kind (and really, the reps-all women-are truly nice, it's the system that is maddening) said:
"Renata from the pharmacy solutions department at Anthem called to say that your co-pay for the drug would be $1825.13, and to go ahead and process it immediately".
This new figure of $1825.13 is indeed wonderful news, a vast improvement over the original $2791.64 that was due.
And somehow (as in it took a day of blogging, tweeting, emails and phone calls) everyone is perfectly fine with billing the balance after the $800 down payment into monthly payments of $512.57
I asked the Precision Rep why the co-pay dropped nearly $1000, and she could not answer.
Footnote: I actually had a few angry commentors to my previous post, one in particular called me, "full of crap". I think the most diplomatic rebuttal is to say, I love business, and if you are selling hand bags, furniture, jeans, paper clips and even coffee; by all means, sell for the highest you can!
But when it comes to lifesaving drugs, medicines, and medical treatment for kids (and adults); shouldn't we be a bit more transparent with the cost and yes, fixed with the fees for these services?
Wednesday, July 22, 2009
The High Cost of a Heart Kid
It's 3am and I am awake. Luna woke for a rare middle of the night milk nightcap and instead of changing her diaper and filling her bottle and then slipping right back into the dream where I left off, I lay awake thinking about...medical bills.
When the Architect and I first learned of Luna's condition, when I was 20 weeks pregnant, the first thing he blurted out was, "we can't afford this!" Or maybe it was, "this will kill us financially". Either way, I winced at his brashness, but deep down inside I knew what he was thinking. We had just finished watching Michael Moore's SICKO and the Architect was terrified. The movie depicted an older couple, both man and woman had suffered cancers. They regained their health, but lost the roof over their head to medical bills.
Now that Luna is 16 months, the reality of having a special medical needs child is sinking in. For the first year of her life, we geared up emotionally to get her through her two heart surgeries and two catheters, and countless testing, shots and doctors visits in between.
Modern medical science of today is amazing. Luna lives a normal toddler life.
But it's the insurance issues (the Architect and I simply refer to it as the Insurance BS) that haunts you and hangs over you for as long as the mind can imagine.
It's not that we don't have health insurance. We do. We have Anthem, and our policy is a HSA. Basically, once we hit a five thousand out of pocket, Anthem pays 100% of all medical bills.
Ha-ha, not so fast.
Most Americans I know have had a good round or two of back and forth over a erroneous medical bill. It's pretty much the status-quo. It's part of the system. Confusing consumers of what has been paid, and what is owed. Usually there is some bogus code that is attached to all of this.... "but what does A9067BS refer to on my bill?? my child did not have a cat scan on March 13th, it was an echo cardiogram!?"
This year alone Luna has cost Anthem nearly 80K. We diligently pay, or the Architect, through his work, pays the out of pocket $800/month for the policy. We then are responsible for the 5K out of pocket, above and beyond the monthly premium, which we have also paid back in February. The Architect's place of work contributes 25% to the policy and then $1500 to the HSA account. And I should note, and this is just an observation; but our insurance went up substantially the year after Luna was born. The Architect's place of vocation couldn't afford the HMO policies for its employees. My guess our family and the family with the child with Leukemia blew the 2009 premiums right out of the water. The pool was too small to sustain the risk. Perhaps I sound bitter, but business terms like 'risk and profit pool' should not be used when referring to children with cancer and serious heart issues. But naturally we can't blame any place of employment for seeking out the least expensive insurance for their employees.
But Anthem doesn't stop there. Every week we are bombarded by medical statements. An HSA statement arrives stating what Anthem has paid out and what we have paid out. Often two statements will arrive in one envelope, stating two different things. The Architect and I pass the statement back and forth, each trying to decode the convoluted bills.
The last series of statement to land in our mailbox have been surprisingly consistent. For Luna's last catheter, we are responsible for $6700.
Did I mention already that we hit our out of pocket max of $5000 and we pay $800 a month for the policy? We fulfilled our end of the bargain, now its Anthem's turn.
So, the games begin. And actually have been for a while. Behind me, on the window is a stack of bills. Smaller bills in comparison, one for $72 another for $616, both bills from the hospitals themselves. Various balances that through "code error" (read complete BS and a practice I have since learned from industry insiders that is used often to confuse consumers), and more importantly, neither are for services that Luna actually endured. They are, in short, bogus claims that we're now responsible for. (and as of this reading, I returned home today, before publishing post to find the $616 bill has gone into collections-this is for a cat scan, a procedure that Luna did not in fact receive!)
I've given up making phone calls as its only an exercise in tail chasing consisting of hours and hours of wasted time, where everyone will be pulled in the mix, including Luna's two cardiologists and the catheter doctor, trying to decipher what a certain charge is for. Rounds of emails and phone calls will be made; to the hospital to Anthem, to the doctors themselves. Each time you're convinced that you've finally made some head way and you won't see the bill again. And then each month the same bill, arrives in the mail.
