Saturday, September 18, 2010

Wrestling with Health Insurance

Over the last several weeks, we've finally gotten off of our lazy behinds and started wrestling with some of the overdue health insurance bills that we've been receiving from St. Barnabas. It's been an interesting education for us, as Grandma's oft-repeated declaration of "How would you know that?!?" says. Thankfully, we had teachers' health insurance (now, we're on public assistance), which covers an awful lot of things, so everything should eventually wind up paid for. Can you imagine being without it? For one hospital stay in April of 2009 - one of the bad ones - we racked up $192,000 in charges. The next week, another stay, resulting in $78,000 in charges. Catastrophic doesn't begin to describe that kind of money.

Side note: and, again, the Valerie Fund has let us down. They have people there that are supposed to help us with health insurance issues. They haven't done a darn thing, and they haven't helped us one little bit. We gave them our bills, asked for help interpreting the bills, and were repeatedly told, "We'll get back to you about this!" Guess what? Nothing. The bills have kept coming, we've been in collections for at least a half dozen bills, and the Valerie Fund has never done a damn thing. They talk a great game, but they have been entirely ineffectual. Folks, that's why I'm not contributing to them anymore. In their defense, they were good about getting the referrals. Ultimately, it's been up to us to resolve the issues.

Recently, though, we've started making progress about getting the insurance money paid. The major factors in getting this stuff paid are:

1) Talk to the hospital / doctors and find out exactly what the bills are for. Make sure all the referrals are up to date and have been submitted with the claims. If bills are being refused or refunded by the insurance company, find out what the hospital / doctors have been told.

2) The hospital and the doctors will bill you separately.

3) Talk to the insurance company, armed with this information. Find out exactly what the reason that it has been refused / returned / refunded. Resubmit all claims as often as possible.

4) Know your health plan as much as possible. Know what's covered and what isn't; coinsurance options; secondary insurance options.

For instance, did you know the birthday rule? That, if you and your spouse are both covering your children with your employers' health insurance, the primary insurance is that of the parent whose birthday occurs earlier in the year? The Wife's birthday is in July; mine is in August. Therefore, her health insurance was considered primary.

That's important, because we had assumed that her insurance was ended when she stopped working in January of 2009. Instead, it was continued to January of 2010, without our knowledge. So, every claim that we submitted in 2009 with my insurance as primary SHOULD have been submitted as her insurance primary. This means that all charges to my insurance can be refused or charged under out-of-network, resulting in huge copayments from me.

Complicated, no? Less so than you think. What made it difficult was talking to the person in the doctors' billing office for St. Barnabas. These people were not your high school valedictorians; these people, for the most part, seem to be barely high school educated and have IQs around a standard deviation lower than average. Things move slowly and carefully, and I had to repeat myself dozens of times and have the person repeat it back to me. Not to mention, they have great difficulty operating the computer systems and finding the information they need to find.

All insurance claims, then, are going to need to be resubmitted. Not my problem, really; except, it IS my problem if I didn't know that and just tried to pay my bills as they came in.

Oh, one other thing: you need to keep careful, OCD track of every bill paid, the check you write, and when the checks are cashed. The hospital bill payment department is staffed by said neanderthals, which means that any check you write will not be applied to the place you want it. There are numerous bills that have been paid for a year that still appear on bills, because they didn't apply the check correctly and don't have records of it. I call and say, "Why am I getting this bill? This was paid with check #596, written for $50, and cashed by you guys on February 1, 2010. The invoices that were paid by this check were A, B, C, D, and E." That goes a long way in solving some of the issues.

Again, how would I know? In this case, hard-earned experience. Above all, don't pay ANYTHING that you're not supposed to pay, until you've fought and fought and fought about it.

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