Score one for the Squeaky Wheel and other odds and ends

Last Friday I walked out of a doctor's appointment after disagreeing with how much I was being charged to have b*tox injections for my migraines. By 5:00 Friday evening, the doctor had called four times and left two messages. Each time she called, I was still too worked up and upset to answer the phone or listen to her messages. But when I finally did, I was pleasantly surprised.

She apologized for the confusion and said that from now on she'd code my injections as an office visit, not a procedure, so I'd only be charged the co-pay and the cost of the medication. Instead of paying $600 for four shots, I'll only have to cough up $250, which, from my research, is pretty standard.

This is proof that being the Squeaky Wheel and standing up for yourself with doctors and health insurance companies can work. I'll be calling the doctor back today to thank her for changing her billing procedure and to make an appointment.

Now on to other bits and pieces.

My cell phone has been missing for more than a week now. I'm pretty sure it's in the house somewhere. I remember getting in the car last Sunday and realizing I didn't have it with me, but I decided not to go back in for it given that Elizabeth and Campbell were standing with their noses pressed against the front window crying because I was leaving them behind.

I have searched the house and have offered a reward to the big girls if they find it. I've looked under beds and in toy boxes and in closets, but no luck.

Much to B's frustration, I almost never carry the thing and rarely use it. But now that I don't have it, I really miss it. Now I'm trying to convince B that I need an iPhone as a replacement, but he's not going for it - yet.

Finally, I had a post picked up by the nice folks over at Deep South Moms blog. It's about trying to find a balance between being a mom and not a coach. Please go take a look, and maybe leave a comment.

I didn't get up to run at 5:30 this morning because I'd been up three times with Elizabeth, who still isn't feeling well. But now I think I'm going to pop her in the jogger and see if I can squeeze in a few miles. It's too nice a morning to miss out on running.

And then I walked out

As I've written, I had b*tox injections in my forehead back in February in the hopes of getting my migraines under control. The results have been mixed. There have definitely been days where I could tell I was having a migraine, but I just couldn't feel the pain. And then there have been days where I was flat in bed with an ice pack on my head.

The doctor told me that she had given me a fairly low dose of b*tox as a baseline and that the effects might wear off before the predicted three months, and that's exactly what happened. So two weeks ago, I called the doctor's office to make an appointment for another round. Amazingly, the doctor herself called me back to talk about my options. I was stunned at the personal response.

In the meantime, I'd received a bill for $160 from the doctor's office. The original amount of the bill had been $350 but they had reduced it by $140 for the Humana "discount," whatever that was. I called the billing office and asked what was going on. I explained that I had already paid the $50 co-pay and the $200 for the b*t0x itself and asked what this new charge was for. The billing office lady told me it was the cost for the "procedure" of actually doing the injections.

I was stunned - $350 plus $50 for four shots.

When I told the business office lady that no one had told me about the procedure fee and that it pushed this treatment out of the realm of affordability for me, she told me that she'd talk to the doctor and give me an answer at my next appointment.

The appointment was this morning, and before I even paid my co-pay, I asked to talk to the business office lady to see if was going to be dinged the procedure fee again. When she came out and I re-explained my concerns, she said, "There's always a procedure fee."

I turned to the appointment lady and told her to cancel my appointment, and then I walked out and cried in the car for a few minutes out of sheer frustration.

I completely understand that doctors need to make money and cover their overhead. I'm not arguing with that. It's just that I don't think that four shots into my forehead should cost me $600.

So now I'm looking at other options, including calling my primary doctor to see if he has any suggestions. I may even go to one of those shopping mall med-spa places that host b*tox parties. At least there, I can get cocktails along with my b*tox.

Speaking truth to power

All day yesterday I stewed about the inappropriate and inaccurate response I received from Senator Hutchison's office. At first, I didn't have any plans to send another message to her, but the more I thought about it, the more it bothered me. I am one of her constituents, after all, and I do have the right to have my voice be heard, even if I don't agree with her position.

Last night I went back to her online message form, and sent the following:

Last week I contacted Senator Hutchison about problems I am having with my insurance company and expressing support for health care reform measures currently being considered by Congress.

In response, I got a form letter that made it very obvious that no one on Senator Hutchison's staff even read what I wrote. Her response doesn't address my concerns and ignores completely that I don't support Senator Hutchison's actions. I wrote to the senator hoping that my voice would be heard, and it's obvious that it wasn't at all.

