Friday, Apr 18, 2014
Joyce Minor

Insurance: both a blessing and a pain


Published:

One of the greatest frustrations of cancer treatment is the ongoing, ever-increasing chore of tracking the bills and insurance claims, not to mention actually paying them.

For instance, my insurance company sends me a statement every three weeks showing all of my claims, what was paid to whom, and what, if anything, I owe toward each one. This is very helpful; I do appreciate it, and I know I'm blessed just to have insurance.

However, if I disagree with or don't understand something on my statement (which runs eight to nine pages every month) the company has assigned me a care coordinator whom I can call to help me handle the problem. She's kind and caring, though I'm sure she has numerous cases to juggle. She's rarely available to answer her phone, but I can leave voice messages and she will call back, if I wait long enough - usually from two to 10 days. Unfortunately, I have one problem she has either not even tried to solve, or couldn't figure out, or simply forgotten about. This is a real conundrum because the solution sounds so simple.

My policy deductible for in-network expenses is $5,000, which I surpassed way back in February. However, for more than six months now, my statements have listed the portion met as $4,845. Though I have continued to shell out hundreds of dollars, that figure has not changed one penny in five months.

It's obvious the company knows I've met my deductible. They've been paying my claims and showing the portion I owe on most of them as $0. But because they continue to show that I've not met my deductible, doctors continue to charge me $40 co-pay for every visit. When you find yourself seeing at least two doctors every week, this gets a little old. Invariably, once they call the insurance company, doctors find that they must refund my money, which is a huge hassle for them as well as for me.

Why can't the insurance company find a way to correct this simple error and save us all a pile of irritation, unnecessary phone calls, and paperwork? My care coordinator promised to work on this months ago, but every statement - there it is again. So every time I'm required to see a new doctor, as happened this past week, the same old hassle plays out all over again. This is more than frustrating. I don't always have an extra $40.

My last chemo treatment produced an unexpected side effect - an abcess that had to be lanced immediately. I was referred to a local surgeon, then to an outpatient surgery center for the procedure. They both worked me into their schedules and did an excellent job.

However, the surgeon's office insisted I fork over the $40 copay. I was in too much pain to argue, but when I got home, though still woosey from anesthetic, I once again called my insurance care coordinator and, of course, got her answering machine. I left her a detailed message reiterating the problem, all the while gritting my teeth to keep from screaming. As of today, it has been seven days and she has not returned my call.

I have a theory that perhaps insurance companies have an ulterior motive for these snafus. Maybe they've discovered that anger has healing powers and somehow an overload of it results in fewer, lower claims. Or maybe they've found that policyholders with cancer eventually get frustrated enough to just give up and die, ending the stream of claims.

Well, I have news for them. I'm not giving up; I want it fixed, now . please.

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