Big Blue Monster

Continuing from last time, I had about five claims that were being denied by my shiny new health insurance provider, Blue Shield. I had overcome one barrier (preexisting condition) only to be met by another... Imagine that by now it is approximately April 2010. My new prescription medicine has healed me! However, I am still dealing with the financial fallout...

I was still enrolled in United Healthcare, in addition to being enrolled with Blue Shield. Because UH was provided by my employer (as opposed to being from my spouse), they were considered to be my primary insurance provider. Why is this a problem, you ask?

PROBLEM: Blue Shield slapped a footnote onto EVERY claim, stating that they didn't have to pay a dime because United Healthcare was primarily responsible.

So....back to the customer service minions. I explained the situation to Blue Shield, and even included my explanation of how United Healthcare won't cover it because I don't have a referral to the specialist because they wouldn't give me one. They explained how [they don't give a rat's ass] and that I have to send all the claims to United Healthcare first. I was told that if the claims are denied (and I simply interpreted this as "when" rather than "if"), then United Healthcare could send the claims to Blue Shield to pay any "remainder". This is commonly referred to as "cooperative benefits" when an individual is covered by two health insurance companies. One company processes the claim, denies or pays their share, then sends the leftovers to the other company to pay the remainder.

So....I called up United Healthcare and explained this to them, asking for their cooperative benefits department as I had been instructed to do by Blue Shield in order to set up this cohesion between my two insurance providers. I was quickly informed that United Healthcare did NOT have cooperative benefits (this figures), and that I would instead have to do the following in order to get Blue Shield to pay for my claims:

1) Call up every lab, hospital, and doctor's office and tell them to resend the claims to United Healthcare instead of Blue Shield.
2) Wait for United Healthcare to process and inevitably DENY all of the claims.
3) Take the denied claims, and send them to Blue Shield along with the original claim that was submitted to them in the first place.
4) Hope for the best.

Confused yet? Yes.
Frustrated? Yes.

Anyway, I follow step 1, and wait a month or two for United Healthcare to get around to denying everything. At least I can count on them to do that correctly. They did; step 2 complete!

Fearing what happened with the letter faxing debacle (see previous post), I decided I'd rather take my chances with the postal system. I wrapped up my carefully denied claims and mailed them away to Blue Shield, assuming they would arrive. Luckily, step 4 panned out quite well, and most of the claims were processed and many bills were paid!

In the meantime, I had learned that I could waive out of my employer health insurance (United Healthcare), and I did so promptly. I faxed the necessary paperwork to the Student Health Center, and didn't hear back. A brief call confirmed that they had excluded me from their terrible health plan. Yay!

I thought all was well, until I noticed that the claim to the pathology lab had not been paid. This got a little tricky, and is one battle that as of today, remains a loss for this poor graduate student. Stay tuned...

New Blue Horizon

I had just signed up with Blue Shield of California, and was still very much sick. Excited to be on an actual PPO, I quickly located a specialist that suited my needs and made an appointment. I was excited to meet with a specialist after being told by the ill-informed general practitioner that I did not need one, even though they could not figure out what my problems were or fix them. This was a problem with my United Healthcare graduate student "PPO" since I needed a referral to see a specialist...or even my general practitioner.

Anyway, I waited a month for the new Blue Shield to kick in, and then I went to see my specialist. She was great, and immediately suggested that I have a minor procedure performed in order to investigate my illness. I was scheduled within a week, had the procedure, and scheduled a follow-up appointment. Before going to the next appointment, I had to go to a pathology lab and have more samples taken for analysis. I went to said appointment, viewed results, and received a new prescription medication.

Summary of potential health insurance problems: 2 doctor's visits, one procedure (which involved being put under, a biopsy and brief hospital tenure), and a visit to the pathology lab

About a month and a half into all of this, I was blissfully imagining that Blue Shield was magically taking care of everything. You know....paying the bills, letting me have peace of mind...all that jazz. I was wrong. VERY WRONG.

So apparently, Blue Shield had decided to deny all of my claims on the basis on my having a "pre-existing condition" which exempted them from covering all of my bills. Well, I did, but according to California law, this doesn't matter as long as you were continuously covered under another insurance provider for at least six months prior to switching insurance providers. I had obviously been "covered" continuously by United Healthcare.

Back to customer service....my favorite. I explained that I had been covered, and they said that I had to get a letter from United Healthcare proving that I had been covered by them for at least the past six months, and send it to their provided fax number. I want to note that this is ALL they told me (this will be important later).

