Well, it is a holiday weekend and people are sleeping in today. As for me.... I have been up since 2am with allergy sinus pressure that makes me want to close my eyes, but a cough that refuses to let me get any sleep. So.... I may appear a little bitter in this blog entry, but I have a pressing question that will not get an answer until after the holiday weekend is over and then I get to sit on hold for an hour with Blue Cross Blue Shield of Illinois healthcare insurance company. One department in mind... the claims department.
Is it just me, or is that automated answering system just a tool to piss off the caller? I have no doubt that they use this system to at least attempt to try to route the call to the right department, but when you finally do get an actual person.... they ask the same damn questions that the automated system asked. Does not seem all that efficient, if you ask me.
Well, I have no doubt that after getting the 20 questions game with a computer that answered the call first over with, I will be required to do it all again to an actual person that sounds like they would rather be anywhere but their job. Then, I will be put on hold as they type a little on their computer to pull up my policy and mention some lame excuse as to why a claim has been denied when I took the time (literally) to call ahead and check for coverage and to make sure that I am leaping through the correct flaming hoops to be assured that there will be coverage. Yep, I am one of those people that ask first and then follow the rules to get the end result that we need. Especially, for services that I know will cost a blooming fortune and has the potential to put my family on the rung below the poor house (since we are already there).
With this apparent "wonderful" healthcare initiative that our previous president spearheaded without really thinking it through.... I make it a requirement to check for coverage before eve thinking about making an appointment. Pretty sad to say that I do this with a PPO plan that should not require pre-authorization for treatment, but since there was so little concern for the working class that is required to purchase this insurance.... the insurance carriers now have more red tape and flaming hoops that allow them to not pay their share. That is beyond the insane premiums that they can charge. It is painfully obvious that all insurance companies are "for profit" organizations. If you have ever really looked at an itemized doctor bill, you will get to know intimately how the system is played.
Let's just say you are to see a specialist. In my case, it was for an orthodontist for DD. She needed braces because the cross-bite that she has, along with some misaligned teeth, is one of the catalyst for her migraine headaches. Sure, there are other factors for the headaches, but dental issues can also span abilities of chewing as well as, in a small way, cosmetic needs. The dentist has been screaming for DD to get braces before she turned 10 years old. I waited because of two factors..... all of her teeth were not in yet and once they were all in, her need for braces could diminish, and the big reason is because we just could not afford them. When the Affordable Care Act (ACA or also known as "Obamacare") was pushed into effect, pediatric dental is a requirement. Didn't know about this because when trying to read the bill online, it was hidden in so much legal jargon that when our healthcare insurance carrier was required to show it on our insurance card, I finally became aware of it. Upon calling our insurance company (Blue Cross Blue Shield of Illinois or BCBSIL), I checked about coverage, restrictions, and availability for my 17 year old child. While our insurance is a PPO plan, I was told that we can select any orthodontist to get the much needed braces for DD, but there are a few ortho offices that they (the insurance company) prefer over others. I found out percentages of coverage, the cap for our of pocket, deductibles, copays, and everything in between. I was assured of what the cost would be before even stepping foot in the office and figured that if everything quoted remotely matched what we could afford... I could get DH on board to getting this done.
After checking everything, making sure all the i's were dotted and the crosses on those t's, we set forth with the assurance that our insurance would do their part in this $7100.00 adventure. We had to make sure that we got this done before the end of June because where we were on Deductible and out of pocket would be set back to zero and the math would be different and could quite possibly not affordable with our incomes. Well, needless to say.... DD got her braces well before the end date of that policy and before we renewed our plan, so according to all my research and math... we should be covered, right?
Well, apparently not.
The orthodontist managed to lose the claim to the insurance company TWICE and if it was not for me being a royal pain and hyper critical. I made sure that BCBSIL was aware of the service date and they made sure to figure the claim from that date and time to the plan that was active at that time. Working with the numbers from my previous calls to BCBSIL. I was assured that the service is covered and the percentages are as what was quoted, but apparently, people LIE. Currently financing the agreed out of pocket amount for the next 2 years has now been changed to us being required to finance the whole thing with no discounts that insurance carriers make with providers, no coverage what-so-ever of services performed. Yep, what was covered care (as little as it was) has now been denied. No real explanation as to why, but now an added burden to our already painfully restricted budget. Of course, they (BCBSIL) has the audacity to claim that we have pediatric dental coverage for our daughter because she is under the age of 21 and is a full-time student. WHAT A CROCK OF BULLSH*T!
Now, I get to wait for the holiday weekend to be over (since we received this tidbit of news in the mail on Saturday) to call and find out why our family is being financially raped without buying us dinner first.... screwed sideways without any lubricant. I have to figure when I can carve out at least an hour of my day, in their open hours of operation, to speak to a machine - then an unhappy person, to get the run-a-round to hear them vomit out their apologies and some lame excuse as to why I was lied to with some cockamamie flaming hoop that they decided to not mention to me before, and then give me some impossible red tape path to take to see if maybe they can help us out. Otherwise, I get to watch DH toss and turn in his sleep from stress that we yet again are sh*t out of luck and have me sleep even less than I do trying to find a way to figure another creative math equation to cover this new responsibility and avoid any other hiccups that can potentially sink us financially. All the while, hope that nobody will require seeing a doctor or need medications until we can figure this out.
I guess on a brighter note, it took me a little over 2 years of saving to get my husband a new chair. It was delivered yesterday and sadly makes my couch look quite sad, but at least my overworked husband can at least have a comfortable place to sit when he comes home from work. Pretty sad that it took me a little over 2 years to afford a small token of luxury in my house, but every time I was close... something took that saved money away. Sucks to have a job that strictly pays commission.
Oh well, time to streamline the grocery list to a new, smaller budget. Thanks for letting me vent. I hope you have a better day that I am.....
