My company just changed health care insurance as of the first of the year. I’ve been covered by the previous company for eleven years at least. I’d never had a problem. I thought this was going to work out fine, the clinic we go to was in network so we could keep our GP’s and Alergists and I could keep my same poop doctor. Trouble was just lurking in the shadows ready to pounce. I guess the company went with Joe’s Cheap Ass Health Ins. Low cost and incompetant. I had some lab work ordered by the Rear Admiral and I got a bill for the tests. They claim the doctor out of network. But it says right on their useless piece of shit website that he’s in network. I called customer service and they said they would resubmit the claim. Didn’t hear from them until today. Actually I didn’t hear from them, they heard from me.
I’ve decided to pursue this ADD issue. I’ll go into more detail why I think I have it another time, but let me just say that it never dawned on me until recently, but looking back on my childhood I said in my daughther’s vernacular, “duh.” Also Q told me recently that she thinks she has it as well. My first response was, “Kids with ADD don’t get straight A’s” But wait, I did. And remember, I’ve told you I worry about her because she’s so much like me. The other day she told me, “I want to read, but I can’t sit still long enough to read a book.” So, anyway, I’m looking to get an eval and go from there. It turns out that one of the guys on my tennis team is a “mental health professional.” I started talking to him about the situation and he said he couldn’t see me because he knows me, but he’d make a recommendation. He works for the large local clinic that I’ve gone to for years and is in network so I assumed that the shrinks there would be covered as well. He gave me a name and yesterday I made the call. I started this at work at about 3:30. I had everything done that really needed to be done, Friday afternoons are usually very quiet and I thought it would only take a few minutes to make the appointment. What follows is an account of the kind of customer service nightmare that seems to becoming all too common these days:
I called the number on the web page print out that my friend gave me. I got an answering machine left a message. Half an hour later I got a call back and was told that I needed to call a different number for first time patients. I called that number and got someone on the first try without being on hold too long. My plan was to set up an appointment for myself and then bring up my daughter and plan a course of action for that once I talked to the shrink. The person on the phone took my info and then asked me what I wanted to see the psyche about. “I want an evaluation for adult ADD.”
“That would not be appropriate with a psychologist, adult ADD evals are done by psychiatrists, the counsellors do child ADD evals but not adults.” That has a certain dinosaur logic to it, but I guess I can play along.
“OK….how about an appoinment with a psychiatrist then.”
“Do you want one at the same clinic?”
She set up the appointment and then asked me if I was sure I was covered, because it would be about $400 bucks if I wasn’t. I told her I was sure that I was, after all my all of five of the other doctors that my family sees regularly are with that clinic. But I’ll check just to make sure. I made the appointent with the understanding that I could call back and cancel if I wasn’t covered.
No problem, I’ll just check the web site the HMO has out there to make me think they are easy to deal with. It’s agonizingly difficult to navigate and you usually can’t find anything that really answers a question and the contacts are really no contacts at all and the only phone number in the whole site is for “customer service” and I think goes to a call center in Bombay. It does have a find a physician search engine. You can select either Primary Care or Specialist If you select specialist there is a pull down menu. Psychologist, psychiatrist, mental health professional, head shrinker, none are listed in the pull down. There’s a button under the pull down labeled “Medical Specialties” I click on it and then click on “psychiatrist” it takes me to a definition of “psychiatrist.” I know what a fucking psychiatrist is! I’m starting to get irritated. I spend another five minutes searching the site for some way to get answers. You can email the webmaster if you have technical problems with the site, you can chat live with a nurse about your ingown toenails, but the only way you can get any answers about coverage is to call the customer service number. which I’m fairly reluctant to do since, as we have all come to learn, calling customer service these days is like falling down a rabbit hole. But it seems I have no choice.
I am not a Xenophobe, OK. Well OK maybe I cringed a little when the woman who answered the customer service line had a thick Indian accent. She was polite, well trained and tried to be helpful. In her defense I didn’t have the spelling of the shrinks name, so that held things up. BUT. My hearing is suffering from the effects of way too much loud rock n roll music without ear plugs, if I’m in a place with a lot of background noise or trying to follow the dialogue on West Wing I’m pretty much SOL. Accents over the phone really throw me. She kept getting frustrated and sounding peeved that I had to have her repeat everything two or three times. I never got the feeling she was really understanding me either. To make a long story not too much longer, after much confused back and forth which included this exchange:
“The Brookdale location only has optomitry.”
“I’m sorry, could you repeat that?”
“The Brooklyn location only has optomitry.”
“Brooklyn Center?” This is the town that Brookdale is in.
“Yes, well, I know that’s not true, because I go there all the time it’s a full service….er, a regular or….I know it’s not just an optomitry clinic, place um facility. fuck”
“I will research further.”
“Thank you”
“You are welcome.” I have no problem with the woman personally, she’s polite and helpful, even though she appears to hate the hearing impaired. Nevertheless, I’m starting to get pissed.
“He is not in network.”
“Not covered?”
“It looks like he is not in network.”
“OK, can you tell me who someone is covered?”
“I can refer you to someone who is in network.”

