Monday, March 10, 2008

AAARRRGGGHHH!!

so today, i sat down with the mail, meaning to just make sure that the letters with the "explanation of benefits" from our health insurance we all correct. and lo and behold...

nope. they were trying to deny the claim for mental health benefits for me, saying i had exceeded my maximum. given that my maximum is "unlimited," i think that this was wrong.

so i called the number on the letter, and proceeded to spend twenty minutes trying to get to an actual person who could explain what went wrong with the coverage, and what to do to correct the problem (since we're talking about ~$1000 worth of therapy from last year, plus however much it would come to for *this* year, it's an important problem to correct!) the first two times i made it to an actual live person, they said they weren't the ones to answer my question, and then i wound up getting bounced back to the very first part of the voicemail system. i hate voicemail.

anyhow. the thing is, before i started going to therapy as often as i have been, my therapist and i both called to make sure that DID is covered under mental health parity in new york. and the people my therapist talked to assured her that it was. and the first time this bill got sent back unpaid, she called again, and they assured her again that it was covered. so we're working under the belief that... you know, it's covered.

after spending so long trying to get to a person, and dealing with people who spent several minutes taking my information, and then telling me they weren't the ones to answer the question, i couldn't help but think, "boy, it's a good thing for them that the hospital people who diagnosed me as borderline weren't right, because if i were borderline, i would SO be screaming at someone by now."


**update**

brought this up with my therapist today, and she had already talked to them, and they *insist* that they've corrected whatever, and she should get a check in the mail. we'll see. i just hope they finally get around to paying her. and i'm grateful she's willing to put up with the stupidity of insurance companies, because she's a good therapist, and i couldn't afford therapy if she weren't on insurance. and certainly not the amount of therapy i've been getting!

5 comments:

Rising Rainbow said...

I remember those days of fighting with insurance companies. When I hear all those complaints of rising healthcare costs I think of how much money they waste making such dumb mistakes all the time. I hope you get it settled soon. I know how distressing it was for me to have these things hanging over my head.

Medicoglia, RN said...

About every 6 months, Medicare denies a months worth of claims from my t. It's gotten to the point where her biller just calls them and resubmits without me getting involved. I really think that insurance companies routinely deny covered mental health benefits as part of internal policy. If they can make the "loony" (I know neither you nor I is this but the word works well) get completely frustrated and quit seeking treatment because it's so hard to get the insurance to pay...then the insurance doesn't have to pay anymore. Would be really hard to prove this, but I do believe it is true. "They" do this with some other benefits too...diabetes care, cancer care, some GI isuues. I did medical billing for 10 years and I saw this often. It's terrible.

Anonymous said...

Argh, sympathies.

We don't have therapy coverage, but our Medicare part D plan does send us regular letters to tell us we've used up our coverage and they won't pay for anything else, around about April and continuing for the rest of the year. They DO keep paying for the medications, but nothing we've done or said can get them to stop sending the letters!

Anonymous said...

sounds like the insurance people are so frustrating! and it isn't fair.
i hope all this can be solved very soon, so this does NOT happen again ...

Kim said...

I can SO relate to this! Last year my insurance decided to limit my benefits becuause they said I was not "making enough progress" in therapy. Like who the hell are they to judge my progress?!?!?!?!?!