Monday, June 29, 2009

"Insurance" for Dummies...Now with visuals...

This is what my current insurance policy clearly ensures:

1.) 45 minutes is not a long enough amount of time in which to make a phone call to customer service to get information about injectable reproductive medications.

2.) You will have less of an understanding of what is actually covered, and how much of any covered procedure or drug is actually covered, based on your deductible, the amount billed versus the amount allowed (which they are not at liberty to discuss with you) by the time you get off the phone.

3.) The person on the other end of the phone will have a southern drawl and demonstrate slightly anti-semetic leanings in casual conversation. Said person will also go on for several minutes about the difference between a procedure that will get me pregnant versus a drug that will get me pregnant, and make sure, several times, that I know the drug itself will not get me pregnant.

4.) You will be broke. Because you will be paying for every single penny of your fertility treatments out of your own pocket.

5.) IF a drug is covered (which you still won't know for sure after almost an hour on the phone with said anti-semetic customer service rep), you will most certainly not be able to purchase it at the specialty pharmacy that's within your own neighborhood and convenient to you. No. In order to maybe, perchance, depending on how the review board feels that day, get your prescription covered, you'll have to use one of two specialty pharmacies that they contract with.

6.) Don't worry about #5, because odds are a million to one that your prescription will be covered at all.

7.) You will need to drink heavily after getting off the phone. And eat a piece of cake.

This is a picture of the notes I was able to take while Marilyn, my helpful customer service rep, gave me misinformation after misinformation. Perhaps you can get a sense of my state of mind---note the "our insurance is a giant vat of suck" commentary, written during one of the eleventy billion times she put me on hold to dig up some more bogus information to give me. You see the few lines in the left-hand, sideways Sarah-created column? That is the only actual valid information she ended up giving me, after calling me back. It basically says--you pay for it all. Then you get to file a claim and if you get denied, you get to appeal. Awesome.


lonek8 said...

that sucks. I used to work in medical billing and by far the worst part of the job was calling the insurance companies. And of course, it's so much worse if you are the customer- I guess they figure you aren't going anywhere so why should they bother with customer service? Maybe you can get your doctor's office to call and see what is covered- like a pre-authorization. And then you can sit back, relax and enjoy your cake!

AJU5's Mom said...

Although the people I have talked to have been fine, I did not get anywhere 99% of the time I had to call the insurance company. There are just so many hoops to jump through to get things sorted out with benefits! I agree with lonek8 that you should see if the doctor's office could do some research for you - they can often get places we "customers" can't!

Amy said...

The doc's office billing dept could probably tell you in about 5 seconds what is covered. They bill that stuff all the time.

But I would still eat the cake too.

Sarah said...

what a farking nightmare. cake for sure!