United Healthcare customer service.... I explain that I need a letter proving that I was covered for the past six months blah blah blah and the minion seems to understand. I ask her to fax it to me, and she does. When I receive the fax, I discover that she sent a letter expressing that I had been covered for the past 3 months only. >:-O Ok....I call again and explain the situation very carefully. The minion explains that because I am a student and the health insurance is provided on a quarterly basis, that the letter can only reflect a 3 month period. I try explaining that I need 6 months proof, and they are required to grant this to me by law. Minion thinks quickly, and decides that they can send me two letters, one showing coverage of the most recent 3 month period and another reflecting the previous 3 month period. This seemed inefficient, but I went with it.

Both letters in hand, along with my fax cover sheet, I send it all to the fax number that Blue Shield sent me. Thinking all was well, I went on my merry way.

Two weeks later, I notice that none of my claims have been processed by Blue Shield. I call them again, and ask about the verification letter from United Healthcare. They tell me they had never received such a letter. >:-O Ok....I ask how I can get the letter to them as I had already sent it to their fax number and that apparently doesn't work. "Did you put your provider number on the fax?" minion asks pointedly. "No," I say, "Nobody told me to do that. Why would I know to do that?" After further discussion, minion also informs me that I was given the wrong fax number. >:-O Ok, I send the fax again, using my newly garnered information...

I will spare you the details of what transpired, but I will tell you that it took me 4 more phone calls, 5 more faxes to 5 different numbers, people, and departments, and 4 more weeks before they actually acknowledged that I had sent the letter to them. They processed the letter, and eventually re-processed the claims.

Did they pay the bills this time, you ask? NO. While they were no longer denying them under the previously existing condition caveat, they had discovered a new and more annoying way to deny my claims. Stay tuned for more fun times...

Down with the Minions

Basking in the glow of my short-lived victory after having gotten United Healthcare to pay for my most recent doctor visit, I received another large bill from the pathology lab where I had gotten my blood work done (I went there one day after having gone to the doctor, December 31st, 2009). However, knowing that I had won the previous battle based on the UC Irvine holiday caveat, I figured this would be no problem...

I called up United Healthcare and explained the situation, explaining that they had just paid my bill for the doctor visit based on said caveat. In addition, I now fell under an additional caveat, "when the Student Health Center is closed." I had gone to get my blood taken on New Year's Eve, which was a legitimate university holiday; the SHC was for sure not in operation. However, that didn't stop United Healthcare from denying my claim and making me exert myself in order to get them to pay the bills.

About 30 minutes later, the low level customer service representative refused to submit my petition, stating that I simply did not have the necessary referral from the SHC. Seriously? Yes, this is what happened. However, since I was on to their ways, I demanded that I speak to the management. Again, I explained the situation, and...all was magically taken care of. Moral of this story: You should only be talking to the management when calling health care customer service. I believe that the sole purpose of the lowest tier of minions is to frustrate you into submission. Well, they have met their match!

I had become fed up with my health care plan, and had recently been presented with a luxurious alternative. I had just moved in with my fiance, and could be covered under his employer's health insurance as a domestic partner. Without hesitation, I quickly signed up for the Blue Shield California PPO plan. I felt like a new woman. Watch out world!

I thought this would solve all my problems. It did not.

The Curtailing of Idiots

As I last left you, I was still dealing with a large amount of unpaid monies for United Healthcare due to UCI's negligence.

I began reading through the informative UC Irvine student health plan pamphlet (which I had never received, and had to locate online). I was trying to discover if there was any way out of this horrific debt into which I had traipsed.

Imagine my surprise (and relief) when I found the caveat I so desperately craved. Buried in the handbook was a list of situations as to when you would NOT need a referral in order to visit a doctor outside of the Student Health Center (discussed in the previous post). Luckily for me, I fell under situation #3: No referral is necessary "when service is rendered at another facility during break or vacation periods."

As a chemistry grad student, I do not personally have breaks or vacation periods. Fortuitously, I had gone to the doctor on December 30, 2009, smack dab in the middle of UC Irvine's winter break.

Feeling quite smug, I called up United Healthcare with my new found information. They took note, said they would send my claims to a review panel, and get back to me.

...