You ought to be embarrassed at providing such poor service to your constituents. I used to supervise the Citizens' Assistance center for a statewide elected official, and I would have NEVER allowed such an inappropriate response to be sent.

Shame on you.

I'll be interested to see what kind of response, if any, I get back. Who wants to bet that I'll get the very same form letter again?

Ladybug

And now back to our regularly scheduled Halloween costume posts . . . if I have to write or think any more about the BlueCross BlueShield insurance fight, I'll start crying again. Thank you to everyone for your comments and e-mails of support. They have helped.

Here's a cute baby to make everyone feel better. Elizabeth dressed as a little ladybug for Halloween. Lily wore this same costume when she was Elizabeth's size. There's a hat that goes with it, but Elizabeth refused to keep it on.





Before we went trick-or-treating, we had our annual pot-luck with several other families. The big kids left a whole row of empty juice and milk boxes on one of the benches. Elizabeth cruised along the bench, testing each box to see if she could slurp up any of the remnants. She was so proud of herself that she kept giving us huge grins and showing off her one tooth.

Elizabeth hung out in her stroller while we trick-or-treated, content to watch the kids run back and forth. Next year, though, she'll be toddling right along behind them.

At war with BCBS

I know I said that I'd have a post about the cutest lady bug ever today, but I'm going to have to delay that until tomorrow.

A few weeks ago I wrote about my ongoing fight with BlueCross BlueShield of Texas to get Elizabeth's delivery covered. Yesterday I went another round with the insurance company.

I received a letter in the mail telling me that my appeal had been denied because my situation didn't match any of the items on their list that would allow them to pay for the delivery. So I girded my loins and called BCBS. As soon as I got a human on the phone, I asked for a supervisor. I had the bad luck of being connected to Kelly C.

Here's where having a photographic memory for conversations comes in handy.

****

Me: I'm calling about my claim, which was denied.
KC: That's right. Your condition doesn't meet any of our requirements for being covered.
Me: Can you explain that please?
KC: We will pay for treating complications of pregnancy, but we won't pay for delivery.
Me: Did you get the letter from my doctor?
KC: Yes, we have it. But doctor's letters don't matter. Only medical records matter, and yours don't show that we should cover the delivery.
Me: When my son was born three years ago, you paid for his delivery because he was breech.
KC: We've gone back and reviewed claims, and it turns out the company paid for a lot of claims it shouldn't have. You son's delivery probably shouldn't have been paid, but we're not going to try and recover the payments.
Me: With this delivery, you paid for the claim from the anesthesiologist.
KC: That was a mistake, and if you ask for a review of this claim, we could end up reversing that decision.
Me: So I'd have to pay back the payment to the anesthesiologist?
KC: That's correct.
Yes, she did essentially threaten that if I pursued this they might make me pay more money.
Me: As my next step I'm going to be contacting the Department of Insurance, an attorney and my legislators.
KC: You can do that, but it won't do any good. No one in medical review is going to approve this claim.
Me: How can you work there and still sleep at night?
KC: If you're going to attack me personally, I'm going to terminate this call.
Me: Please put your supervisor on the line.
KC: There's no one higher than me.
Me: Bullshit. I want to talk to your supervisor.
KC: No one here is going to approve this claim.
Me: I don't care. Put someone else on the phone now. I'm finished talking to you.

After a few more back and forths where she claimed there was no one else to talk to and I told her I didn't care and that she needed to find someone immediately, she put me on hold. I sat there crying while listening to perky, cheerful hold music.

After about 10 minutes, Tanika got on the phone.

Me: Kelly told me that BCBS would pay to treat complications of pregnancy but not delivery. My complication was five weeks' pre-term labor with fetal distress. Now I'm not a medical person, but it seems to me that the treatment for that complication is to deliver the baby.
T: I'm not a medical person, so I can't explain why the medical section made this decision. But that seems reasonable.
Me: BCBS also paid for my anesthesiology bill without any protest. It was just paid automatically.
T: That's odd, because medical review says no claims from this date of service should have been paid.
Me: What do I do next?
T: You can file a second appeal - you're allowed two appeals. (Something KC never told me.) When you file your second appeal you need to include any other information that you feel is relevant, and have your doctor do the same. Anything you can give us that would help your case. After that, you can also contact TDI for help appealing this.
Me: Thank you so much for at least listening to me. Kelly C wouldn't even do that.