I think to myself we simply won't pay the $6700. But then worry come January of 2010 will our family have health coverage.
Meanwhile the media buzz has been all about Obama's healthcare reform. Tonight he held a press conference on the very topic. I receive endless tweets to share my story, but wonder where to begin. The opponents views bubble-up through social media in vicious statements and articles to block universal healthcare and I'm reminded of the bumper sticker, Republicans solution to the healthcare crisis: don't get sick! I can't bring myself to even follow what's going on. It's too close to home. All I know is health care is one scary mess.
When the Architect and I first learned of Luna's condition, when I was 20 weeks pregnant, the first thing he blurted out was, "we can't afford this!" Or maybe it was, "this will kill us financially". Either way, I winced at his brashness, but deep down inside I knew what he was thinking. We had just finished watching Michael Moore's SICKO and the Architect was terrified. The movie depicted an older couple, both man and woman had suffered cancers. They regained their health, but lost the roof over their head to medical bills.
Now that Luna is 16 months, the reality of having a special medical needs child is sinking in. For the first year of her life, we geared up emotionally to get her through her two heart surgeries and two catheters, and countless testing, shots and doctors visits in between.
Modern medical science of today is amazing. Luna lives a normal toddler life.
But it's the insurance issues (the Architect and I simply refer to it as the Insurance BS) that haunts you and hangs over you for as long as the mind can imagine.
It's not that we don't have health insurance. We do. We have Anthem, and our policy is a HSA. Basically, once we hit a five thousand out of pocket, Anthem pays 100% of all medical bills.
Ha-ha, not so fast.
Most Americans I know have had a good round or two of back and forth over a erroneous medical bill. It's pretty much the status-quo. It's part of the system. Confusing consumers of what has been paid, and what is owed. Usually there is some bogus code that is attached to all of this.... "but what does A9067BS refer to on my bill?? my child did not have a cat scan on March 13th, it was an echo cardiogram!?"
This year alone Luna has cost Anthem nearly 80K. We diligently pay, or the Architect, through his work, pays the out of pocket $800/month for the policy. We then are responsible for the 5K out of pocket, above and beyond the monthly premium, which we have also paid back in February. The Architect's place of work contributes 25% to the policy and then $1500 to the HSA account. And I should note, and this is just an observation; but our insurance went up substantially the year after Luna was born. The Architect's place of vocation couldn't afford the HMO policies for its employees. My guess our family and the family with the child with Leukemia blew the 2009 premiums right out of the water. The pool was too small to sustain the risk. Perhaps I sound bitter, but business terms like 'risk and profit pool' should not be used when referring to children with cancer and serious heart issues. But naturally we can't blame any place of employment for seeking out the least expensive insurance for their employees.
But Anthem doesn't stop there. Every week we are bombarded by medical statements. An HSA statement arrives stating what Anthem has paid out and what we have paid out. Often two statements will arrive in one envelope, stating two different things. The Architect and I pass the statement back and forth, each trying to decode the convoluted bills.
The last series of statement to land in our mailbox have been surprisingly consistent. For Luna's last catheter, we are responsible for $6700.
Did I mention already that we hit our out of pocket max of $5000 and we pay $800 a month for the policy? We fulfilled our end of the bargain, now its Anthem's turn.
So, the games begin. And actually have been for a while. Behind me, on the window is a stack of bills. Smaller bills in comparison, one for $72 another for $616, both bills from the hospitals themselves. Various balances that through "code error" (read complete BS and a practice I have since learned from industry insiders that is used often to confuse consumers), and more importantly, neither are for services that Luna actually endured. They are, in short, bogus claims that we're now responsible for. (and as of this reading, I returned home today, before publishing post to find the $616 bill has gone into collections-this is for a cat scan, a procedure that Luna did not in fact receive!)
I've given up making phone calls as its only an exercise in tail chasing consisting of hours and hours of wasted time, where everyone will be pulled in the mix, including Luna's two cardiologists and the catheter doctor, trying to decipher what a certain charge is for. Rounds of emails and phone calls will be made; to the hospital to Anthem, to the doctors themselves. Each time you're convinced that you've finally made some head way and you won't see the bill again. And then each month the same bill, arrives in the mail.
I think to myself we simply won't pay the $6700. But then worry come January of 2010 will our family have health coverage.
Meanwhile the media buzz has been all about Obama's healthcare reform. Tonight he held a press conference on the very topic. I receive endless tweets to share my story, but wonder where to begin. The opponents views bubble-up through social media in vicious statements and articles to block universal healthcare and I'm reminded of the bumper sticker, Republicans solution to the healthcare crisis: don't get sick! I can't bring myself to even follow what's going on. It's too close to home. All I know is health care is one scary mess.
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