Insurance

Take note people: don't get sick. If you get sick and you don't have medical insurance you're screwed and if you get sick and you do have medical insurance you're still screwed.

I am in the process of driving myself to drink. I receive an Explanation of Benefits from my health insurance company for my wife's hospital stay (actually the radiology that took place during the stay but it's related), which informed me that payment was not paid. The notation provided indicated it was a penalty for non-certification of the stay.

I contact my insurance company and ask what's going on. They tell me that until they receive certification they cannot release funds against the bills.

I call the hospital and tell them what my insurance company says and the billing department tells me they have an authorization number and read it to me. I happen to have in my briefcase an authorization letter sent to me from the insurance company when this started, however it only certifies 1 day. And wouldn't you know it, the authorization numbers match. I inform the hospital that authorization is for one day only and not the 5 days my wife was admitted for. The hospital isn't too concerned, they tell me until they hear from the insurance company they cannot do anything. No biggie for them. But i'm the one getting a $17,000.00 bill.

I call my insurance company's Pre-Certification department and ask them what they need me to do to resolve this. The nurse replied I can't do anything. The hospital has to provide clinical documentation in order for the insurance company to certify the 4 days. The hospital was contacted twice and has not complied with the request, so the insurance company closed the issue. NICE!!! They don't pay anything on this, the hospital is waiting for further information, EVEN THOUGH THEY RECEIVED NOTIFICATION!

I call back the hospital and they tell me that they received no request for information. I tell them that the insurance company has closed the case and will no longer contact the hospital. The hospital still is not worrying about it.

I suppose I should be so relaxed. I'm not going to pay a damn thing for this. Let them fight it out. I'll just sit in the background. It's just so frustrating that I'm trying to push this along and all I get is fingerpointing and aloofness.

This is why the cost of medical bills go sky high. Jackbooted bureacracy.