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.