A story about how an insurance company paid a Painkiller.
Everybody has a doctor, and everyone needs health insurance in order to see one. A case in which means defeat their end. One spends one hour at a regular visit to his primary physician, yet one might spend three or four times as much time making sure he will spend only a copay for that service. Matching providers and health insurances they accept is another nightmare. In network, out-of-network. Go figure. You will pay anyway.
My wife recently had surgery and the anesthesiologist’s bill amounted to over four thousand dollars. A lot of money for a dose of morphine-like drugs. Enough to knock you out (but not get high), but not enough to kill you. These innocent-looking doctors hold the key to the administration of really cool pain-suppressing (very) controlled substances. The Painkillers, I call them. Ten minutes of work before surgery, a lit bit more drugs here or there during surgery, and wake the patient up with some anti-whatever was in the original cocktail. When my first kid was born, the anesthesiologist joked that his real job was keeping the husband calm and out of the way.
For my wife’s surgery this time around, we had to check that the corporation, association, whatever, that would send out a Painkiller, whoever, was an in-network provider. Both sides said we were good to proceed with surgery. The Painkiller was covered.
Except for one thing. The company was an in-network provider, but the handsome Painkiller sent by them was not. As strange as it seems, one thing was certain: here comes a bill.
After filing a government form stating that the bill was a surprise and telling both insurance and provider of that fact, we felt safe. Not. Presumably the form protected us from having to pay before some kind of settlement was reached between them, i.e., insurance company and service provider. The consumer support phone service at the provider company did its job diligently, calling us periodically for the next three months to remind us that the bill existed. Thank you.
The insurance company also did its job. It denied the payment, only to change its mind (an honest mistake, of course) and put on their portal, that very same day, news that the case had been resolved and payment had been made on the day before. Sigh. In the process, I was told I could not speak on behalf of my wife about the bills she had to pay. Even though “there are cases” in which the partner may give authorization over the phone for the other to resolve matters of mutual interest (bills?), such prerogative was limited to one phone call per member per year. If I only knew. I wouldn’t have called them about coverage for her Pillates classes during her recovery. Wow.
E la nave va. We go on spending three, four times more of our time managing health-related paperwork and bills (many bills), than we spend with our health itself and with our providers, who presumably are those we want to talk to in the first place.
I feel dumb. And I feel numb. I’m sure I’m not alone.