You people are all so very sweet. Really. I love you all. Here, have a pony. No, wait—have two. But honest to Jesus, folks, you have PLEASE got to stop emailing to tell me that my data is recoverable. As I spelled out earlier today, it turns out that my MacBook had a Seagate drive with a known habit of, oh, BREAKING INTO PIECES. Apparently the heads snap off and scratch the disk all to shit as an added bonus. The result is that yes, I probably COULD pay upwards of two grand to have 20% of my data recovered in fragments, or I could just practice that thing called acceptance and move on with my life and my money. So.
But hey—three cheers for our hero Otto, because when he was at the Genius Bar the guy tried to give him another Seagate drive and Otto persuaded him to “make a mistake” and give him a different brand. Not that it was necessary, because now that I have automatic back-ups my computer will never die again. HMPH.
Anyway. Moving on! Let’s talk about how much I hate our HMO!
Last week—back before I had any idea that my weekend would feature the carnival of FUN I just experienced—it became clear to me that Monkey was in need of a doctor’s visit. Not just any doctor, though. OH NO. That would be TOO EASY. No, Monkey would need a specialist, because HE IS SPESHUL. And that would maximize the annoyance factor.
Being the good little HMO patient that I am, I called up the primary care doctor and explained the situation and asked for a referral.
“Oh. Well. Yes, that’s fine,” the nurse told me, “we’d be happy to sign off on that. You just go ahead and make an appointment and call us with the details, and we’ll do the authorization paperwork.”
“Great!” I said. “Except that, um, I don’t really know who to call. Do you have a recommendation for a local pediatric specialist you use?”
I can’t be certain, but I think that underneath the following sounds of CRICKETS CHIRPING I heard her giggling at my naïveté.
“No, we don’t have anyone,” she told me, once she’d collected herself. “Just find someone on your insurance and we’ll authorize it.” Well. No problem, then, right?
WRONG!
The nurse at our doctor’s office was kind enough to give me the phone number of the largest pediatrics office in town; she suggested I call them and explain the situation—that I am trying to track down a pediatric specialist who takes my insurance, and do they have someone whom they regularly recommend.
I called, detailed our predicament, and the woman on the phone REFUSED TO TALK TO ME. Because we’re not patients there—she told me, before hanging up on me—she is NOT ALLOWED to tell me anything. Thanks! I’ll be sure to check you guys out when I need a new pediatrician and hell has frozen over!
Then I spent some time gathering information; thanks to the magic of Twitter (Motto: Where you end up chatting with friends of friends of friends who then bring you produce!), I’ve recently befriended Yet Another University Type who seemed like she might be in the know about this sort of thing. I asked for some recommendations and before I knew what was happening, she had seemingly pinged everyone in her department, and I had a list of names. Awesome.
I cross-referenced the list with our insurance. HAHAHAHAHAHA!
Yeah. The top three recommendations? Not covered.
Well, that was fine. I would call the fourth person on the list. He was covered!
He doesn’t see children under 13. Um, dude? That word, PEDIATRIC, I do not think it means what you think it means. Here’s a hint: The word you’re looking for is ADOLESCENT, not pediatric. You’re welcome!
I went and looked up the provider directory from my insurance company, online. They don’t list this particular specialty according to pediatric or not, so I was only able to obtain a list of names. I went down the list and called every name to ask if they see children. None of them do.
I then called the insurance company, you know, because that always works out so well.
They were very sympathetic, and by “very sympathetic” I mean that they left me on hold for twenty minutes.
The woman who finally came to my aid happily informed me that she’d found us a pediatric specialist over an hour away. When I pointed out that this is an issue which will likely require multiple appointments, and driving that far, weekly, isn’t terribly practical, she told me that as long as there is a qualifying doctor IN THE STATE OF GEORGIA they don’t have to find me someone closer.
Dudes. I don’t know if you’ve noticed this, but Georgia IS A REALLY BIG STATE. That’s… completely insane.
I asked to speak with a supervisor. She argued with me. I asked again. She argued some more. I reminded her that our call was being recorded for training purposes, and told her she’d done a great job (I even kept the gagging to a minimum), but that I really needed to speak with her supervisor NOW.
The supervisor came on the phone and told me all of the same stuff the other woman had, and assured me that it was all just great and fine, and by this time I had been working on this issue for multiple hours and I just lost it: I started to cry.