They did not get back to me, so two weeks later I called them back and asked about it. They said that my petition had been denied because the Student Health Center was open on that day. I informed them that this tidbit of information was irrelevant, as caveat #3 said nothing about whether or not the SHC had to be open and merely that UC Irvine had to be on holiday. The following is how most of our conversation went:

Customer Service: "Your petition was denied because the SHC was open on that day."
Me: "That is irrelevant, because UC Irvine was on winter break. ::reading the brochure word for word::"
CS: "Yes, but the SHC was open."
Me: "I understand that, but that doesn't matter according to this point. ::more reading::"
CS: "Yes, but the SHC was open on that day."

etc.

I asked them to resubmit the petition, with the proper wording. They said that I could not submit a second petition as the first one was denied, and that I would have to pay the bills. After paying the bills, I would be allowed to submit a written petition.

Me: "Let me get this straight, I have to pay bills for which I am not responsible, and then waste my time writing a new petition because the review committee is unable to read the health plan brochure which they wrote."
CS: "Yes, you can submit a second petition."

HELL NO. I was not about to pay bills for which I had been tricked into having in the first place.

So I did what anyone should do when faced with low level, non-brain-functioning customer service flunkies. I asked to speak to the management.

Surprisingly, this turned out to be super effective (though I did have to have a lengthy argument with said flunky before they would pass off the phone). The manager lady achieved understanding on a level that surpassed all of my expectations. She dealt with the matter, and United Healthcare actually paid their share!! Fact: this was amazing.

However, this is not the end of my story...

Peeved: To make peevish or spiteful

Imagine that it is January 2010. Following my last blog entry, I was stuck with several hundred dollars in medical bills because of failed notification on UC Irvine's part about critical changes to our graduate student health care plan. Namely: Even though on a PPO, we can no longer see doctors outside of the Student Health Center (SHC) without first receiving a referral from the SHC.

In order to continue seeing my general practitioner (GP), I made an effort to get a referral from the SHC. I called them up and explained that I wanted to continue seeing my doctor, and that I simply needed a referral in order to do so. I also asked if I could do this over the phone. After much confusion and discussion, they decided that I needed to make an appointment with the SHC to see a doctor to get the referral. I acquiesced, and went to said appointment.

Keep in mind, the only reason I went was to get a referral to my GP. Nevertheless, the nurse took me back, performed a full basic exam, and then told me to wait in a room for the doctor. The doctor arrived, and when I explained the situation, he informed me that although he could submit a referral, it would not be approved because I was not being treated for anything that couldn't be treated within the SHC. I asked if he could submit the request anyway, and he reluctantly agreed.

I was a little peeved that upon leaving, I had to pay a $15 copay for the doctor exam that I didn't need. If I wasn't going to be able to get a referral, why didn't they just tell me that over the phone, and save me the trouble of coming in to the SHC and essentially wasting $15?

Anyway, the referral was somehow miraculously approved by the SHC (even though everyone involved told me it wouldn't be), but I never acted on it for fear that United Healthcare would not honor it.

As for the pending medical bills, you ask? Let's just say I am a fan of fortuitous caveats...

ZOT ZOT ZOT

It is December 2009. I am still with United Healthcare. What I didn't know is that the health care plan had undergone several "beneficial" changes in September 2009, unbeknown to the majority of graduate students currently being "covered" by this plan.

As some of you may know, California is broke. Since I attend one of its fine institutions for higher education, many changes have been occurring on campus.
1) Payroll cuts for most UC employees.
2) Furlough days for many of the UC staff.
3) Budget cuts, including but not limited to: taking away coffee and cookies from our chemistry seminars, taking away our annual chemistry department holiday party (while still allowing the biology department to have theirs), and changing the graduate student health care plan to the cheapest, most terrible plan possible.
4) Re-landscaping the entire campus with non-native, non-water efficient plants (this obviously has nothing to do with saving money, but I did want to point out the irony).

But I digress...on to the health care plan changes.

Our plan through United Healthcare is a PPO. A PPO means that you get to go to any doctor you want, including specialists, without a referral unless required by the individual doctor. You pay a copay when you go, in addition to a percentage of the amount for the specialty services rendered. If the doctor is not a preferred provider, you pay a higher amount. Regardless of the details, the point is that you are covered by the PPO plan when you choose to go to a doctor.

My health care plan with United Healthcare was a PPO both in name and spirit from September 2007 to September 2009. After that point, it became a PPO in name only. Problem: Nobody told us.

Anyways, I was having severe gastrointestinal problems that had been ongoing for about four months, so I headed on over to my general practitioner's office for a check-up (which is another blog entry in and of itself). My doctor also directed me to a lab to get some blood samples taken.

