Tuesday, July 12, 2011

The Devil you Know

Our"new" health insurance kicked in November 1. I have the "new" in quotes because, as luck would have it, it was the same carrier as the previous job. It's far from perfect but I know what to expect. I believe that's known as "The Devil you Know."

Lately I've been receiving calls from the insurance company touting various programs they have for which Maggie qualifies. These are always "benefits" of the plan that are "free" to Maggie. There is always one problem though. These "free" benefits are not helpful to us in anyway. These are programs for specific diagnoses without regard to any other issues Maggie might have. Certain medications or frequencies of codes trigger something in a computer program and I start getting calls from well meaning but completely clueless individuals. I know what they are going to say almost before they say it because I receive the same calls about once a year and always several months after the policy has any changes at all. This time it was the same coverage, but a different employer, and we were treated as brand new policyholders. Same child, same doctors, same monthly bills, same supplies, same suppliers and pharmacies and same coverage. But we have to start over with all the calls.

Last week it was Program X which could ease my mind and allow me to talk to a nurse once a month to answer questions I have about Mary Margaret's condition. (They didn't specify which one). In the past I would sign up to look cooperative. I would sit while a nurse came here spent a couple of hours taking a report and never show up or call again because Maggie's complexity freaked her out. Now if it doesn't work I don't take it. I don't want to waste anybody's time, but.I wish that went both ways.

I listened politely to the program and then sighed and said, "Thank you very much but i don't think that's something we are interested in. I have a number of treating professionals available to me quite easily." She chided me a bit, which is never a smart thing to do. These nurses will talk directly to you every month. Really lady. I have one downstairs now and another coming at 11PM. I talk to nurses  until I'm blue in the face. My daughter is total care and this program is not designed for her. Thanks you but we are not interested. Done.

Or so I thought.

This morning I got a call about Program Y. Here's the gist of the conversation

Him:Can I speak to the parent or guardian of Mary Margaret.
me: Speaking.
Him: Free program, blah blah blah for which you daughter is eligible.
Me (bored) : and which of her 57 problems triggered this program.
Him: Well I can't tell you until I know her date of birth.
Me: I don't want to give you her date of birth or any other information until I know what this is about.
Him (panicked,) Ma'am there' something called HIPAA.....
I stopped him right there
Me I am intimately familiar with HIPAA. Here's her date of birth (confirm other information)
.Him: This program will help you better control your daughter's illness because you can talk to a nurse once a mon ...
Me: STOP - I received this call last week and told them this wouldn't work for her.
HIM, NO, that was program X, this is program Y. It's specifically tailored to your daughter.
Me: OK, what is it
HIM. (very concerned): I believe your daughter has been diagnosed with (drops voice and fills it with dread asthma. Is that correct? (sounding sympathetic)
Me - (losing all neck control and dropping my head,) OK, You need to listen to me.  No, actually that is NOT correct. She takes many of the same medications that asthma sufferers do which is probably why this was triggered, but she does NOT have asthma per se. She has the bigger meaner cousin of asthma and requires round the clock care. Hence this program is likely NOT tailored specifically to her at all, is it? You have absolutely no idea whatsoever what goes on in this house or what we have to do to care for her. There are nurses here 16 hours a day. I do the other 8 hours. If she did have asthma in addition to the other 30 things wrong with her, it would rank about #27 on my priority list. Please take my name off of these lists because it is inappropriate for you to use medical information - especially INCORRECT medical information - about my daughter for any purpose.  I'm sure that's somewhere in your HIPAA regulations.

The last thing I heard was him stammering. Another call was coming in and I told him I had to take it.
 Fortunately it was my mother and not anyone else. She loves these stories. When I told her she just said, Oh, the poor guy, but she had the giggles going pretty strong. I'm not sure she really felt  sorry for him..

I'm not always so brusque, but when entities that are supposed to be there to help us make additional work, it is beyond irritating.  They need to go back to denying claims for equipment, that's what they're good at.

1 comment:

  1. Sigh. I was struck by how you said early on that you answered the calls to be "cooperative." I had about ten messages and three formal letters about some kind of nurse that was assigned to Sophie -- I didn't respond to any of them, though. Will I have the dreaded "uncompliant" on my file, now? :)


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