Insurance fun

So, the next time your insurance company cheerfully tells you that they have approved a service for you, find out if they are applying it to your out-of-network lifetime maximum. It has come to my attention recently that several of Peter's services have been approved this way. Things that should be covered in-network should not be penalized as out-of-network if there was no one available to provide the service in-network. But that is not how the insurance company has billed it, nor is it how it was presented to me. I was just told the services were approved... and so I relaxed and we cruised along getting Peter the services needed. So now our lifetime out-of-network max is halfway met now, and the one justifiable out-of-network provider that we need every last out-of-network dollar for is Children's Hospital Boston.

"Well, you can still use unlimited in-network providers."

"Can you tell me the breakdown of just where all of these out-of-network costs are coming from?"

"Well, if you access the website and pull up your claim..."

"There are over 250 claims! AND there is NO indication of which ones you have paid in-network vs out-of-network. AND everytime I try to ask someone if this place or that provider are in or out of network I get a different answer! ... If my son needs a transplant at the out-of-network provider, is it still covered if we exhaust out-of-network benefits?"

"I can't tell you that it is covered, but I can tell you that since there is no one in network who does this type of transplant that you would be approved to have it done out-of-network."

"So it IS covered?"

"Well, I can't say that it is, but let's just say that since there isn't anyone in-network then you would have to go out-of-network, and transplant is covered. Do you catch what I am trying to say to you? In other words, I can't tell you it is definitely covered, but it is approved. And follow up services would be approved too since it is transplant and no one in network does that type of transplant."

So, is it me, or does this insurance-talk make no sense at all? I still can't figure out if Peter is covered for transplant if we blow through all of the out-of-network monies or not. And that was the case manager's explanation!! I'm not pushing for socialized medicine, just want straight, consistent answers and fair processing of Peter's bills. It is amazing how so many people in big companies can forget about being human beings and just treat you like a number. What if I were your sister or your mother or your daughter and asked you that same question? Well, enough ranting for now. There are more calls to make tomorrow.