“Ma’am…?” she said.
“Look,” I finally managed. “I understand that you are just doing your job and telling me what you’re supposed to tell me. But what I need to tell you is that you’re supposed to be making this process EASIER for me, and instead you’re making it harder. We pay a lot of money for this insurance. The university pays a lot of money for this insurance. You’re supposed to be here to HELP US. At no point today has ANYONE said to me, ‘Hey, let me help you help your kid.’ Instead I’m being told the hundred different ways in which I am NOT allowed to get reasonable help for my child, and I have to tell you, IT’S NOT RIGHT. Do you think you could just set aside the bureaucrat-speak here for a few minutes and HELP ME? Please?”
There was a VERY LONG PAUSE, and then she said, “Yes, I think I can. Let me see what I can do, okay?”
The angels sang and the music swelled and bluebirds swayed in the trees. For about five minutes, I truly believed in the goodness of humanity.
Of course, she outlined a (very reasonable-sounding) game plan for me which included her calling me back the next day with some information, and that was last Thursday and I never heard back from her, so draw your own conclusions.
I hate this HMO so much, that after having gone through a similar process back in the fall when trying to find a covered therapist for the kids, I ended up going to someone NOT covered and paying out of pocket. Because at a certain point you just can’t keep screwing around, you know? And also because I want to someday be able to tell my children that not only are they breaking their mother’s heart, but DO THEY HAVE ANY IDEA HOW MUCH MONEY I’VE SPENT ON THEIR THERAPY OVER THE YEARS? Anyway, the kids see a fabulous therapist at the university at their teaching facility, so when it came time for me to look for someone I could see, I decided I wouldn’t even bother with the stupid insurance—I’d just ask for a recommendation from the kids’ therapist for someone at the same facility.
Well, the good news is that I had my first appointment yesterday—on a holiday!—and I was really grateful to be able to get in so soon.
The bad news is that I think my therapist is about twelve. Oh, I KID! She has to be at least sixteen.
But hey, um, she had really pretty shoes. That totally makes up for the fact that I sort of wanted to make her a sandwich and remind her to finish her homework, right?
Insurance! :-( Where’s the “I-hate-insurance-companies-more-than-anything-on-the-planet” emoticon when you need it???
And *why* for some reason, the powers that be in the universe seem to allow “pile on”, instead of just a nice, steady flow of c$%p to deal with, I will never understand.
I’m sorry for all the trouble you’re having. I wish I could say I think things will get easier, as far as the insurance goes, but that would be a total and complete lie. Insurance companies suck. I truly believe they are one of the true spots of evil on this planet. (I know this ranting doesn’t help you…sorry for that, too.)
My fingers just got all twisted up from trying to type three rants at once. To sum up:
1. When working half time I paid HALF my salary for insurance that had a higher co-pay and worse hospital and prescription coverage than the insurance offered my teenage daughter at her minimum wage job.
2. This lovely insurance is with an HMO that is bleeding (pun, unintentional, one each) doctors out because they are so utterly incompetent which means there ARE no specialists (none, not one single skin doc on the plan. None. Still can’t believe it).
3. It’s all worth it because this is ‘Merca where we believe in freedom and the right to choose our own practitioner!*
* Actual availability of practitioner may be subject to limitations and provisos.
I might have more ranting in me but it’s still early and I have some fingers to untwist…
Insurance makes me sad. But I mean not as sad as if I didn’t have it, obviously. Just that they make everything so difficult sometimes. Like say when you have cancer and your doctor tells you you need radiation but the insurance says the radiation is optional and they don’t think they will cover it. Radiation is damn expensive, but I think I’ll choose life, thank you.
I hope everythng works out and that someone eventually helps you! I used to be all happy and carefree and be positive that everyone in the world was good. Now I am all jaded and stuff because of my experiences with dealing with insurance for both myself and my son. I’m being a tiny bit dramatic here, but not much.
sigh. . . . there are no words to use – really – on situations like this.
I’ve often wondered why the post office gets such a bad rap. . . . Surely, HMO’s are worse. MUCH worse.
I knew she would not call you back. I’m pretty sure you have to be human to use the phone.
