Health insurance, and the gods

I have been pretty blessed of being able to afford good PPO insurance. Recently my husbands company went with a new insurance policy. I will call this insurance company Suck-na, for the sake of not being slanderous. This company was a three ring circus from the get. I remember when I first filled out all my information and sent our packet in and they sent us cards, and I finally used my insurance. I was told I didn't have coverage! Knowing there was some mistake I called Suck-na up and asked them why I didn't have coverage. They asked me to give my name date of birth, blood of a virgin, one rare gold coin and my social. When I gave my social the Customer Service Rep says, "Oh you gave us the wrong social for you." I knew better. I told her no, I filled out my packet, and I know my social maybe my handwriting is bad, what do you have? She called off some unearthly number that couldn't possibly be mine and then says, "Oops I am in the wrong account please hold." So I guess I now have someone else's social...WOW.

My son has to get oral surgery, because he had an extra permanent front tooth, we are sooo Dracula like that, anyways Suck-na Pre-approved the procedure. I was told to set up my appointment within so many days or I lose my pre-approval. Why in the heck am I getting a deadline? Anyways, needless to say the bulk of the surgery was paid for, and that's good, but I had already met deductible, and really the whole thing should be paid for. I paid the remaining balance to the hospital, thinking I was good. Only to get another hospital bill and the entire anesthesia bill about two weeks later. What in the heck!?!?! I called thinking this was a misunderstanding, but I was informed that they applied part of the surgery to in-network max and some to out of network maximum. I told them the oral surgeon i used was in network and all of his other claims were defined as in-network why not this one? I didn't get a response but a summary of what wasn't paid. I asked them why was the anesthesia not covered, and I was told because the anesthesia bill came after the surgery bill. I told them it doesn't matter how the bill was received, but rather how the procedure was preformed, and since the anesthesia came before the surgery, and it all happened on the same day. I was told that was a shame that bill showed up the day after and they couldn't pay for it. As I inquired more I was told by a representative, "So what you are saying is you required anesthesia for your surgery?" OMG REALLY! Losing my cool I told her, "Yes this isn't 1699, we don't give our son a shot glass of laudanum, and a wooden spoon to bite down on, he is ten. The doctor gave him anesthesia so I assume his medical degree indicates he felt he needed it. She replied, "Oh, I see. So your son went in February 9th for surgery and was given his anesthesia February 10th, which is why the anesthesia claim wasn't paid." WHAT?

Finally after a moment of deep breaths, I asked if she had ever had surgery. She responded yes, and I asked her, "When you had your surgery did you get anesthesia before or after it was preformed?" She prompted stated before. "SO you understand my frustration when I say I am upset that the anesthesia wasn't covered for my son." She then said, "Oh, well then...I don't know why we didn't cover that!"

I wait to the tune of some more annoying elevator music for over twenty minutes for her supervisor. Her supervisor comes on the line, "I understand you are upset because we didn't cover anesthesia and it was because the anesthesia bill came after the doctor and surgery portion of the bill." Oh my GOD!!! Representative one and two are sharing a single brain cell!!!

Now that time has passed, I finished up my claim dispute, I got $200 of the anesthesia bill paid, but the remaining $600 was mine because apparently the chicken and the egg scenario apply to medical claims and insurance companies that process them rather than good common sense. I was told going forward that they base their payment on what date was on the bill. I was told legally speaking they couldn't divulge in writing what their practice was for posting and paying surgical bills, and medically speaking they could only give me an adjustment and not pay the entire thing because of a date, and because they felt he could have had his tooth surgcially removed without anesthesia but with gas or soemthing to that effect. I then asked since we were speaking medically and legally, could I please have a copy of the insurance companies legal and medical degrees to ensure I was getting correct information. I was told by the represenative that she didn't have those! I concluded my conversation with them, "Then please do not profess to know medically or legally what is needed, if you don't in fact have the degree to back up your statements. I would like to cancel my policy."

I cancelled my policy and never looked back and its amazing to me since leaving Suck-na how many of my claims get PAID! I will never forget being told anesthesia wasn't considered part of a surgery. HAHAHA! I suppose my son little Achilles was fine with no anesthesia

 as long as we stayed away from his plantar tendon...WOW.