Two weeks later, I receive a bill from both the doctor's office and the pathology lab for the full amounts, both citing that the insurance company had denied payment because I had not received a referral from the Student Health Center on the UC Irvine campus. WTF? I had been going to the doctor before now and had never had to get a Student Health Center referral; I had never even been to the health center.

After looking into it, I had discovered that our graduate student caucus representatives had VOTED to take away our PPO privileges, while still calling our plan a PPO and without notifying us of these critical changes. Apparently, we have to go to the Student Health Center for ANY condition. If they think they can treat you there, they will refuse to give you a referral to a specialist. In addition, you cannot choose which doctor you see; they randomly assign one to you based on who is available during your appointment. This would be great if I had any ounce of faith in the mediocre Student Health Center medical staff...

Oh, and what does "zot" mean, you ask? According to UC Irvine, it's the noise that the anteater mascot makes. Yes; it makes as much sense as my health care plan, also devised by UC Irvine.

At this point I had around $700 of bills looming over my head. Did I fight this? You bet your bootay I did.

Stay tuned...

Pathology Lab Hoedown

The year is 2008. It is October. In September of 2007, my health insurance changed from PacifiCare to United Healthcare. Keep these easily understood tidbits of information in the back of your mind.

I went to the dermatologist to get some moles removed (super exciting). Everything went smoothly, and I exited after paying my $15 copay. There was a claim made by the dermatologist's office (which actually went as planned) and another by the pathology lab that processed my lovely mole samples for any signs of cancer (benign by the way, do not fear!).

One month later, I received a letter from PacifiCare (not my current healthcare provider, mind you) explaining that they had denied the claim from the laboratory because I was no longer subscribed with them. "Well, duh," I said to myself. A week later I received the bill from the the pathology lab for $700, indicating that my insurance company had denied the claim. I called them up, explaining that I had not been covered by PacifiCare in over a year, and to please bill United Healthcare instead. They apologized and left me feeling as though all had been resolved.

A month later, the scenario described above repeated itself. A letter from PacifiCare was followed by a bill from the pathology lab for $700. I called, explained, and left the conversation feeling resolved...

Every month, for the next SEVEN months, the same thing happened. I had called PacifiCare, United Healthcare, and the dermatologist, all in an effort to figure out if it was someone else's fault that the pathology lab could not bill my actual insurance company. It was not someone else's fault...

EIGHT months after my dermatologist visit, the lab actually resolved the issue. It is now June 2009. I was now receiving calls from bill collectors. By now I was being less than cordial towards the receptionist at the pathology lab. One day, the light bulb turned on inside the dim head of one of the lab's sub-intelligent miscreants. "OOOOHHHH, you don't have PacifiCare anymore?" she exclaimed, in wonderment and awe. Somehow, this had not been clear the last SEVEN times I had called and explicitly asked them to bill United Healthcare.

How this debacle occurred is a mystery to me even to this day. I was with PacifiCare for only one year, and had never had any work done by the dermatologist or any pathology lab during that time. How this pathology lab had even received my PacifiCare information was mind-boggling.

Woe is me.

Jacuzzi Death Virus

It was a pleasant Sunday for all along the Southern California coastline. Accompanied by several of my fellow grad students, I enjoyed a peaceful day at the beach. When we were leaving, we had the fantastic idea of going back to one of our apartment complexes to do some hot tubbing. We went our separate ways to scrounge for dinner, and then met up at the hot tub around 8 pm. There were about ten of us in attendance. We socialized, laughed...and we lived!

The following Monday morning was nothing out of the ordinary. We all went to work, enjoying the satisfaction and glory that only a few can appreciate as what comes with being a chemistry Ph.D. student. Following work, we all went home.

And then....it was 10:30 pm. That was the moment we all got the jacuzzi death virus. There is something I must tell you about said virus. It does not discriminate against anyone. All ten of us fell ill at exactly 10:30 pm on Monday evening. We had fevers of 105F, initial vomiting, intense dizziness, nausea, and a feeling like our lungs were filled with a toxic gas that made it difficult to breathe. At first I thought it was something I ate, but over the course of the next 24 hours of communication, we had finally realized that it had happened to all of us that had gone to the jacuzzi on Sunday night.

I was the first to go to the walk-in clinic. I told them I had a fever of 105F and that I was vehemently sick. They gave me some paperwork to fill out and sent me to the waiting room. I felt like I was dying, and all I could manage to do was lay on the ground and cry. The other patrons in the room tried not to stare (or help). I finally got called in, and they weighed me. Two days earlier, I had been 5'4" and 117 lbs. Today I was 108 lbs. Needless to say, this was not good; I could not afford to lose any more weight.

