Where Logic Meets Love

How Not to Provide Health Insurance: Incomplete Directions and Unhelpful People

Friday, May 20, 2011

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How Not to Provide Health Insurance: Incomplete Directions and Unhelpful People | Faith Permeating Life
Since you got a short post yesterday, here's a semi-long one -- an attempt to do justice to the ridiculously long process I have had to go through to get reimbursement from my health flex plan. Why, I wonder, is it so freakin' hard to accomplish anything related to health insurance?

Some background:
  • September 2010: My doctor tells me to take a bunch of vitamins so mono won't totally destroy my body. I ask to get a letter for my insurance company because I can pay for it with my flex health plan if I have a doctor's letter.
  • October 2010: I call my doctor's office and finally get the letter I need, which lists the vitamins I should be taking, how much of them I should be taking, and to please give me whatever insurance coverage I need. I then mail the letter to my insurance company and, thankfully, make a copy of it ahead of time.
  • November-December 2010: We are out of money in our flex plan for the year so there's no point in sending in any reimbursements.
  • January 2011: I go to my company benefits day at work and talk to the people from our health insurance who run the flex plan. I have, ahead of time, checked out all of the documents online and the only mention of a doctor's letter is on a list that says "OTC Reimbursable with Doctor's Letter" and has vitamins on it. So I ask the reps about this and they say I can send in receipts along with a copy of the letter from my doctor telling me to take those vitamins and I will be reimbursed. It's a good thing I kept a copy because they don't and I have to send one in every time.
  • March 2011: I go back through all of our grocery receipts, pull out the ones that have vitamins, photocopy them (not an easy task since most of them are longer than the scanner and I have to fold them so the date of purchase and the item price are visible), highlight the vitamins, fill out the form, photocopy my copy of the doctor's letter, and send the whole lot off to my insurance company.
  • April 2011: I get mailed a reply from my insurance company saying that my request has been denied. Why? Because the doctor's letter didn't say what "specific medical condition" the vitamins were for. I go back over every document I have from them and everything on their entire website and I can't find this requirement anywhere.
But they can do whatever they want because they're my insurance company.

I should remind you at this point that what I'm attempting to do is be reimbursed from money that was taken out of my paycheck for my flex plan. So I'm asking for permission to spend my own money on these stupid vitamins. I get the benefit, of course, of the money having been taken out pre-tax, which is really no benefit given all the hell I have to go through to get this stuff reimbursed.

So after finally getting back in to see the doctor yesterday (which I wasn't supposed to be able to do until June but I played up how sick I was to get squeezed in for a May appointment), I had to tell three different people there that I needed a replacement letter before someone actually promised to do something about it.

Since I was missing key information the first time and really didn't want to go through this whole process again, I decided the safest thing was to call my insurance company and ask for what was supposed to go in the letter.

I explained the situation and how my original letter was rejected for not having enough information, and how there was nothing on the website that explained what should be in the letter, and would she please tell me everything that needed to be in the letter before I went through this whole thing again.

Her response? I kid you not: "Well, your doctor's office should know what goes in a doctor's letter." Like I didn't need to concern myself with the details.

OK, did you not listen to anything I just said? They did write a letter and it was apparently wrong.

So I tried again: "The first letter I sent was apparently missing information. Could you please tell me all the information you need to be in that letter so I can tell my doctor's office?"

"Well, you know, length of treatment..."

"OK, length of treatment," I repeated, making it clear I was writing down what she was saying.

"And the medical condition or diagnosis code," she said.

I thanked her and then attempted to explain again that none of this information was on the website so there was no possible way to know any of this without either calling first or going through the whole process and getting denied.

"Well, as long as you have the length of treatment and medical condition or diagnosis code in the letter, you'll be fine," she said.

I tried again.

"OK, but what I'm saying is, it would be really helpful if you would add this information to your website or to the documents about reimbursement so that no one else has to go through the process of submitting all their paperwork and getting denied for something they didn't know they needed."

"OK," she said, clearly impatient and ready to get me off the phone.

I thanked her, hung up, and called my doctor's office, where I talked to a super-unhelpful woman who finally put me on the phone with the woman in charge of writing doctor's letters, and I repeated back to her what was supposed to be in the letter. She sounded a bit baffled.

"Well... what is your length of treatment?"

At this point I wanted to cry. "I don't know! I was in there yesterday and my doctor doesn't even know what's wrong with me. He just said he wants me to keep taking these vitamins and I want to but I can't keep buying them if I'm not going to be reimbursed."

She said she would ask him. I said maybe she should wait anyway because I was supposed to get this blood test to check my vitamin levels and maybe the doctor would add more vitamins and uggggh this is so freaking complicated.

She also sounded glad to get off the phone with me.

Honestly, I understand the purpose of having paperwork and processes and documenting things, but what makes these processes so painful is the combination of incomplete directions and unhelpful people. That is what makes everything take so much time.

Agree? Disagree? Do I just have really bad luck?

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