Sigh. When we moved to Kansas it took my insurance company ONE YEAR to accept that we brought the kids with us. That’s right, every single time I took one of my BOYS to the doctor, dentist, optomitrist, emergency room, etc.(those with girl-only families, please note that the frequency with which boy children require medical attention is far greater) coverage was denied because…and I swear they actually gave me this reason over the phone…”you live in Kansas but your pediatrician is in Georgia.” Can you hear the crickets? I changed their information about two dozen times before the “system” accepted it. Grrrrr….
Mir, I’m sorry. Try doing a few shots of tequila before you call again. It will numb the pain.
It’s not hopeless. There should be a provision in your member handbook that states something along the lines of if your PCP thinks you should see a specialist who is not in network then a referral to a non-network physician may be approved. If it is approved, then the treatment by the non-network physician will be covered as if you are seeing a network physician.
I don’t know if Georgia has access standards or not (apparently not if having a doctor in state is good enough), but this may be what she went to work on last Thursday. I’ll keep my fingers crossed.
Your little speech was heroic and wonderful. Can you make a copy and send it to the presidential candidates please?
I’m so sorry – this sucks.
After going through a similar situation with the same HMO you are currently dealing with, I now pay (significantly) more for the PPO, but I have no complaints.
Reenrollment is in Oct. or Nov. – just sayin’.
If I was a sixteen year old doctor and you made me a sandwich (a good one, like chicken ranch with bacon, not pb&j) I’d definitely do a good job ‘fixing’ the children.
Definitely.
Stories like this make me sick. Maybe I should call the doctor…
Not all HMO’s are like this, by the way. We have Kaiser, and they make the appointments with specialists for us a lot of the time, or give us the number to call. It has its faults, of course, but it’s a fairly efficient medical-care-delivery vehicle.
Oh that blows. God forbid anyone should go out of their way to help out a mom trying to help their kids. What is wrong with people.
yikes. insurance does totally suck. my job gives me a choice of cheaper HMO and bit more $$ big plan. I’ve been in an HMO before – when I was single, young and healthy. Now that I’m married, old-ish and mostly healthy I went for the more $$. (still its cheaper than at my old job, so I’m feeling pretty good about it.)
but does your therapist say anything intelligent after she finishes her sandwich and homework for you? that is what counts, no?
I went through something similar with my father a couple of weeks ago. I called every bone doctor in the city. 99% of them “don’t see car accident patients”
What? You do know that people break bones in car accidents right?
Yeah well…we don’t get paid as quickly with that sort of insurance…
hmmm…Well maybe you should make your priorities about helping people.
I hope you get it figured out. I think I spend the equivalent amount of time of a part-time job dealing with insurance and drs. offices. Except I pay them. What’s wrong with this system??
I have always thought of HMOs as Health Mangling Organizations.
We have decent insurance through my husband’s employer but since his company and most of its employees are in California and we’re not, it’s not the “local monopoly”. We get screwed all over the place because local doctors only know how to say “local monopoly” and just give you a blank stare if you say you have something else.
I’m about ready to take a job at my former employer at two thirds my former salary just to get back on the “local monopoly” plan.
“Local monopoly” isn’t much better, but there are more choices in doctors and locations, and no shortage of specialists. To sum up, they are “not for profit” yet made over 600 million in profit last year. You do the math.
Ummm…I am about to move from Canada to the states and I am now VERY SCARED about dealing with this whole HMO thing. Terrified, is probably more like it. Especially since I have a medical condition which requires the care of a specialist. EEEK! I think I would already have been bawling to the nurse at the first doctor’s office you called. I think I need to breathe into a paper bag now!
Heh. I totally know who Kim is talking about there with “local monopoly.” Said local monopoly actually trains their customer service staff tactics for being difficult. OK, so they call it something like “suggestive techniques,” but their suggestions are mostly about how peeps should just try using their awful, horrible, no good web-based system to look for answers, no matter what the question might be. “Your kid swallowed four bottles of poison and appears to be dying? Just check online and see if you can find somebody that can help you with that! The address is http://www.ultraoverpricedmedicalcare.com.”
We’ve got to have insurance, but it’s always such a hassle! Best of luck with it, Mir!
Do you want to scrub the makeup off her face too?
