Singing Finch Studio - Fine hand painting porcelain by Ellen Wilson-Pruitt

Recent Posts

Basketball 24-7
Poppy Puppy Report Westminster 2015 Day 1
Super Supper
An Eye Opener
2014 Season Greetings from the Pruitt Farm


Archive Posts
powered by

My Blog

The Lady From Diphtheria

I would like to beg the forgiveness of the lady at the health insurance company for losing my temper but I am totally exasperated with the company.  I wrangled with them some time ago just to get an approval for the MRI on my shoulder with an approval, denial, approval finally only with my surgeon calling personally.  Now for some reason that even our local insurance representative doesn’t know why I do not get any EOB statements from the insurance company.  Their records say that they send them out to me and they have the mailing address correct but since January 1 I have been black listed.  Consequently I never know what has been filed, how it has been discounted in the network etc. so when I get a bill from the doctor or hospital I never know for sure if that is the final amount to pay. 

I received a plea from the hospital the other day that they had filed the MRI with the insurance company and had never heard anything back.  Well since I am noncommunicado with the insurance company  I didn’t know if they had even received it.  I felt it surely had not been discounted in the network yet because the bill was $4,800.00!  The lady at the insurance company told me “yes we have received the claim and it was all applied to your deductible because it was processed out of network”.  I say “this hospital is in network and besides you approved this procedure not once but twice!”  So they resubmitted the claim for processing again.  I have already purchased by boarding ticket for the upcoming train wreck.

Leslie uses the insurance company’s mail Rx service because it is supposed to be cheaper than the drug store.  In the last year he has run out of medicine numerous times.  He is out of medicine right now even though he mailed in the order over a month ago.  He calls me this morning and says that some man from Cigna Rx called him but he could not understand what he was saying.  It is difficult for Leslie to hear some people on his cell phone with his hearing aid and if they speak fast or not clearly it is almost impossible.  Leslie said this man’s accent was so thick “I think he was from Diphtheria”.  ?????   So he asked me to call the company back and try and find out what they were calling about.   

I make the call and get this nice lady that isn’t from a region whose very name gives the CDC panic.  Even though I provided her with all personal information birthdates, phone number, address and I think even the name of Leslie’s favorite Beatle,  because of HIPAA (government) regulations they couldn’t tell me why they called him originally.   I told the lady it might be something concerning his order for prescriptions which is now seriously overdue and he is out of some medicines because of it.  She asked me if I knew one of the medicines he was out of and I told her.  She then says “well can you verify the milligrams?”  I say “lady I can’t tell you the milligrams of any of my medicine.”   She says that Leslie will have to verify that it is alright that they speak me why they were calling in the first place.   She asks to speak to him and I say that I am calling from work.  I tell her that is fine that she can call him at his cell phone number for his permission.  She then says “Oh no, we cannot call HIM and ask if it is alright if we talk to you about it!  We can’t ask him THAT!  He will have to call us and set up a conference call to discuss it.”  At this point my own heart rate is off the charts.  I want to say to this lady that asking Leslie to set up a conference call was just about as absurd as this entire conversation had been.  This is when I lost my temper.  I am sorry insurance lady.   I know you were just doing your job but I felt as if I had fallen down the rabbit hole and was being greeted by the mad hatter.  I just told her to “FORGET IT!”

I am thinking to myself, “and they are talking about the government supervising health care?   Don’t you know that the only thing worse than speaking with an insurance man from Diphtheria is a government agency.” 

(c) 2013 Ellen Wilson-Pruitt    
Website Builder provided by  Vistaprint