Insurance crap stinks

I’m feeling rather disgusted with our insurance company (CIGNA) lately.

First of all, I’ve been trying to get them to acknowledge a claim (just acknowledge it, not even pay it) for Julian’s home birth since, hmmm, let’s see, probably January 2007. So, what’s that, like 8 months now? Every time I call they say it’s in “pending status” and they need something else – one more code, one more form, one more dotted i. I’ve mailed or faxed them everything they’ve requested and when I called today for my monthly status check, I was told it was still not in the system.

The good news is that the woman (Jennifer) I talked to today seemed honestly interested in helping me get this resolved. Perhaps she was just placating me or perhaps she sensed the utter frustration in my voice and genuinely wanted to help. I guess time will tell.

Sadly, with all of this exposure to insurance crap I’ve been getting over the past several month, I’ve found I’m getting more savvy with their jargon. So today I was able to tell the rep what information has been requested, what I’ve sent in, and where to look on documents for the information she should need, etc. She seemed to think they should have everything they need now and said she would forward it back to the insurance adjuster.

Jennifer is the first person I’ve spoken with there who actually asked for my phone number and said she would call me to let me know how this is resolved (which should take up to 15 business days). I was shocked! I was actually just starting to ask her when I should call back again to get another status report and she said that she would take my number and call me. I’m not going to hold my breath, but I did think that was very nice of her.

I’m still holding out some hope that somehow this claim will be acknowledged and then (*gasp*) approved and they will cut me a check for at least part of the $2200 I paid for my home birth. It’s not that the money wasn’t well-spent (my home birth was worth every penny and then some) or that I would hesitate to do it again, but, plain and simple, we could really use the money. Really.

Since I had this live insurance rep on the phone, after we finished talking about my home birth claim I had another question (one I’ve been trying to get answered for two weeks) about coverage for Ava. I have called the insurance company at least five times over the past two weeks and tried various selections on their phone menu system to try to find out if a speech evaluation would be covered. Unfortunately using the phone system to check eligibility never got me to a live person, no matter how hard I tried. I tried pressing zero, I tried saying “speak to a person” and was met with, “I’m sorry, I didn’t understand your request. Did you mean… (insert everything under the sun except speak with a live human being).” I even tried a few choice swear words which got me nowhere as well (but it helped me feel a little better).

Anyway, I’d been in the process of setting up this speech evaluation for Ava for the past month or so. I had to fill out several forms, fax information in and talk to a “case worker” at the rehab center to get this all arranged. I found out today from Jennifer at CIGNA that speech evaluations for developmental issues are NOT COVERED. In other words, it doesn’t matter if you child has a lisp or can’t say sounds that she should be able to at her age, they won’t cover it. If, however, she has a medical diagnosis, like autism or had been in a car accident and lost her ability to speak, then they would cover it. Is that F’d up or what?!

I got back in touch with the case worker at the rehab center and found out the speech evaluation would cost $441(!) if not picked up by the insurance company, so I canceled it. We will have to go another route. The case worker gave me the number for “Childfind” and said I could schedule a screening with them. I guess that’s our next step. Yay for wasted time! :oP

Maybe tomorrow I will call up CIGNA again and cuss out their automated system, just to help me feel better. :)

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20 thoughts on “Insurance crap stinks

  1. hmmm – sometimes pressing multiple buttons on the phone kicks in a live person.

    Such a drag dealing with these sort of things. Our insurance isn’t so bad, but when it comes to dealing with the Work & Income government department or Inland Revenue…. ugh, ugh, ugh.

  2. Amy, I’m sorry you are dealing with all that insurance crap. I was a utilzation review nurse at an insurance company for awhile. It sucked. But I learned A LOT about how the insurance industry works and how to get through all the mumble jumble, so let me know if you need any help.
    Second, you should be able to get Ava evaluated for free (services would probably be sliding scale) through the Early Childhood Intervention program in Colorado. One of my good mom friends works in ECI here, and my mom works for the program in Texas. I’ll ask her about contact info tomorrow. (or Google it – there are contact numbers listed by counties)

  3. So sorry to hear of your troubles. That must be so hard not to get anywhere with them!

    Even though here in Canada “everything” is covered we have had many troubles and I have fought time and time again to get things sorted and failed. My daughter’s first 6 months of life we ended up spending over $7000.00 dollars in medications alone that our extended benefits (which we pay extra for) wouldn’t cover. Now this $1000.00 per month medication is being covered by a special program and we have to re-apply every 6 months and wait on pins and needles to see if we are accepted.

    I FEEL FOR YOU! :)

  4. I hate to call companies in the UK. Oh my god,you can’t speak to a HUMAN here. Always automated speakers! As your case, sometimes their options doesn’t cover your problem and you can’t speak to anyone. In Turkey, you could always find someone to speak to. Good luck with your case!

  5. Ugh. I feel for you. I spent over a year trying to get Nadia’s birth covered, as my insurance changed thier policy to NOT cover labor & delivery a week before I found out I was pregnant – without telling me. I kept fighting, and in the end they did cover part of it but only because I had complications which made it a hugh risk delivery. Now I’m having the same fight all over again, this time with the pacemaker manufacturer since it was suppose to be under warranty. And my daughter’s insurance is crap, covers 2 vists a year and that’s about it. I REALLY hate insurance. And I hate when ya can’t get a live person on the phone. And voice recognition systems are fun when you’ve got a little one talking to you, huh?! haha

  6. Oh no! We’re Cigna too now!! So this is what I have to look forward to. Blah. And the county always signs up for the crappiest plans too, so nothing is covered.

