I Don’t Speak Health Insurance

Documenting the pure insanity of #youcantmakethisshitup

It took 1.5 hrs and 13 phone calls this afternoon to learn that no one working in health insurance or health care communicates with anyone.

At 2:46 pm we received word from doctors (YNH) that Oo’s procedure will not be covered by our health insurance (HPHC). They quoted us a ridiculous fee-for-service price. (Half the value of my house kind of price.) 

Between the 2:55 and 4:46 I made 13 phone calls. 

Call #1:HPHC member services informed me a request for services was never made by YNH.

Call #2: YNH to reach out to original provider who informed us of denial. She explains that not only did HPHC deny coverage they denied additional means to receive coverage including extra letters of medical necessity and peer to peer (doctor to doctor) review. 

Call #3: HPHC claims. Can’t file appeal, because they say request for service was never made.

Call #4: YNH seeking women who made original request for service. (She is gone for the day.) 

Call #5: HPHC Member Services request supervisor who tells me same thing, but does suggest calling YNH med records department. 

Call #6: YNH Med Records get read detailed accounts of three phone calls made from YNH to HBHC including procedure codes (42382) and diognostic codes R10.8 and R108.4. YNH tried both to get HPHC to cover procedure. 

Call #7: Patient Advocate line at HBHC. Learn that 42382 will be denied. But other diagnostic codes might be able to be used for possible approval. 

Call #8: Call YNH back get receptionist. She explains I need to call provider services line at HBHC.

Call #9: HBHC provider service line refuses to speak with patients and transfers me to member services. Ask for supervisor. 

Supervisor is sending letter to YNH that will explain different diognistic codes to use for potential coverage. (The letter will take 3-5 business days.) Supervisor also says to call back provider line, and don’t tell them you are a patient (I’m not the tiny human is) and immediately ask to speak with supervisor.

Call #10: Back to HBHC provider services. Speak immediately to supervisor who informs me that 42382 is problematic, and that all phone calls between YNH and HBHC are recorded, but she can’t access them for me because I’m not a provider. I get direct contact line to give to YNH. HBHC says I can’t have anything in writing because the only documentation of exchange is in recorded phone calls, that I can’t have access too, because I’m not a provider. 

Call #11: YNH leave voicemail with direct contact information for HBHC provider services. 

Call #12: YNH med records to get this insanity documented in the notes for Oo.

Call #13: Leave long detailed message on doctors line explaining all of this, and asking for documentation of request for services. 

4:46pm: Everyone is gone for the day, and I just get to stay in this nightmare.

The irony is fucking profound. One of the reasons we have tortured Oo with gluten for the past 3 weeks is to get a positive diagnosis so continued care will be covered. The procedure we were told will be required by the health insurance company that won’t cover the procedure. 

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