When your university does open enrollment you might want to see if they have a PPO option. That way you don’t have to mess with the referrals as much. There is a huge shortage of many pediatric specialists. They are very hard to recruit and probably no matter what they’ll try to send you to Emory because they’ve managed to recruit one :)
I hate my HMO, too. Nothing infuriates me more than paying them several hundred dollars a month so they can refuse to pay for even the most minor and REQUIRED treatments. If I wasn’t so afraid of a major illness/injury, I would just drop them and put the money in a savings account to use for doctor’s appointments. (In fact, that thought is sounding better and better to me all the time.)
I’m with All Adither. Send this to the presidential candidates, PLEASE!
P.S. Does your insurance have a PPO option? It is more expensive, but it is really worth it. Maybe you might want to consider switching over next open-enrollment period?
I think the universe should give you a break already. Here’s hoping the supervisor calls back with helpful information today.
Mir, that is total bullshit! So sorry you’re having to deal with this on top of your computer shitting the bed!
Heh. This is why I don’t get sick – I have no insurance. Which means it takes my being unable to function completely, or an obvious life threatening condition for me to consider scraping up the 80 bucks it takes to see the local Physician’s Assistant and pray I don’t actually have to add to the 2 year old hospital bill I’m still paying off in $25 increments. My kids are covered by the state 100% (when we find doctors that accept that care, of course – so far I’ve been lucky), but I’m not, as I make enough to not qualify for myself, yet I don’t make enough to afford any other insurance – and if I somehow manage to get ins. for myself, I lose the state coverage for my kids.
And somehow – I think my situation is easier to deal with rather than HMOs.
I’m so very sorry for all you are struggling with. Wow. Hope better times are just around the corner, somehow.
I have two piece of advice. Which you may or may not want, but once it’s there? the advice? in my brain? Once it’s there, I am helpless to resist the urge to share. Blame my mother, who taught me well. At least I’m not emailing you.
Piece of advice the first: Don’t rely on online information to tell you whether a provider is covered. Those lists are notoriously out of date. If you want to know, you’re going to have to call and ask. Call the doctor’s office, not the HMO. I guarantee you, the billing department will have the most current information available.
Piece of advice the second: Find out who the benefits administrator is at the University and when you get bullshit runarounds like you’ve experienced recently, LET THAT PERSON KNOW. The University is the customer, not you, so they have a great deal more pull in these matters than you do.
We went from a reasonably manageable PPO/co-pay type plan to a clusterfuck of a high deductible plan (motto: “We can find a reason to deny any claim [even though we don’t actually pay any claims until you’ve had to sell your firstborn to cover the costs you’ve paid out of pocket]”) and it’s like having a part-time job on the side trying to keep up with it all. If I had time for a part-time job, I can think of ones I’d rather do. Like gouging my eyes out with a fork as performance art. Or, you know, cleaning my own bathrooms.
I know you’ll get what you need for Monkey, but you shouldn’t have to work so hard for it.
sorry about the hard drive – i was one of those who said it could be recovered – so i get 2 ponies right? one for me and one for my kid- perfect!
man, those HMOs it stands for something else except for not being helpful? i had to deal w them for a whole year because they kept billing us and then saying we had overpaid so when we stopped paying, they billed us late fees and called them back again and said we are still overpaid. so it took me 6 mos to sort this out bec they are apparently using an abacus over there, and the only way i can talk to them is when i am at work pretending to do my job. its such a pain. im glad you got the appt. anything for our kids right?
Oy. Bossy feels you.
Beat. Someone. Now.
Geez.
i’m so sorry — insurance seriously sucks. there’s just no way around it. and for those who need ongoing treatment…you just have to deal with it and try to learn the dance. :/ for me, the dance usually involves lots of deep breaths and cursing under my breath. but the tequila beforehand is sounding like a mighty good plan…
UGH, this is all too familiar to me. After being told by oxford that the $3200 for my infertility meds would be reimbursed within one billing cycle, it took me 6 months to get them to pay for what they said they would pay for to begin with, mostly because their adjusters just hit the deny button before even reading my policy coverage! There is a special place in hell reserved for HMOs I’m sure.
