Health Insurance Hell

Health Insurance Hell

Its been a year since we started having JP evaluated for sensory, language and fine motor skill problems. After a ton of research, appointments and evaluations we learned last spring that JP has ASD. Luckily we live in the best place possible to get JP all the services he needs. Some of those services are free through the department of education. And some of those services are very expensive.

In addition to all of the research and networking we did to learn more about the services we could obtain for JP, I dug deep into our health insurance benefits to see what they could offer. One good thing came out of many phone calls to our insurance company, UnitedHealthcare. Because JP has an ASD diagnosis we are able to have a behavioral therapist come to our home to help us. The cost is $25 per session which seems almost cheap compared with what we have spent so far.

But since all of the evaluations we got for JP and all the private therapies are out-of-network, I have spent the better part of this year calling, begging, pleading and yelling at our insurance company to reimburse us for the 70% of services that they state they will pay. If you’ve ever had to do this then you know what I’m talking about. Now try having a weekly call with your insurance company and you will realize why I’m in health insurance hell!

Everyone knows that all of the excellent service providers don’t take insurance. I don’t blame them. Why deal with a horrible incompetent bureaucracy if you don’t have to?!

I take all the steps I’m supposed to and follow the exact directions of my insurance every time I submit for reimbursement. I even make sure to get pre-approvals when necessary. But this is not enough. I’ve spent hours at a time on the phone and I’m told one thing by one person and then another thing by the next person. I had a supervisor working with me to help me get $300 back for reimbursement and then 8 months later I was told they overpaid me $300 and they stopped reimbursing me for the monthly OT (occupational therapy) receipts I sent it. For months I had somewhat consistent reimbursement checks and then in May I was told I had to write “POS-11-office” on my submission forms to get reimbursed. I did that but it still took months and weekly phone calls to get the reimbursement. I’m still not getting the reimbursements that I was getting before. In the meantime JP had one more evaluation to help determine his kindergarten placement. I called for the pre-approval and was told to call back when it was the same month as the appointment. I did that and was told to have the provider call for pre-approval. Even though the psychiatrist doesn’t take insurance she agreed to call and help me to get reimbursed. She called and was told we didn’t need a pre-approval. I called again and asked if there was a loophole or some reason one person thought there should be a pre-approval. Ah ha! “Yes, if the evaluation is more than 45 minutes then you do need an approval”. Well that at least makes some sense. Better than the insurance company saying something like “if the evaluation sheet the psychiatrist uses is pink than you don’t need a pre-approval” which is something I would not be the least bit surprised to hear! So I had the psychiatrist call the insurance again and again she was told no pre-approval was needed (even though she told them the evaluation is 6 hours which is more than 45 minutes). So now I’m just bracing myself for when I get the psychiatrist’s receipt and submit for reimbursement. Even in my most optimistic state I know this will take at least several hours and many months to get even a few hundred dollars back from a $4,000 evaluation.

Is it worth it? That is what I keep asking myself. It seems worth it when I actually cash a check (as long as they don’t take it back). Ray said to think of the reimbursement as my paycheck for all the work I did trying to get it. Sounds good. But I really do feel that the motive of the insurance company is to get people like me to finally give up and stop trying to get reimbursed. I feel like I’m in this tunnel with no one to talk to who has any responsibility for the system. Or maybe it really is just hell.

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