It goes on like this for awhile, and she gives me the name. “Pastor (spells it out) Colon (spells it out)”
I reply, “Pastor Colon?”
“That is correct, sir.”
At this point I decide I need to try a different tack. Not with her, a different tack altogther. I need to end the conversation.
“Is there anything else, sir.” Please stop with the sir….it makes my knees hurt.
“Weeeeeelllll, I was notified that I owed for some lab work that you were supposed to cover…..”
“Do you have the claim number.”
Amazingly I did.
“I will research that, sir.”
Thiry seconds of silence.
“Yes, you sent this claim for review. It was denied.”
“Denied, Thanks for letting me know.” OK I didn’t say that but sitting here, I wish I had.
“Yes sir. It says you were out of network at the time the services were provided”
“The services occurred on 1/26 and your company started covering my company on the first of the year, that was the cutover.” My voice is taking on a tone.

On and on it went, we agreed that she would resubmitt the claim and I calmly (I’m so proud I stayed reasonably calm, there was a time when I would have been standing on my desk waving my fist and screaming into the phone which doesn’t work in a corporate environment although it might work to my advantage as an intimidation factor; don’t mess with the crazy guy) gave her some notes she could put on the claim which actually got a laugh out of her.

Then I left the office and hour after I started this mess. M.N. if you read this go ahead and dock my pay. I was going to the store to get asparagus and lemons to go with the Halibut fillets in the freezer.
I forgot to take the route that takes me past the grocery and had to backtrack. When I arrived at the store, I realized my wallet was still on my desk and I had to drive all the way back. Kind of brings us back to why I made the call in the first place, doesn’t it.

10 thoughts on “

  1. The way I finally got my ADHD stuff at least under some kind of control was by discovering ways around every health insurance pricedure. First by using university level psychiatrists with psychologists to diagnose, prescribe, watch, and update. Later by finding a psychiatrist who would break all his hospitals rules, meet with me at 7 am surreptitiously, so he could combine therapy and prescribing. The whole mental health process sucks so completely, separating medication from other support structures, not providing follow up, not helping people keep track of what helps and what hurts. It’s why we’re still all so fucked up.

    Rant away. It’s a very rantable topic.

  2. there is some level of pleasure to be found in the irony of making an ADD-sufferer deal with those kinds of phone conversations.  that is, as long as you’re not the one with the ADD.  i think i just bit a piece of sand.  what were we talking about again?

  3. I don’t understand how an entity that is supposed to provide health care always tries like hell to do anything but.  Bastards.  What’s worse is that this is such a far reaching problem that affects so many people here in the United States, one would think people would be protesting in the streets or setting fire to the home offices of Uonlythinkyourecovered Insurance, Inc. or something.  Oh wait, we’re too busy sitting on our fat asses in front of the TV eating junk food, getting sicker and hoping our insurance will cover our quadruple bypass surgery.

  4. Hmmm…pretty sure I’ve got ADD, too, but not sure if I wanna go through any sort of channels just to know officially…

    Yea, accents over the phone ALWAYS throw me off.  It’s a bitch ordering pizza in Stillwater from our on-campus pizza place.  All the international students suck up those jobs like crazy. 

    Jeez, it’s like you were in a Seinfeld episode all day.  Good luck with that in the future, though.

  5. :::sending good thoughts your way:::: as a 22 year old who was just recently diagnosed with ADHD after struggling for three months to find a psychiatrist that would be covered under my new insurance, i feel for you- it is more than entirely possible for people with ADD/ADHD to get straight A’s, to go their whole lives without knowing what was making them different- not hugely different- but just slightly different-

    i wish you the best of luck!

  6. Hi, bkeller. It’s not just your rant. Thanks for sharing your experience. We all need to know that such things may happen. I fully understand your situation. I mean… these guys … Sometimes I wonder whether it is their organizational mistake (in good sense) or somewhat intentional (if you want money back you have to work it out really hard but we hope that you customers be worn out and give up).

  7. Yes, what a nightmare indeed.  I have a traditional indemnity plan, so I don’t fuss with in-network or not.  But the reason I don’t have that plan is because my co-pay would exceed the amount we typically lay out for doctors now.

    Anyway, you may find the whole meds thing to be a trial-and-error journey through all kinds of interesting side effects.  I medicated my ADD for a couple of years, and I finally stopped because we were dirt poor, and I couldn’t afford the initial layout of 50 bucks a visit and 60 or 70 for the meds, each month (I would submit a major medical claim, but only for the meds, and only some of it would be covered.)  But yeah, they helped . . . but only after I’d gotten accustomed to pissing a lot, dry mouth, and for a little while on this one med, an involuntary muscle spasm right behind my chin that was becoming more and more frequent.  But really, once the dust settled, they did help.

    So how is it we scatterbrains find each other so easily?  You wouldn’t happen to be a closet misanthrope too, would ya?

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