Monday, September 08, 2008

Friday I Cried

Friday was a day of all sorts of drama.
Some drama that caused tears from my eyes but may not have bothered you one ounce of a fly caught in a spiderwebs nest. Other worthy drama enough to make your own heart ache for awhile.

Health insurance companies suck jagbags.
I am not one to pat myself on the back openly, although I can fit into a suitcase-at least I used to be able to- but I take pride that I am up to date on my insurance information. What my policies cover, what they don't, how much will it put me in debt, how much can be written off, how coverage is based on different codes through a level of criteria; revenue, physician, diagnosis, routine, facility, in network, out of network- it's the labyrinth of all labyrinths.

Years back there was a convenient care facility built in our town that is affiliated with our massive expensive top of the line local community hospital. The purpose of this urgent care is meant for the following; "your doc has gone home, your kid's got a cold and you're screwed until Monday-so come here!!- because going to the ER with a sliver in your finger that you can't get out is not an emergency and they will be happy to tell you-so come here!!"

We've been there a few times.
Like when Brian fell down the stairs and fractured stuff in his foot.
Like when Sullivan fell and cut his head a tad and needed one stitch.
Like when I had a pulled muscle that was causing me to wish I could climb up a wall away from it all.
It's convenient, you do wait, but not for long, and it sure as heck beats the drama of going to the ER-plus you're not supposed to go to the ER if the problems are minor and the onset of symptoms occurred a day or so earlier-because to them a nose that has been running since Friday is absolutely not an emergency.
Makes sense.

It would make sense that because my copay for an ER visit is $75, my copay for any physician's office is $20, and anything that requires hospitalization, blood draws that are sent to the hospital for diagnosis, adjustments to my spine compliments of the chiropractor-is applied towards my deductible.

I thought that urgent care was also part of the clause of facility/physician's office coding for the $20 because it's not at the hospital. I was wrong.

We've had the same policy and plan since July of 2006 and nothing has changed as far as coverage goes. In that time we have been to the urgent care location and paid our copay and never had any issue afterwards, matter of fact our insurance paperwork would reflect the copay and that the coverage was taken care of as facility/non emergency blah blah black sheep.

Nothing had changed.
But after a recent bill that continued to come back to my happy address from a visit to the urgent care back on April 11Th, after the bill continued to recirculate with a balance of $78 and change, after I continued to call the hospital billing department requesting a resubmit because something must be wrong with the coding, after back and forth since May, I finally snapped on Friday.

Apparently after making phone calls back and forth for over an hour while my two younger boys sat starving on the kitchen floor eating refrigerator lint from the vent, after finally getting a decent representative from the hospital and conferencing the insurance agent with my plan on the line as well, it was "discovered" that my policy doesn't have anything in it that covers urgent care. So if I do go to urgent care, any cost of it is applied to my deductible, which means more money that I pay out.

My husband falls down the stairs and fractures a bone-I can either take him to the ER and pay a flat rate of $75 (so long as he is not admitted) or I can take him to "convenient care" and pay at least (based on where we're at with our deductible) $105's minimum.

How jacked up is that?

I spent over an hour on the phone with the two reps with all my notes from previous conversations with insurance reps and hospital reps that stated the coding must be wrong because the hospital bills the insurance so there are times the insurance company misreads the claim based on the facility, that stated the copay is $20 for urgent care, that they will resubmit, that the physician must have put the wrong diagnosis code, blah blah blah. Since May I have been given different excuses as to why this damn bill was returning to me with that balance. Since May I have been instructed that the insurance company will be receiving the claim form with a different code reflecting the change.

This claim was denied each time due to it being a duplicate claim. Nobody changed jack although they told me they did. By the point of this conversation when I was informed that my coverage for urgent care visits are applied towards my deductible I actually lost it.
Crying on the phone like a Sally that just lost her Schroeder, worked up and actually expressing my utter fear that I am "this close" to having a panic attack because of all this unnecessary crap.

