This is a whiny post - I just want to let you know ahead of time in case you wish not to read on during this season of cheer.:)
So back in October I took Nina to an urgent care pediatric clinic because her breathing had gotten so bad, and it was a Saturday so I couldn't take her to her ped. Well ends up our insurance has decided not to cover this trip to the clinic because they didn't deem it as an urgent medical need. I guess the doctor coded Nina's visit for "wheezing" even though he told me she had croup and prescribed steroids and Xeopenex. Apparently our insurance company does not accept "wheezing" for urgent care visits. I'm just sick over this. I mean we have the means to pay for the visit, it's just that it's going to add just a little more financial stress right now, which with Christmas is just not fun.
The main reason I'm sick over it is that I've now talked to 2 different people at our insurance company and both were immediately defensive and would not even listen to what I was saying - both cut me off constantly. Oh, they were so rude! I tried to ask why all of our visits to this same clinic for the same symptoms with Nina have been covered in the past and they said that it did not matter, what mattered was that the doctor had "coded" the visit for "wheezing" and that is not covered for urgent care treatment. One of the insurance reps even said to me, " There is a big difference between blunt force trauma and a headache and it looks like what you took your child in for was a 'head-ache'". I said, "No, I took my child in because she was having a hard time breathing." Yeah, but that didn't matter. I really just can't believe that this is how we treat each other as human beings. I know insurance companies are known for denying benefits, but I've never had a situation like this were I know my benefits should cover this visit and I have no recourse. I just have to pay. I'm going to try to have the clinic resubmit the records, but it sounds like from both ends, the clinic and the insurance company, we just need to pay.
Isn't it a bummer that this is the way things work. I think I'm going to rent that new Michael Moore documentary Sicko about our crazy health care system, just to help me feel better because I totally know that insurance denials are a huge problem, I'm sure everyone has a story... And most of them are of course much worse than my one time clinic visit costs... It's very sad. Thanks for listening to my whiny-ness. Now I need to put on some Christmas music and change my focus to all the positive things going on in my life.
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12 comments:
ooooh. i'm so sorry. insurance is such a frustrating thing (i've had a few of these experiences, luckily nothing that would break the bank but the snotty customer "service" responses i've gotten have been enough to put me over the edge). as a nurse, i can't believe this country has the insurance issues we do.
definitely have the clinic code the visit correctly and resubmit the claim. Escalate your case beyond the doofuses you've had to deal with once it's been resubmitted.
sorry, but i was always taught that cardiac and respiratory issues got top priority in ERs/urgent cares. so why your insurance has decided that "wheezing" isn't worthy of being checked out is beyond me.
OK, off my soapbox. good luck!
Ugh Jenni, that is horrible. I'm sorry they were so rude to you, they are just programmed that way. I know this doesn't help any but "wheezy" in infants is in fact a very serious issue because their weaker respiratory systems can suddenly give up "shut down". It can be very dangerous in babies. We took Kaden to the ER for the same issue, and trust me for Tim to agree to take a baby to the ER, it has to be serious, but they must have coded it something different. I would keep at it.
Man, I hate stuff like this. I would totally ask the clinic to resubmit. Asking to talk to higher ups than the rude customer service people is a good idea. Then explain to them exactly how you have been treated throughout this whole thing. I am so sorry you are dealing with this Jenni. Hugs.
Robbery without a gun! Insult to injury! Rude people are the worst. Eli's ped has ALWAYS said to bring him in for even the smallest bit of breathing issues. Better be safe than sorry. Even if they don't pay for it, you did the right thing. What bugs me most about things like this is the RUDENESS! Especially to you since you are such a kind person. Maybe there's a chance the dr will recode it....give 'em hell until they do! :)
Im with Christina on the getting the Dr to recode it! He should have known not to put wheezing. All I have to say is "Socialized Medicine" I know that americans poo poo it, but I and my family have never had any trouble. Only goodness. You can take your baby to the dr for a pimple if you want to. Also, they send a Home Health Nurse/ Lactation Consultant to your home a few times after you take a baby home to make sure that all is well with you and the babe and that the baby is gaining weight and mom is not depressed. It is very nice. MMMMM, I miss home.
seriously, anything to do with medicine is so frustrating. we had our own issues recently with croup and the pharmacy.... i totally sympathize and hope you can win the fight against the system!
We actually have Sick-O at our house right now. Come on over.
I'm sorry about all the lame crap. Sometimes things like this just KILL me. I hope everything is ok and that people stop thinking you are crazy hypochondriac mother about all of your children.
I had a lame doctor experience today, but nothing like this. They just lost my paper and I waited an hour before I asked and then it took 2 seconds to take my blood at that was it. Argh!
Jenni, that is the craziest thing I've ever heard! Back when Maia and Mason were "wheezers" I could get them in the pediatrician any time I wanted--all I had to do was say, "S/He has a history of wheezing" and BAM! I had the next appointment OR the nurse on the phone told me to go to the ER. And then they had me buy a nebulizer to use at home. How can not be serious? Your situation is just unbelievable!
I'm so sorry you have to go through all this! Insurance is so messed up. And customer service is horrible too. When I worked CS I was really nice at first but it just wears you down. It's a crappy job but some of the people who work it are just jerks any way.
FRUSTRATION!!! I HATE dealing with insurance stuff. I HATE IT. I am having a problem right now. GOOD LUCK to us.
Jenni,
Speaking as a nurse, wheezing can be an emergency condition, especially if it is severe enough to cause labored breathing. The guidelines from the American Academy of Pediatrics say so--here is a link: http://www.aap.org/terrorism/topics/EMS_TIPP_VIPP.pdf
I suspect the insurance company is flat out lying, but it may be worth asking the physician to document that Nina's wheezing resulted in labored breathing. Then, there is no way they could say it is not considered a medical emergency. Hope this helps.
I know this frustration all to well. We are having to pay astronomical amounts for things and it's jsut ridiculous. I'm sorry about your little one. I hope they are feeling better. Good luck.
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