Insurance Insecurities

I’m on “hold” again with my insurance company, or “benefits administrator,” which gives me plenty of time to share some thoughts. This call started off, as they all do, with a recording that claims: “Any verbal explanation of benefits or statements of eligibility or coverage is not a guarantee of payment. Accuracy of benefits is only determined when bill is received…”

What? Then, when a real person finally answers they ask if I heard the “disclaimer.” Usually, I say, “Yes, anything you say to me cannot be used against you,” which I think is fairly clever, but has yet to get even a courtesy laugh.

So, how much is this going to cost?

When your neurologist suggests a new treatment or therapy, is your first thought, “Oh, this might be helpful in alleviating my symptoms,” or, “How much is this going to cost?” Recently, my doctor recommended two new ideas. One was physical therapy and one a very expensive infusion treatment. The PT should have been simple enough, but nope, despite all my calls and questions beforehand (I literally asked to speak to the therapist’s supervisor before my first session after the insurance company couldn’t quote a price), I still did not know my “patient responsibility” until my “bill was received.” After which, my budget and I decided that we need to put PT “on hold.”

When I looked into the high-priced infusion, I was assured that “most people only have to pay a small 'co-pay' after completing the screening process that used scary terms like “prior auth” and “pre-determination.” This was after the insurance company talked to me about worrisome terms such as “deductible” and EOBs which I understand and “OOP,” which I’m less clear about and does not inspire confidence!

Problems with my insurance

Then, when I was all set up to go in for my first infusion on a recent Monday morning, I received a call the Friday before, at 5:00 pm that there was a problem with my insurance. I did not have a “prior auth” after all! Nobody was available to talk to, of course, so I went through the weekend wondering if this procedure I worked so hard to understand, financially, physically, and emotionally, would even happen. It did not. It was rescheduled until the next week.

How do you budget when you can't get straight answers?

It’s not just me. I go through the same when any member of the family needs a treatment or procedure and anyone I know who has or cares for some with chronic or acute illness expresses the same concerns. I say “I” go through it because as someone home on disability I’m the only one who generally has the time to do all this research. What do people do who have full-time jobs? Earlier today I was on a website for my new treatment and read disturbing stories about people who have received their EOBs with huge “Patient Resposibility” numbers they weren’t prepared for because, really, how do you plan and budget when you can’t get straight answers? Meanwhile, I’m on “pins and needles(!)" waiting to see what this will all cost.

We need better communication

I don’t know what the answer is. I do know the current healthcare system needs help. Universal health care and other reforms bring so many controversies and complications. Currently, however, there are so many companies, codes, and co-pays involved. I’ve had three party phone conversations with me, the provider, and the insurance company and even then we cannot resolve the issue and there is a lot of finger pointing as to who is responsible for what. All I know as a former counselor is that we need better communication at least! Better minds than mine seem unable to untangle this mess. Thoughts?