Friday, October 09, 2009

The continuing saga

It's been months since I last wrote about my ongoing battle with BlueCross BlueShield of Texas, and, unfortunately, the problems are no closer to being resolved.

In mid-April, BCBS sent a letter to the hospital, copying me, stating that my claim for Elizabeth's birth was denied because there was no evidence that the situation met any of their definitions of complicating factors. Once I stopped sobbing, I called the insurance company. The woman I spoke with told me that no one should have ever told me the delivery would be covered because they were just in customer service, not medical review. So I asked how to appeal the decision and whether I had a deadline.

My next call was to my doctor's office, and I sobbed on the phone to the nurse about how I was having continued panic attacks every time I got the mail and saw another hospital bill or insurance envelope and every time I saw the hospital billing office number come up on caller ID. She passed a message along to the doctor and then called back to say that the doctor would be sending an appeal letter on my behalf.

That was in April, and I hadn't heard anything back since. I called once last month to find out what was going on and was told the claim was pending. I called again on Wednesday, and this time the woman I spoke with (and yes I have notes on whom I spoke with and when for every call) told me the claim was denied as of mid-April. That denial was the one that caused me to call my doctor's office in tears.

I told the woman that my doctor was supposed to have sent a letter about the appeal, and she said they hadn't received it. The BCBS woman assured me that I hadn't run out of time to appeal, and I told her I wanted it clearly marked in my records that I am officially appealing the denial.

Then I called my doctor's office. The nurse promised that the letter had been sent and even read it to me. She said that insurance companies "lose" letters all the time and that she would re-send it. So now I have to call back next week to make sure BCBS has received it and that whoever is supposed to be reviewing it actually is.

I mentioned this whole saga to one of my editing clients, and he told me that my next step should be to pay an attorney to write a letter to BCBS, copying my legislators, informing them that I am not willing to give up on the claim. I never wanted to HAVE to hire an attorney, but I will if it comes down to it.

My stress level about all of this had dropped drastically in the past few months. I haven't had a panic attack while getting the mail in ages. But it's all come back now; I've been upset ever since the calls on Wednesday.

I'm also amazed that the hospital hasn't been calling or sending letters looking for their seven thousand dollars. They called at least once a week and sent regular collection letters in the early weeks of this fight, but I haven't heard a peep lately. I'm a bit scared to call them and check on the account, though. I figure that if they haven't noticed me, I'm not going to call attention to the account.

On Wednesday I tweeted (I'm still not sure I like Twitter) that I wished I had Dooce's influence. She posted several tweets about a broken washer and her failed attempts to get it fixed or replaced, and within hours her washer was fixed AND she had a company offering to send her a new one for a give-away. If I had more than a million readers and followers, maybe someone at BCBS would pull his head out of his a** and fix this.

I hate, hate, hate that I am having to go through this again. I really feel that I lost out on some of the joy of Elizabeth's first few months because I was so worried about insurance and medical bills - and we actually have insurance. I can't imagine how hard it must be for those who don't. And every time I hear someone at a tea party or at an anti-reform rally saying that they don't want the government running health insurance, I want to kick them. If we lived in pretty much any other industrialized nation in the world, I wouldn't be going through this. There would never have been a question about whether the insurance company would pay for the delivery - it would have just been taken care of.

I need to stop writing and thinking about this now. I'm on the verge of panicking all over again.


Dee at Pedestrian Palate said...

I'm so sorry to hear that you are having this kind of problem. Hope your doctor's letter helps the situation.

Ann Imig said...


No surprise to me about the panic attacks. Every time I have to deal with our insurance company I have major stress as well.

And I don't have a big unpaid claim. YET. 2.5 has to have a simple outpatiend procedure next month, and I dread the bills that are supposed to be covered.

RP said...

We have BCBS too and have had many battles with them over the past 10 years. Our son was born with a flat head and they refused to cover the helmet to correct it ($3000). We've also had a hard time to get them to cover our deliveries. Hang in there. It will work out - it just takes time.

Ann in NJ said...

That's horrible. And yes, it's awful that you have insurance and you're STILL going through this. Anyone who says that the government will ration care has never had a claim (or a procedure)denied. After my father died, my mother spent 6+ months terrified that she would have to sell her house to cover the medical bills. Fortunately, in that situation, everything was covered. But it was still a painful time.

Baino said...

You should publish this as a pro for the universal health care option. Clearly the insurance companies have you lot over a barrel. I have had two children and a miscarriage. Both in a private hospital, with private health care and paid only $100 excess (part of my basic cover - note I only have basic hospital cover). If I'd gone to a public hospital, I wouldn't have had the doctor of my choice (which didn't matter anyway since he wasn't there for either delivery) and it would have been totally, absolutely, without a shadow of a doubt FREEEEE!

Shelly said...

There are so many problems with our health care system. Insurance companies practice medicine, telling us what drugs we can take, what procedures we can have, what doctors we can see. And this is for people that have good private health care. I don't see how a public option could be worse. If that option is so unpalatable then why aren't we trying to privatize Medicare? I'm well aware of the flaws of Medicare but they are not any worse than the flaws of my private insurance.

Unknown said...

You know what? I don't want to sound trite at all but even if it is eventually denied and you do have to pay it, as long as you are making a real, visible effort to make monthly payments (even $20 a month), they have to leave you alone and cannot send it to collections. It's a pain in the ass and a waste of energy but it it NOT worth panic attacks or shortening your life over, so please stop!!!!

Hug your little girl and tell her how expensive she is, and then make the last payment the day she leaves for college...

Cookie said...

Yikes! That is horrible that it was just denied. Have you tried contacting one of your local news stations? Sometimes they like to do news stories like this and can get you help/attention.
Oh, and not every country has free health coverage for babies. In japan you have to pay several thousand $ to have a baby. no wonder their population is decling, huh?

Vanity's Fare said...

Did the doctor offer to send you complementary medicine for the panic attacks? If so, maybe you could sell the drugs to Rush Limbaugh and collect enough money to pay the hospital.

(Sorry you're having to deal this.)

the mama bird diaries said...

I'm so sorry. Hang in there.

Ann in NJ said...

Ooh! I like the new look!

shrink on the couch said...

I don't understand why the denials based on complications or no?

I feel your panic. We are dealing with a large BCBS claim at the moment (large for us, I should say). The bills from the providers are coming in the mail and we have no idea who did what. It's a nightmarish maze. I remember going through a really hard time after my twins were born (half the claims were denied because they thought the providers were double billing.. um, hello.. twins?)

Deep breaths. Hope it works out for you. And I'm all for the public option. Make those insurance companies have to compete. (Actually I'm all for universal health care but for now, the public option will do).