The One Where I Cry at My Insurance Company

Before I left for the memorial service, I met my new doctor, Dr. Egret, for a check up. At this practice, I’m basically alternating between my doctor and my midwife until I make a decision about delivery. And I’m sucking at decisions right now, so I will continue to flip flop until I get my brain back.

Any way, I liked Dr. Egert a lot. I had to move up my appointment because of the memorial, so the office knew my mother had passed. It was the first thing Dr. Egert asked about. We spent about 10 minutes talking about how I can get the emotional support I need. She talked to me first as a person, secondarily as a pregnant person. Which I appreciated.

While we were there, we discussed Downs testing. Because I have a geriatric womb (i.e. over 35) they recommend testing, which I’m on board with. I’d like to know my risk factor so Mr. O and I can be prepared.

There is one in particular I’m interested in. Panorama Prenatal is a non-invasive blood test that helps determine your level of risk for Downs. It doesn’t confirm, but it does identify if the pregnancy is high risk. From my understanding, other tests are more conclusive but also more invasive and come with higher risks to the pregnancy. So this non-invasive test sounds perfect to me. The trouble is not all insurance companies cover this because it is still fairly new.

Enter Incompetence insurance.

I hate this company. So much. So so so much.

First, I check with the company to see if they cover this test. I am not given an answer. Nope, I am given a policy number. After searching for the policy and breaking down the insane jargon, it appears that because I am old, they will cover this test. They even list the brand name, Panorama, in the policy.

But I know better. I really do. Because though the test is covered, they may not cover the lab that performs the test. Soooo, I’m a good health care consumer, and I called Incompetence to see if the lab is covered. This led to yet another completely surreal discussion with an insurance rep (I’m going to have a collection by the time this is over.)

ME: I’m calling to see if the Panorama test by Natera is covered under my benefits. According to policy 12345,…

REP: Oh, I’m not allowed to review the policy with you, ma’am.

ME: Er… Why not?

REP: Those are written by medical professionals. I’m not a medical professional so I can’t discuss them with you.

ME: So you can’t discuss policies written by your own company?

REP: That’s correct, ma’am.

I lost my shit a little. After giving my “I’m trying to make responsible financial decisions when it comes to my health care!” speech, the rep finally conceded that  the lab does not appear to be in-network so would not be covered. But she can’t confirm this. However, if my doctor can call and receive prior authorization they will count it as an in-network request.

Okay. Fine. I have had enough painful conversations about my medical care for one day.

A few days later, I called my doctor’s office and explained that they need to get approval on the lab. Not the test, but the LAB. They thought I was crazy. It was like no one had ever asked this before. Given how stupid my insurance is, this is probably a first for their office.  Still, they took the information and did their best.

An hour later, I got a call back. They’d put in the request, but Incompetence takes 15 business days to review all approval requests. This seemed off to her, so she collected all the information I need (CPT, NPI, Tax ID, etc.) and suggested I call them too.

15 days?! 15 DAYS?! God created the earth in less than half the time, assholes!

I can’t wait that long because I’m taking a trip next week, then almost immediately heading to my mom’s funeral mass. I have 3 days this week when I’ll be able to get the test done. Not to mention, this is just stupid.

So I called Incompetence again. I got this rep who is clearly not into her job, which I can’t blame her for. She has to deal with people like me all day. I started off warning her that I’m getting frustrated because this is the 3rd time I’ve contacted them and cannot get the help I need. I patiently (okay, maybe not so patiently) explained what’s happening.

  1. I need to find out if the lab is covered because no one has been able to confirm this for me.
  2. I need to expedite my doctor’s request because a 15 day wait is not feasible.

Fairly quickly, I’m punted off to the “Patient Management” team, which I suspect is a euphemism for “Deranged Policyholders.” Here a woman calmly explained that Dr. Egret’s office did not specify that it needed to be expedited so there is nothing they could do, and the doctor was the only person who can request that. As a patient, I cannot.

I lost my shit again. Only this time I told them that my mom just died.

I started sobbing. Like those chest-heaving, snot-oozing sobs that come from the depths of your soul. I haven’t been upset like this much over my mom’s death. It isn’t that I’m bottling it up. More that there are a handful of occasions when I’ve felt truly pitiful about where I am in life right now. It turns out that arguing with my insurance company about prenatal testing is just such an occasion.

I started babbling about how this is my first pregnancy, I have no idea what I am doing, and though I respect that they have policies, this is just not working for me right now. (Yes, I actually talk like this.)