I felt like Tanika was sort of telling me, without actually telling me, how to get the claim paid. Kind of like the scene in "The Incredibles" when Bob Parr tells the little old lady exactly what forms she needs to file. And while Tanika didn't approve my claim, she did at least listen to me without being rude or telling me that the claim would never be paid.

*****
After I spent about 15 minutes sobbing on the kitchen floor with Campbell asking, "Why you sad mommom?" I pulled myself together enough to call my doctor's office. The woman who deals with the insurance companies wasn't in, so I left a message for her to call me today. Maybe she has some further thoughts.

After I got off the phone with the doctor's office I cried some more. This has just worn me out. I feel helpless and out of control dealing with this immense company. I know the medical review section is nothing more than pencil pushers going through checklists without putting any thought into whether their decision actually make any sense. There is no reasoning with people who can only see checklists.

But yesterday also made me mad, not angry, MAD. I'm going to fight this as far as I can. BCBS has stolen my time, energy and joy at having a new baby from me, and that's what really upsets me.

I also truly believe that anyone who thinks our health care system is fine the way it is has never had to pay for his or her own health insurance and has also never had a claim denied. Anyone who has had to fight with an insurance company should know that the system is broken.

Tomorrow, a cute ladybug. I hope.

Baby clothes

So it turns out that when you're 35 weeks' pregnant with your fourth child and you think you're past getting excited about baby gear, you can still get all mushy over tiny baby clothes.

My mom, otherwise known as knittergran, went a little nuts at the store the other day and bought a bunch of baby clothes for Baby Bee. The box arrived Monday, and I sat on the floor oohing and aaahing over all of it. There's a particularly sweet little fuzzy jacket with ears on the hood that sent me into raptures. B watched me unpack the box and rolled his eyes the whole time.

The girls were just as excited about the box of stuff. They spent quite a while looking everything over and exclaiming about how tiny it all is. Even though they both remember when Campbell was born, they don't have any recollection of just how tiny he was as a new baby. They're going to be pretty surprised when the finally see Baby Bee.

Speaking of seeing Baby Bee, I get to have another ultrasound in two weeks. I'm measuring small, so the doctor wants to take a peek. On the one hand, it will be nice to see the baby. On the other, our stupid #()*@(*# insurance doesn't cover ultrasounds, so I know I'll be coughing up a big chunk of change for the chance to see the baby.

I hate insurance companies

B and I are both self-employed, which means we are self-insured. We pay a pretty large premium each month for so-so coverage and a large deductible. Our insurance plan does not cover pregnancy or delivery, which means we're paying everything for Baby Bee out of pocket. We had to pay out of pocket for Campbell, but because I had to have an emergency c-section, insurance did cough up for part of it. At any rate, this pregnancy and delivery will cost us somewhere in the neighborhood of $12,000, and that's including the 20% discount my OB offered since we paid up front for her services.

Last week I received a letter from Blue Cross Blue Shield touting this new FREE BENEFIT they're offering pregnant women. It's called something like Healthy Start, and basically all it involves is assigning me an OB nurse who will call and check in with me every few weeks to see how the pregnancy is going, answer any questions, and make sure I'm getting the appropriate pre-natal care. I ripped up the letter and threw it in the trash.

Wednesday afternoon I got a call from a BCBS rep checking to see if I had received the letter and asking whether I was interested enrolling in the FREE BENEFIT. She kept stressing what a great program it was - and did she mention it was FREE. I told her I'd be a whole lot more impressed if BCBS would actually cover my pregnancy and delivery. That stumped her for a moment, but then she got back on script about what a great service they were offering by providing guidance throughout my pregnancy - for FREE. I told her it was my 4th pregnancy and I pretty much knew what I was doing at this point. She paused again before getting back on script, asking for the third time if I wanted to enroll in this FREE BENEFIT. I answered that I only have 8 weeks to go, so they're a little late with the offer. At that point she gave up and ended the call.

I just found the whole thing insulting. They are offering this FREE BENEFIT like it's something I should be so grateful for, when it's nothing more than a couple of phone calls from a nurse. BCBS is touting it as a way to help women have healthy pregnancies and full-term babies, but really it's nothing more than a cost-saving effort on their part. The more healthy pregnancies and safe deliveries, the less money they have to pay out in claims later on. Not that having regular calls from a nurse would have prevented my emergency c-section with Campbell. No phone call in the world would have stopped him from flipping breech three days before he was born.

There is the chance that I'm being cynical and unfair. Maybe BCBS really does care and really does want to to help pregnant women, no ulterior financial motives involved.

Fat chance.