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It’s all my fault

You don’t want to read this post. Why am I writing it then?

Therapy.

I have a theory for why I’ve been feeling down lately, and the title to this post is a strong clue. Since it’s apparent no one else is ever at fault for things that go wrong, the logical conclusion is it must be my fault. When everything is your fault and you accept responsibility – even if it’s just a small part of your subconscience doing the accepting – it’s really easy to hate yourself.

Take one guess where this is leading. Did you guess something related to healthcare or insurance?

A month or so ago, Cheryl went to have a procedure done. It required preauthorization from our insurance company (health insurance, if haven’t been keeping score at home). Before they did the procedure, Cheryl asked them if the preauthorization came through, and was told “don’t worry, it’s done.” Cheryl had the procedure done, along with two others under similar circumstances. Then we got a bill. Make that bills.

“So, why did we get a bill? I thought you all were submitting a claim to our health insurance.”

“No, we didn’t.”

“Alright, then submit it now.”

“We can try, but insurance will reject it. They require PREauthorization for this procedure. They won’t authorize payment after the fact. The bottom line is your insurance company won’t pay, and you’re responsible for services insurance doesn’t cover.”

“So you lied to us when you said you had taken care of the preauthorization.”

“No. I said no such thing. In fact, I didn’t even know you had health insurance.”

Brain cells screaming in agony from the abuse of high blood pressure suddenly running through nearby arteries….

“WHAT THE HELL are you talking about? I’ve lopped years off my life bugging you people about which insurance you were supposed to make the claim with, and now youre going to sit their and lie to me, or worse – imply I’m a liar? Check my file and tell me you don’t have a copy of my health insurance card.”

Unappologetically…. “Ah yes, I see we do have it. But you know, it’s your responsibility to see that procedures are preauthorized when it’s required.”

“But you’re supposed to submit the initial request…! (Fists clenched) So you’re telling me it doesn’t matter what you say, we should assume you didn’t do what you told us you’ve done… that we can’t trust anything you say? We should go on the assumption that you’re incompetent, to cover our ass?”

I’m not sure Cheryl really said that last bit, but that was the gist of the conversation. I kind of wish I was on the phone. I think it would have been good for my mental health to say it myself.

But here’s the thing: I know it’s our responsibility to verify those kinds of things with insurance. So all that anger I felt before has done a 180. I’m angry with them for not doing their job, but I’m also angry with myself for being such a rube.

Then there was yesterday. I got a letter from the good people at my health insurance company, saying they were not going to pay for my last visit with my oncologist. Why? He’s not “in the network.”

To truly appretiate this letter you have to understand two things. One: I’ve been seeing this doctor for two years – two years he’s been “in the network.” Two: my last visit was before all of the trouble Cheryl had.

On my last visit I had to meet with a “financial counselor” before seeing the doctor. This was when I found out my oncologist’s practice merged with another company. As the “financial counselor” put it: “the company doesn’t have a contract with your insurance provider to accept new patients, but they’re working with us to ‘grandfather in’ existing patients.”

That was news to the office manager who took my call yesterday, after I opened my letter. She didn’t know who I spoke to (I wish I did) but they had no such agreement with my insurance.

I started to say I’d been a patient for two years without any problems, and it would have been nice to know this before my last visit so I could have planned accordingly, but the nice lady interupted me after I got out the words “two years.”

“You do know you have an HMO, right?”

It’s possible I might have thrown the phone at her if we were sitting in the same room. My what a fucking presumptuous mouth you have. I know how the game works. I know I’m at the mercy of changing provider lists. I accept this trade off.

Mind you, I had this conversation with the doctor’s office after spending ten minutes trying to convince a customer service rep my oncologist had EVER been “in network.”

What I’m having trouble accepting is this evolving trend: I can’t trust a damn thing anyone says. Frankly, I feel betrayed. I trusted my doctor. I trusted his staff. A woman told me to my face that things were taken care of – when they clearly weren’t.

These things happen to everyone. It’s not that big of a deal. But with everything else, it feels like one. Trips to the mailbox feel like they merit hazzard pay. Integers with three digits qualify for an “only.” No one you speak to knows what they’re talking about. Insurance companies find every excuse to question claims. Playing go between for attorneys, insurance companies, doctors, therapists and hospitals becomes a full time job. Being sick or injured is beginning to feel like a secondary problem. I tell myself things could be a lot worse, but I’m a bad listener.

At the end of the day it boils down to me. I should have known better. If you think I’m angry with any of them, I’m twice as angry with myself.

note: I wrote this post a few weeks ago. By the time I finished, the tone didn’t fit my mood. As therapy, it worked. Now I’m hoping posting it will have the same effect.

4 Comments

  1. Accepting blame and accepting responsibility are two different things. Don’t be so hard on yourself. Be hard on the shitheads instead.

    I’m a free market capitalist, yet I live in a country with socialized medicine. And you know what? It works GREAT. During all the years I had American-style insurance the deductable was always high enough that the insurance company never paid for anything. It’s a scam. People get rich merely because other people get sick.

  2. I am so sorry about all this! I think this is why I memorialize everything, because I really seriously don’t trust anyone. I go so the other way that people actually are offended with me and ask me if I don’t trust them = to which I respond, no offense, I just don’t know you.

    This really sucks. I would still, by the way, file a complaint against that medical office that lied to you. There are standards of conduct and they outright lied to you and in some ways you have to wonder if it was intentional. They lose money on insurance and don’t want to deal with it. Perhaps she intentionally lied to you hoping you would not follow up and then intentionally did not file in order for the entire burden to be on you. You never know. I trust no one in that situation. So file a complaint and send a really strongly worded letter to the partnership that owns that medical office, saying you are writing them up to the medical board.

  3. Let me start with this; I hate insurance. It scares me. The whole thing is a system that is designed to fail. It is set up to put the burden on the hurt and scared person who needs it desperately but can’t slog through the intentional pitfalls.

    My last two “career” jobs, both have had insurance. The first even paid for the whole thing! Over the combined six or seven years I have never once used it, not even for a physical. I’ve been lucky that I haven’t needed it, but none the less I can’t even bring myself to open the stupid binder to even try to understand what I am and am not covered for. It feels, top to bottom, like a scam.

    I don’t deny that medicine is expensive and that doctors should be paid commiserate wages for the time they put in and this skill that they display. However, I know that between the insurance companies, the pharmaceutical companies and the rest of the health cartel, the price of healthcare has very little to do with the doctor’s salary.

    Where is the desire to make the quality of life better for everyone?

    In a world where nearly everything (and everyone) else has been commoditized why are we seeing these consistently rising costs? Where are the two for one specials? Where are the loss leaders? I don’t think that this is an example free markets. I think it’s more an example of corporate oligarchy.

    I’d rather be socialist than dead.

    I mostly blame old white men…

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