Wednesday, September 07, 2005

Insurance SUCKS!

This title is all the more funny to me, as I am an insurance agent employed by the largest insurance broker in the world. Heh.

Yesterday ended on the note that the Children's Hospital had a two month backlog. This morning, I thought I'd get cracking at that. There's always a way in. I'm a bulldog. Heck, I'm an insurance agent, I'm connected. I call hospitals all of the time, and if I am diligent enough, I always get what I want. Eventually.

So, I call around to the other referral number I was given yesterday. Leave a message.

After a half hour of no results, I decide to call the pediatrician back to get either more referrals or a better roadmap to get what I need. I have, of course, to leave a message for the pediatrician and she will call me back.

When she eventally does (to her credit, in less than ten minutes), we talk about my situation. We talk about The Kid, about how dire things are at school and how badly I need attention quickly. She gives me one more phone number, suggests I call my insurance company and wishes me luck. Thanks, I'll need it.

Leave a message with psychologist 3.

I'm starting to wonder what people do when THEY are the one that needs the help. Like, say I was having a nervous breakdown today. How do you leave that message? "Um, hello Dr. Smith, this is Joe Smith. I'm currently feeling anxious, depressed and the little voices in my head are telling me to jump off of the Brooklyn Bridge. Due to the high volume of little voices in my head I may not be able to answer your returned call right away, but I urge you to call back if I haven't answered within two days. My phone number is 555-1234, thank you, and have a fantastic day!"

I call the insurance company. My employer, the worlds largest insurance broker, provides me with mental health coverage. I get transfered all over God's holy earth before I actually speak to the rep from the mental health area to get referrals. She asks me my zip code, and she searches within five miles of my home for a psychologist/psychiatrist specializing in children. Nada. Not a single one.

So, I ask her to cast the net more widely, say, a 60 mile radius from the center of downtown Denver, Colorado. I'm not remembering 7th grade geometry right now, but that' s a pretty big area, and would encompass most if not all of the 2 million people that make up the city and its outlying suburbs. She returns to me with seven phone numbers. Seven child psyciatrists/ psychologists in the Denver metro. Only seven?

Two of those docs were in the same office, so really, it's more like 6.

I call each one, leaving messages at each. After each message, this is getting me more and more mad. If there's a two month wait at the hospital, shouldn't we have started this earlier? Especially if The Preschool's reports are true that these violent behaviors had manifested themselves daily for months? Hmmm?

Then, slowly, throughout the day, the calls are returned. "I'm sorry, doctor so-and-so isn't taking new patients right now" is a regular response, as is, "Dr. blah-de-blah has a waitlist of about 6 to 9 months." Suddenly, two months doesn't look half bad.

So I call Children's back. They are happy to hear from me! I speak to a human being! The world has righted itself again! Hooray!

What insurance carrier do you have? I tell her. Oh, we can't see you.

Why? I ask.

Well, we require that if you have insurance, that you use it, but in your case, we don't have a contract with your carrier, so we won't be able to see you.

Even if I pay out-of-pocket?

We wouldn't let you even do that, she responds.

Flustered and shaking, I get off of the phone call to immediately get another one. The University of Denver's center for neuropsychology is calling me back regarding my inquiry, this being the second referral phone number I was given on Tuesday. They offer a full psychological assessment over three sessions for $1,200. This is totally outside of all insurance. They could get started right away, but the assessments take about two to three months to complete. Gotta think about that one.

A couple of hours later, I get another call back from a psychiatrist who has an opening on Thursday. Whoo hoo! Book it up! We have an appointment! Finally.

Towards the end of the day, I get another call back from another psychologist. Ends up that this is actually psychologist #2 that I called, a direct referral from my pediatrician. She and I had an amazing conversation, I truly like this woman. But first we talked about insurance. I asked her if she worked with my carrier.

She told me the story, which illuminates why there are seven child psychiatrists contracted with this carrier in the city. This carrier (the Mental Health one) went bankrupt about two years ago. They liquidated the company to a mega-huge health insurance company, who now piggybacks the mental health services on to the health insurance. When they went through the reorganization to join the mega-huge health insurance company, the mental health company sent out new contracts to providers, but failed to provide any kind of fee schedule or any kind of "reasonable and customary" guideline. So, providers could sign up to be in their network, but they had no idea if or what they would get paid. Sounds like a crappy contract to me! I just can't believe that my company, the largest insurance broker in the world, who provides consultation and brokerage services to employers across the nation in regards to their health insurance, would have as their carrier one as disappointing as this!

Okay, enough with the insurance rant.

I'm getting behind in my ongoing story, but I'm also getting behind in my sleep. I've got so much to tell you! The psychologist who seems to be awesome! Meeting the psychiatrist! And DRUGS are involved! It's all very exciting. More tomorrow. A LOT more tomorrow.

1 comment:

mister lady said...

Response to former post...Speechless.

Response to this one...Hopeful. And Speechless.

Have you tried drinking heavily?