Ladies and gents, there was SILENCE on the phone. We now know what it takes to leave cold-hearted bureaucracy jockeys speechless: a first-time pregnant woman who has just lost her mother.

Perhaps their small hearts grew three sizes that day. I don’t know. What I do know is that in an instant two reps were on the phone, conference-calling their managers, and approving my request for expedited approval for my lab. I cried some more. I hung up the phone.

Wait? What was that? Yes, you read that correctly. All that drama did was lead to approving my request for expedited approval which should take 2-3 business days. I still don’t know if they will approve the lab.

I haven’t played the “Motherless and Pregnant Card” a lot. It feels icky and manipulative. I don’t want to be pitied, I just want things to stop being so fucking hard. Next thing you know, I’ll be audited. Or my car will spontaneously blow up.

The thing is I don’t remember my life always being so shitty. There have been long stretches when I felt down right fortunate. I do not feel fortunate right now.

I feel Rocky Balboa’s face.

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12 comments

  1. My Perfect Breakdown · February 8, 2015

    I’m so glad they expedited the request!! But, I am so sorry that in order to have the request expedited you were out through the ringer!
    I know right now is hard, I cannot even begin to imagine just how hard. But I do believe you will begin to feel fortunate again in the future. Try to cut yourself some slack right now as you work through so many different emotions. Wishing you peace and calm whenever possible!

    • thecommonostrich · February 10, 2015

      Everything feels like a fight right now. I’ve certainly been through periods in my life when things have been difficult, but this is exceptionally sucky. I guess I just need to let it be sucky, instead of trying to make it go away? I don’t know… I’m sure there is a life lesson in here I am missing…

      • My Perfect Breakdown · February 10, 2015

        Sometimes I think sitting in the sucky is the best approach. But, I do think the trick is knowing when to pull yourself back up before you get stuck in it.
        Maybe one day we will both understand the life lesson? But until then, I will keep cheering you on from the sidelines.

      • thecommonostrich · February 11, 2015

        Ditto. 🙂

  2. AdoptiveBlackMom · February 8, 2015

    Ugh! I’m so sorry. How horrible. Don’t feel bad about losing it or pulling any “cards.” Do what you gotta do to get what you need during this critical time. Sending you lots of positive energy and peace. Hang in there.

    • thecommonostrich · February 10, 2015

      Thank you. I’m 100% over my insurance company at this point. (There is a follow up to this story which is too complicated to outline in a comment…) I can’t wait to break up with them!

  3. Katie · February 8, 2015

    It felt weird to like this post but I did because although the topic is incredibly raw you wrote it in such a beautiful way. I have no idea about other country medical stuff but, in Australia, with my son they could tell a lot from his scan and blood work at 12 weeks to help put your mind at ease. I was given the option of more testing for DS but to be honest, it wouldn’t have changed a thing for me anyway. I hope the insurance guys come through and it didn’t sound like you played any card, that kind of incompetence would reduce anyone to tears regardless of what they’re going through.

    • thecommonostrich · February 10, 2015

      Yes, and that’s what I am ultimately doing today. (There is another post on the horizon.) Panorama offers a much higher accuracy rate, and is just a blood test. And since my insurance claims to cover it, it seemed like a good option.

      What I find so annoying is that my insurance company DOES offer coverage for this test, but there are so many rules around it that it makes it impossible to actually get the test. Honestly, if someone had just told me three weeks ago that this wasn’t an option, I would have gotten on with it.

  4. Elizabeth · February 9, 2015

    The “like” was for getting insurance to stump up coverage. That is a monumental feat.

    Losing a parent is brutal. Losing a mother when you’re becoming a mother is just not fair. You must feel throat punched. I hate to lob the cliche of “give it time” at you but I deeply believe one has to hang on to that. It will get better. In the meantime, we’re all here to cheer you on.

    • thecommonostrich · February 10, 2015

      Thank you. After a arguing with bureaucratic drones for a half an hour, it’s really nice to know people are in your corner. 😉

  5. lovingthemarriedlife · February 9, 2015

    I’m sorry you had to go through such a headache with your insurance hopefully they cover it and things can go smooth you are going through enough right now and it’s okay to have a break down every now and then sometimes it just feels good to let it all out!

    • thecommonostrich · February 10, 2015

      No kidding. Sometimes I just go into an empty conference room at work and have a good cry. Then I can get on with the rest of my day. I don’t mind crying. What I don’t like is when crying at someone seems like the only way anyone will listen to me. That’s just shit.

      Thanks for reading all these crazy rants. It feels so good to let it out!

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