That sucks. I had a perfect Canadian Health Care rant all saved up and now I don’t even feel like using it because I’m not quite sure it sucks as much as HMOs would suck. But I do know what would have happened if you lived in Canada: you’d have to make an appointment with your family doctor (2-3 week wait time), have the appointment, convince her you want/need the specialist. Wait for the referral (a couple of weeks) then book the appointment (up to 12 months away). But wheeeee! you wouldn’t have to pay for it!
Ok, I turned that into all about ME ME ME. I’m sorry.
I have to take my kids to the walk in doctors office when they’re sick because I can never get in to see their actual doctor that’s covered by our insurance when they are. I’m convinced their pediatrician only does well-child appointments.
Ask the insurance company if they can help cover the death of the mac since they have been so helpful with your human needs. May I offer you a bubble bath and a glass of wine?
Ditto what Elizabeth said. In our university system we can choose between HMO and PPO (preferred provider). Rule of thumb around here is, if you need to actually see a doctor and get care, sign up for the PPO. Sad but true. So I pay a little bit more per month and a little bit more copay but get to go to the doctor of my choosing. And if they are ‘out of network’ I still go to them and pay a little more copay and co-insurance. More $$ per year yes but less crying. :-(
holy hell…can i say that? i’ve been through similar experiences and wanted to cry, but somehow didn’t…i am so crying on the inside for you! usually i read your blog for amusement or inspiration or commiseration, but this post? whenever i feel like my life has gone to shit, i’ll re-read the last 2 days…i know my comment is not helpful, but really, i can feel the weight on my chest as i can completely imagine this happening to me. i’m so sorry.
It would seem like we all are cough in a rock between a hard place.HMO so-so.Insurance companies so-so.so what are we to do you ask? Pitch a fit untill the congress can get their act to gether and give us the same kind of health care that they themselves get on OUR DIME I might add.
Um, I love Canada.
I’m so sorry Mir :( That just sounds crazy frustrating.
Insurance companies are evil. I should know. I used to teach a class on horror. Vampires have got nothing on insurance companies. Absolutely nothing.
I feel guilty for having good insurance now. I am glad that I went with the plan my sister’s husband recommended (he’s a doctor) rather than with the slightly cheaper alternative (he said that company was horrible to deal with from a doctor’s perspective.)
Does the university where Otto works have any options besides an HMO? I’m in a PPO and I like it very well. Based on my experiences with the dental HMO I’m currently in (not very good) I plan to avoid ever using an HMO for medical if at all possible.
The government backed scam that is the American Health Care System. I give it all caps because I pay enough to afford all those friggin’ caps on something, because I sure as heck can’t afford them for me teeth.
I am screaming just reading this…….. Last year I got completely SCREWED by my insurance when I delivered my son. The doctor was covered on my insurance, so I figured, if the doctor I used was covered under insurance, they would cover the hospital where he practiced. NO. Of course not. Did not know that until AFTER the fact! So, after a c-section and hospital stay, I came home to a beautiful baby boy and A HUGE BILL. The thing is that he was one two ob’s my insurance accepted within a 75 mile radius (75 miles, in labor, I don’t think so….). The only hospital that would take me had no participating providers. So take one or the other. Apparently, this discrepancy did not matter to them……. my claim was denied even after a 6 month fight. IT SUCKS! So I feel your pain….
Oh, this makes me so angry- and so hopeless. When educated people who have jobs and insurance and the ability to advocate for themselves and jump through hoops STILL get screwed, that means that there are so many people who don’t have those advantages and are getting HORRIBLY screwed.
I know that my family is lucky, in that we get a PPO that we can afford, but in the middle of my pregnancy the company switched to another PPO that has lame maternity coverage- 80% of the total. And we ended up paying over $3000 out of pocket- for a healthy full term pregnancy and a healthy infant. And they raised our office visit co-pay to $25, which really, isn’t a lot, but there were a few months in there where between my postpartum care and a newborn and a toddler with recurrent ear infections we had upwards of 6-8 visits a month. And $200 can be a lot to swallow, when you are paying off your $3K copay and dealing with an extra $100 in gas, and an extra $100 in groceries each month, thanks to rising costs for everything, and sometimes all I want to do is put my head down and cry. I think I almost did cry in the pharmacy when my daughter’s antibiotic co-pay was $45 because she’s now resistant to cheapo amoxicillin; it was just the last straw.
How awful is the system when a family with a decent income and supposedly good insurance is having trouble paying for their medical care?
