Dealing with Health Insurance

Everybody knows this is bad news. All health insurance companies suck. But nothing sucks quite as worse than Medi-Cal managed care. 

My insurance is IEHP, and as the story goes, I’ve been trying to get top surgery since August. Maybe you’ve been following along on my blog, or perhaps it’s just too damn fascinating and electrifying for you to read it all in one fell swoop. I’d understand if you don’t want to. It’s been nothing but grim shit these last few months.

Well, after a long, hard road of appeals, I learned on Friday that they overturned my denial. IEHP said they were finally approving my surgery. Great news, right? But not so fast. They didn’t really approve it afterall. 

They only approved an office visit. That’s not the same thing at all. I’ve already had two office visits with these surgeons and paid for them with my own money. I don’t need approval for a damn office visit. I need them to pay for my whole surgery. That’s what this whole thing has been all about from the get-go!

Yesterday they still said it was fully approved and said they faxed the approval papers to the doctors–to both my primary doctor and the surgeon. But no such paperwork exists at either office. Not Friday, not Monday, not Tuesday. Nope. Not here, sorry. I quadruple-checked.

I keep calling back IEHP to tell them, and they say, “Well, I don’t know what to tell you. We faxed everything the doctors need on Friday and again this morning.”

Lies! 

My mind is swelling and spinning. I feel like an ape, ready to break things.

“Try asking your doctor again if they have it,” they suggested. This would have been the third time, but I have absolutely nothing else I can do.

So after another hour of being on hold with my doctor’s offices to find that they still don’t have faxes from IEHP, I’ve wasted more time in my ball of frustration that climbs up the walls of my psyche.  

I called IEHP back again, waited one hour to get to a representative, who then transfers me to Appeals, where I waited another 25 minutes to get to the right person in that department. BTW, you have to give all your private information to each person along the way in the assembly line. Then, right when I reach the right person (the woman in charge of my case), I was instantly disconnected! Fuck! Despite her having my call-back number, she didn’t bother to call me back. 🙁 Now that just sucks on a personal level.

No…., That’s all right. I’m not frustrated at all. I don’t want to throw my coffee mug across the room in the slightest. I don’t feel like punching a hole clear through my monitor with my fist. Nope. 

Three Ativans later, I started over again to track down the mystery fax. It was also unclear as to what was on that mystery fax. Was it even the right papers? I couldn’t tell. IEHP was so UNCLEAR about what papers they’re sending to which doctors. It sounds to me that they still don’t have them right.

It’s specific shit. They need to send two approvals and two Letters of Agreements. Is that so hard? They are the insurance business, not me. This is not my fucking job to know what is supposed to be submitted to doctors that are out-of-network. Why am I telling them how to do their jobs?? I don’t fucking know how to do it. Do I look like I work in the health insurance industry?

Meanwhile, if this doesn’t get settled in a timely manner, the whole thing can stale date, and I can lose these benefits completely. 

No one but me is advocating for my case. No one is taking the responsibility to fix it. But I’m absolutely powerless to do it. IEHP says the surgeon should call them, but the surgeon won’t. That’s not how it works! The surgeon’s offices faxes what paperwork they need, and the Insurance office faxes that paperwork back. Simple. 

The surgeon’s office says I should call IEHP and make them fax the papers, but IEHP is lying about doing just that. And no one is accountable. 

I’ve tried to get them to fax these papers to me personally, but I’m just sitting here–waiting with the crickets. The only fax I got was the one for the office visit, so I’m pretty sure they don’t know what the hell they are doing.

Tell me someting. How do people who have way less motivation than I do (be real: most people) that aren’t very proactive about their own illnesses receive anything that even resembles healthcare in this country? Really. How do they live in this world? Why aren’t ALL of them dead, on drugs or drunk, or just way more mentally broken? Well, most of them are, I suppose. People who tell broken people to pick themselves off the ground or “buck up” should be slugged square in the face.

This country’s healthcare system is grotesque. 

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