    Ava should be able to get a free evaluation through Headstart or something government funded. Talk to HL….I think J had a speech eval done and it was free.

    Insurance SUCKS!! A few years ago I went to the eye Dr. for an eye infection. I went Monday for the infection and Thursday for a follow-up. The Monday visit was covered, the Thurs one was denied bc it was not an approved provider. Huh??!!! First I tried to fix it w/ the doc’s office. Long story there and I’d be happy to tell you which eye Dr. never to see bc their staff are idiots AND jerks ;) Then I spent MONTHS calling our rep at the administration Co. trying to get an answer. And Dwayne would say “sorry, not covered. Provider not in network.” And I’d remind him, for the 500th time that MONDAY was covered but THURSDAY was not and he’d say “Oh! I’ll have an investigator look at it and call you back.” Finally, 2 years later the county switched companies and that was that. SO FRUSTRATING!!!

    It’s good to know where CIGNA stands to far with HBs. We have a medical account so the money is there and won’t hurt too bad to lose….but insurance coverage would be nice. Although….we had the crappiest insurance when S was born and we ended up paying $4000-$6000 out of pocket for a vaginal birth and my prenatal appts. So HB is a bargain ;)

  7. it might have been said already – i didn’t read the previous comments – but you should look into local universities for one with a communication disorders department. you should be able to get a reduced rate or maybe even free, i’m not sure. it really is worth looking into, and you will get some personalized attention.

  8. Damn, why didn’t I try cussing out their phone system? Had a similar experience yesterday with ADP and their call center which must be in Bangalore, India.

  9. Yes, sometimes a little person-to-person communication really does change the world! Let’s hope it works for you. And isn’t it shocking to find out that “insurance” doesn’t insure that you get healthcare, but rather insures that you don’t?

  10. The whole system is royally screwed up and needs a SERIOUS overhaul. I count my blessings each and every day that Aidan, my husband and I don’t need to deal with that sort of stuff.

    I still think it’s outrageous that you had to pay over 2 grand to give birth to your baby in your own home! It should be covered 100% by insurance afterall you freed up a hospital bed. Midwives certainly need to be paid for their services and you shouldn’t have to be punished for your choice.

  11. Amy – have you tried taking Ava to the pediatrician to get an order for a speech/language eval? that might be what you need to get it covered. otherwise, I’m with everybody else check any local universities or see what’s available through your state… you might also be able to get her a speech eval through your local school district. Good luck with the insurance c r a p!

  12. Aetna denied our appeal on their refusal to cover Kieran’ s birth. And they are in violation of NJ law in doing so, but that doesn’t seem to trouble them a bit. And today I had Liam in to see the dentist for a toothache, and that’s not covered either since it turned out not to be a dental issue but rather some fluid in his ears. I am so mad.

    Hang in there. If enough of us fight them, eventually something has to change for the better.

  13. thank you all for your words of advice and empathy. i’m so sorry there are so many of us having to deal with these insurance troubles. it is so frustrating.

    for the record, even with insurance (a different provider at the time), i had to pay well over $2000 for a vaginal birth when ava was born in the hospital. it took us over a year to pay it off. i think julian’s home birth (without insurance) was actually cheaper for us this time around.

    kristen – thanks! i will chk into that.

    erinne – oh my. that has to be so hard not knowing what will be covered. gosh – i really thought canada’s system was supposed to be so much better.

    christina – ugh. i feel your pain. glad they covered at least part of it. sheesh.

    nicole – i had that same thing happen to me before. i went to see an acupuncturist and they covered the first visit, but not the next one because she wasn’t my primary care provider and i didn’t have a referral. but why did they cover the first visit then?? so frustrating.

    amy – i totally agree that the system needs a major overhaul. midwives definitely deserve to be paid well for the awesome job that they do. and yes, i saved the insurance company thousands and thousands of dollars by having a home birth, so we’ll see if they will give me anything.

    it does seem like there is at least one way to get a free/low-cost screening done here and there may be others available. i will be doing some research.

    kim – when i took ava to the doctor for her 3 yr check-up, that’s when she recommended i take her for a hearing test and speech eval, so she did write an order for them. i guess that doesn’t matter to the insurance company.

    liesl – that just sucks! :(

  14. So I used to (*gulp*) work for an insurance company. I left for many many good reasons. In most states companies must – BY LAW – acknowledge your claim within a set period of time. Almost always 30 days. If not, the insurance commissioner in your state might be a good place to make your next phone call. And if you mention the words “insurance commissioner” to an adjuster it almost always means a fast response.

    On the evaluation front…don’t know if you have them in your neck of the woods, but around here Area Education Agencies do free of charge evaluations for speech and hearing issues and also provide assistance on sliding scale basis.

    Good luck with all of it!!! Definitely thinking of you!!!

  15. Insurance company…a dirty word in my book. My first son was 7 years old before the claim for his birth was settled.

    Good luck. About the speech eval, yeah insurance usually stinks in that regard. I’ve been there many times and it costs me. :)

  16. Pingback: Insurance update - the home birth saga continues | Crunchy Domestic Goddess

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