Laurie, your situation is very similar to ours, down to the figures you’re quoting! We are expecting #2 in August so I squirreled away our stimulus check for the big bill. Does your insurance offer a flexible spending account option? I signed up for that last year and it has been a big boon for unexpected pharmacy expenses. I was amazed how many OTC things it covers, too.
Mir, I hope Monkey can get the help he needs without you losing your sanity. Hang in there.
I ranted on this yesterday, if you are interested.
In the book: The End of Medicine by Andy Kessler – “Doctors will do what doctors are paid for.” Or something to that effect. I laugh a lot reading your posts – it’s therapeutic for me but I hate how true this story is.
In my vocabulary “insurance” is a serious swear word.
I have walked in your shoes. I pray that somehow God smiles on you and they call back.
I’m so sorry – insurance sucks balls. I just got a refusal from my insurance to pay for the 3 months of physical therapy and an MRI for my knee (multiple surgeries, etc.) that they previously approved because I had injured it in a rollerskaing accident a very long time ago. Really? I’m not covered for rollerskating? If I was ice skating it would be covered. Fuck HMOs!
Oh my lord, I feel your pain. I’ve been there. Insurance people are heartless, and yet we’re all supposed to be thrilled if we have insurance. Ugh. I am grateful that the ins. my company offers is decent and (so far) hasn’t denied any of my many MS-related needs; I still feel like I’m sitting around waiting for that other shoe to drop, though, so I’m almost afraid to let down my guard. (When will they NOT pay? Which stupid little exclusion are they going to point to… BAH!)
Anyway, sending positive thoughts your way and hoping things start looking up soon…
I…am not so happy with insurance companies. That’s about all I can say. That and my sincere condolances in the loss of your hard drive. That bites.
And after reading all the other comments, I’m getting flashbacks.
It took me 4 months and several times of crying on the phone before my insurance finally realized that I wasn’t going to pay them the pre-delivery fee for a baby that I miscarried.
WTF?! I don’t even understand how they can charge for a service they haven’t even performed yet.
That must have been very frustrating experience! I’m sorry that we have to manage with this so often nowadays and instead of helping, this insurance thing makes it more complicated for patients!
Grrrrrrr. Frackin’ HMOs.
Am so sorry you got the HMO runaround. We recently switched plans, due to COBRA from my last corporate job finally ending, and I got hit with the HMO blues too when I tried to refill my allergy prescriptions. Yes, think about that timing — no allergy meds in the spring.
Hope things start looking up.
So sorry. Have BTDT, including the crying. Now I know better when the birds start to sing – it’s a hold-track they have on their phone system. Just designed to trick you. :)
I’m a little late to the party, and I don’t want to be guilty of giving Ass-vice, but after 8 years of working in HR I tell people repeatedly that if they have ANY kind of ongoing health condition, go with the PPO.
I realize that might not be an option for you (or for awhile), but it is so worth it if you can. There is a reason HMO’s are cheap–you get what you pay for, and some of the better doctors won’t even accept them because they are such a P.I.T.A. for everyone involved.
WooHOO did you hit the nerve, girl! Of course, you knew that by sharing your crazy-making experiences with an HMO, you were just openin’ the floodgates, right?
Yeh, we’ve had our share of fun stories too. Like when we changed from Healthy NY, with all 3 of us on it, to ChildHealthPlus for just the Bunker Monkey (we enrolled in another plan for the grownups in the Bunker), and our HMO just, um, got confused? And said we couldn’t enroll Bunker Monkey because he was already enrolled in Healthy NY? And since now it was past the 20th, we would have to wait until next month to enroll him in CHP? Yeh, because they have their heads up their asses? Um, yeh.
That’s when I sic Bunker Hubby on them, sit back, and sip my cosmo while he deals with it. Advantage: He doesn’t cry, and he doesn’t feel bad when he insists they do their job (I know, I have a problem – I’m getting help, ergo the health insurance change). Disadvantage: I don’t get the pleasure of telling them to bite me. Oh well, life is full of compromises.
We ended up with $8000 worth of hospital bills last years NOT covered by insurance, such fun.
Sorry that they are being such a pain. I have no helpful advice, but I can send you some hugs and tea and chocolate, how’s that? Or booze if you prefer it.
Karen