It was ridiculous.
I felt like a jagbag myself for bawling on the phone like that. Blubbering like a baby about how I've been given conflicting information in regards to this bill and other bills past, about how coverage has been accepted with just my copay on previous occasions without applied deductible and 10% coinsurance applications but not now, about why I've been told urgent cares are $20 copays, all since this bill hit my mail box in May.

The hospital wrote it off under the area of "patient satisfaction."
But it didn't make me any happier. Had my policy changed since July of 2006?
Nope. They just had used different criteria based on the different types of visits and all that other jazzy stuff I listed at the beginning of the post regarding codes.

There had been complete silence from these ladies while I blubbered through my emotions about how is it that I am just now being informed of that when I'd been told other things in the past.
They had no explanation for that.

But the representative at the hospital wrote it off due to patient satisfaction (or lack there of) as I mentioned a few sentences ago.

I was all worked up about the time and energy and knowledge and understanding of this damn bill and all the time it has taken away from me, until later on that afternoon.

Until I got a phone call from my mom telling me to stay out of our downtown, that a bank less then a half of mile from my house had a gunman in it with hostages. Hostages that my parents are connected to, have relationships with both personal and business. Naturally then I am aware of all the helicopters hovering above the houses above our streets and the other information that came in regards to Jack's school being on lockdown, what was being viewed live on TV and other information from people that could provide up to date info due to the line of work that they were in.

The tanks were brought in, trains were stopped from going into our town as the bank was also located across from the train tracks/station. You were instructed not to go near the downtown, all roads were closed with multiple police from different districts standing by, urging all residents to stay out not only because there were snipers on rooftops ready to take a shot when they could. FBI on sight and naturally the SWAT team.

I cried when I got the news that a friend of my parents had been dubbed a hero after the 3hour standoff by allowing other employees of the bank to be released ahead of her. She chose to put them first. The bank president as well remained behind while all the other hostages were eventually released. The woman, the bank president and the man with the gun remained in the bank. Then the man disconnected the negotiator line, closed all the blinds and all you heard was a single pop.

Where'd the gun come from you ask?

The man had got the gun from a scuffle with a policeman after he phoned in a fake 911 hit and run call across the street from the bank in one of the train commuters parking lot. When the officer arrived at the parking lot and began looking for the alleged car in question that might have been involved in the hit and run, the guy ambushed him from behind, pulled a knife and held it to his neck. It was then that he was able to wrestle the gun from the holster of the officer's belt. In the midst of the scuffle the officer's arm was cut, although thankfully it was a minor cut.

The man did take his own life.
The two remaining hostages may or may not have had to witness that awful scene.
To have to witness the man in his last moments as hope and all things good were no longer seen in his eyes, only fear and hopelessness.

No one knows what made the man snap. No one knows.
I cried because this man left behind young children, three young children as a matter of fact.
They live a couple of miles west of us in the same town. No I didn't know him, but to think of what will haunt his family for perhaps the rest of their lives makes that stupid claim worth nothing but a fly caught in a spiderweb. Wrapped up but not that big of a deal compared to what his family must be going through.

Just tragic, and I wish there was a way I could reassure the family that he left behind that I for one will not cast a downward eye upon them, but instead open up this town more for them with support and compassion versus judgment and disdain.

His life was the only one lost this past Friday. The hostages all survived physically, although I'm sure emotionally this will take quite a bit of time. Why he did it no one seems to know.

All I know is that near my house sits a house with three young children near my own children's ages without a dad and a mom that cannot possibly come up with the answers to their questions over what happened.
My heart breaks for them and that is why this past Friday, I cried.


austere said...


Brad said...

Horrible. It makes me wonder was he driven to this act trying to keep a roof over the familys heads? Food? - scary times we live in.

ummmhello said...

You never know what trials and troubles another is going through, so it's best to always be kind. Some days, your kindness may be all the kindness a person gets. Unusual for me to get soft, but your post calls for it.
Sorry your insurance company is staffed by jagbags :( We won't like you any less for crying on the phone - haven't we all gotten that frustrated?!


austere: It is just awful. :( Also is something that never ever happens "in this town."

now it does because it did this past Friday.


