Insurance Woes

The saga continues. (If you don’t want to read all of this – mom – skip to the last two paragraphs, I am asking for advice there.)

Last summer – July and August – I had a couple of doctors visits that were not covered due to my doctor leaving my insurance and me not wanting to deal with finding a new doctor for two visits,I have out-of-network claims. And as you know, I got married in August. Upon return from our honeymoon I processed my name and address change with HR and filed the out-of-network claim.

Now my insurance says they will cover 70% of reasonable and customary charges. What they actually cover is 37% of what I paid. I really want to know where they are finding this reasonable and customary – because my doctor actually charges a little less than several others that I looked at in Manhattan. This kind of stinks, but I still want my $130 back. It’s not a ton, but when you are unemployed, it’s a godsend. Why then is the insurance making it so hard to claim this smallish amount.

In October I got a call from my doctor saying that the insurance had reimbursed her, not me. Which is wrong. So she sent that check back with a letter explaining to send to me. I heard and waited. Finally November 30 I called about the claim. I felt it should have been issued by now. And I was told the check had been mailed four days earlier to Kasey Powers at MY OLD Brooklyn address. Unfortunately because Kasey Powers never lived in Brooklyn, Kasey Frazier did, the check will not be forwarded. And until 30 days have passed the insurance won’t send a new check. Also they tell me that they can’t correct my address. I have to do that through HR – which I did when I changed my name. I confirm with HR that the name and address were both submitted.

I called on January 13 and was told a new check would be sent to the right address and I should expect it in 7 – 10 days. Because the address has now been fixed.

This brings me to today. I spent 45 minutes on the phone with a very nice customer service agent at the insurance company. Who can find no record of the check that was authorized on the 13th. And says that it looks like the check was cut under a different claim number than originally submitted. I told her I didn’t care how it was submitted as long as I get my check that was authorized for me nearly six months ago. We found that the problem finally. The name change went through on my old address, and my maiden name was attached to the new address. You would think this is an easy fix. But no, I have to fix it through either my company (where I don’t work anymore) or the overall insurance – there are all these sub-divisions in the insurance we have (where I am no longer insured because I don’t work there anymore) So the very nice customer service agent tells me that she will put through the authorization (why couldn’t she do that without all the explanation and my HR department (where I don’t work) already submitted all the information TWICE, because I made them re-do it in December. Anyway, it will take up to 30 days for the name / address issue to be resolved but I should call back in 10. And then, only then will I be allowed to receive my check. Ridiculous I say.

And as the eve of losing all insurance coverage through Rob is upon us, I am trying to weigh the options. I know we can’t afford good insurance, or COBRA, a downfall of the no-job thing. I have been looking into catastrophic coverage, also known as major-medical. But I can’t find anything for under $320 a month. And I’m not sure I can justify spending $4000 a year on the chance that something might happen and we’d still have to pay $10,000 before insurance would start covering most costs, where there would still be co-pays, and most likely physicians fees (which surprisingly are not covered under many of the catastrophic plans)

So what do we do. Insurance companies are a nightmare and expensive. Any advice on how to go when stuck in the place of having to buy your own insurance.

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