The doctor looked in my nose, saw that it was plugged, and proclaimed that I had a cold. I told her that I had been crying for the last 3 hours, and that I did not have a cold. She scowled at me, barking "why are you crying???!?" I explained that I felt like I was dying and had a high fever in addition to the trouble with my lungs. After confirming that I had a fever, she gave me some Tylenol and explained that I must have the flu, because everyone else had the flu. I explained that there were ten of us that had all gotten sick following exposure to the jacuzzi, and she said it was probably because of something we ate. I told her we didn't eat together and she said it was because we drank too much and were hungover. I told her I didn't have anything to drink, and she said that somebody at the jacuzzi had the flu and that we all must have contracted it. She also told me that you can't get sick from a jacuzzi. Unfortunately, facts and logic beg to differ. My phone rang during our visit as I was expecting my boyfriend to come pick me up and he didn't know how to get there (which I explained to the doctor). The doctor immediately became irate and informed me that she would leave if I answered the phone. I silenced it, and she told me to leave. I was too delirious and emaciated to argue.

Anyway, all ten of us eventually made it to the doctor, and every one of us was told that we had the flu because "everyone else had the flu." After doing some research (as chemists, I like to thing that we are at least partially competent enough to determine the scientific validity of what diseases we might have, based on facts), we had all come to the conclusion that we most likely had a virus known as Pontiac fever. This is a milder form of the more widely publicized Legionnaire's disease, and can only be confirmed by a blood test. Grad student F brought this up to her doctor, who replied, "I don't know what Pontiac fever is, but you don't have it." How can you know if someone has something if you don't know what it is? You can't. Grad student T was given Tamiflu by his doctor, and upon taking it became violently sick and ended up developing a serious and recurring cough. A few of us asked for the blood test, and all requests were denied by the doctors (all of which admitted to having no knowledge of any diseases that could be caused by a public hot tub). The last couple of our group that made it in were greeted by remarks along the lines of, "oh, you're one of them." We had inadvertently become notorious throughout the local hospitals and clinics.

I was on my back for an entire week before I could get up and walk around. The sickness in my lungs hung around for a good month following the ordeal. We never confirmed that it was Pontiac fever, but we also never confirmed that it was the flu. We complained to the apartment complex about their jacuzzi, but they informed us that somebody cleans it once a week (public spas should be checked daily!) so that this was an unlikely occurrence. They closed the spa for a week until the cleaning crew came by, but other than that they did nothing.

I found the complete ignorance and lack of caring on the part of at least five different doctors to be utterly appalling. We were violently sick and looking to them for help, and all they could do was sneer at us from atop their self-entitled pedestals.

As I left the doctor's office that evening, feeling dejected and abused, I pulled out my wallet to pay my $15 co-pay. The desk attendant informed me there would be no co-pay, so I staggered out of the building and into my boyfriend's car. A week later, I received a bill from the clinic in the amount of $15. FML.

Health Insurance Romance: A Tale of Woe

Have you ever had a health insurance debacle? In my line of work, the answer is almost always a resounding YES. (and I use the term "debacle" lightly)

As a lowly chemistry Ph.D. graduate student at one of the fine institutions within the University of California system, my expectations for health insurance are low. I do not expect the amazing. I do not expect the extraordinary. I do not even expect the occasional fortuitous surprise.

I do however, expect the people involved in various levels of the health care process to put forth the minimal effort necessary to complete their job requirements. Apparently, this is asking too much.

I dream of the day when I can go to the doctor, have them bill my insurance, and have the insurance company pay their percentage...and then have that be the end of the story.

Fortunately for you (and unfortunately for me and several others), that has never been the end to my story. I have been failed at every level of the health care system to the point that it has now become blogworthy. The ridiculous nature of what I have had to deal with (and most likely will continue to deal with) is mind boggling; I would not wish this upon anyone. I shall be sharing my own stories as well as those belonging to some of my coworkers. These escapades traverse multiple insurance companies, diseases, prescriptions, doctors, treatments, diagnoses, and prescriptions. Nothing proceeds as it should. Murphy's law applies strongly to each tale. These are tales of abusive romance with our health insurance; although we are repeatedly torn down, we have the need to keep crawling back.

Stay tuned for the frivolity yet to unfold...