Brad: From what I know he worked the nightshift, had a "normal" home like the rest of us and a family to support--it was obviously thought out-in what timeframe we don't know--perhaps like you said and so I've thought due to economic reasons and personal insurance doesn't pay out on suicides--unless in certain circumstances it involves police activity.

I'll never know and that's okay because I don't know him--but his family---it just breaks me to know that a child's father isn't coming home because of something far from heroic...
what happens when the 2 year old asks questions someday.



Uh,HI!: Ha, so you're in insurance eh? Can you provide a blog post on tips for consumers? :) heehee..
you are right you never know what is going on behind the shades of the eyes that you glance upon on the streets, for some of us coping is managable, for some, crackable. And they (media) had to say in the first few lines after disclosing his name, children's ages, address as well that he was on antidepressents.

that really got to me. :(
irrelevent for our information.

Susan said...

CB -

Personally knowing the police chief of your has a devastating profound effect on the police force that training can never ready them for.


bonnie said...

Yes, that is a sad story. So much that is awful and out of reach of any human understanding really does happen. And right here at home. It makes me feel so vulnerable sometimes. As for insurance companies, you'd have to delete anything I have to say. I feel you, girl.


Susan: I couldn't agree with you more--and he is a wonderful person with so much pressures--he's definitely no phony :)
I read that people were giving the officer a hard time and mocking his training because of what happened--needless to say that really pissed me off.
let's see them try and do the jobs of the officers.
Today---the "cleaners" were there--so that the bank will be reopened tomorrow---the cleaners focusing on the front carpet near the front entrance way--my guess, where he took his life after closing the blinds.



Bonnie: Let me have it! :) I'll delete later--lol.
Yes, it is scary and naturally (at least for me) it makes me do the "scrolling list" of people in my life that I feel are on that cusp and then wonder to myself, "you just never ever know."
too scary.
Too often.

Love your new pic, btw!


Summer said...

I hope today was better for you.

Leann said...

Hi crusty, I am a "Brad" visitor and wandered over.

I've always thought it a shame that someone gets to be so hopeless they see no alternative other than ending their life. Especially given the people that love and adore them.

My prayers will be with the family.

jAMiE said...

I am sorry you had such a sad Friday...was a sad situation all the way round.

I hope the rest of your weekend was happier and you're having a good week so far.


Summer: Thanks! IT was actually compliments of Monday and Pam leaving my "house" ehem. ":)


Leann: WelCOME TO CRUSTYLAND! :)teehee.. I know what you're saying. I for one have had moments in my past that I would have considered dark and alone and fearful and I can't imagine hurting myself because of it--although I can't imagine not because the feelings of that dark dispair can truly control your body--it's just painful for that family.

Hope to see you again!
Brad is a great guy, a great friend, I'm glad you enjoy reading him--he is a HOOT!


Jamie: HI there! The rest of the weekend was very very busy that's for sure--and it was fun although it did go by too quickly with all the activities-How was yours? HOw's Tim? How are YOU???

The Real Mother Hen said...

ohhhh, I got all teary eyes reading this post.

For whatever reasons, a man is lost, people are hurt, and families suffer.

Re insurance - it's so ridiculous isn't it? I really hope that no matter who gets into the White House this Nov, they will seriously do something about the healthcare, and not bow to any interest groups.

captain corky said...

That's really sad. I hope I never understand what could make someone take their own life.

Insurance is so fucked up in this country...

Gypsy said...

This post brought tears to my eyes just because of the sheer tragedy and waste of that man's situation. It does put things in life into perspective that's for sure.

simonsays said...

Aww honey, it seems these things are happening all over our country these days, and many times, if I think about it too much, it makes me cry, too. I certainly understand. The fact that it was so close to you makes it even harder to accept.

As for the insurance bull****---you are not alone. I had surgery LAST DECEMBER and we are still trying to sort out the insurance. I will NOT pay more than I am supposed to and they cannot get it right. Sigh.

Hugs. I hope this week is happier for you. :)