Was I supposed to just grit my teeth?
The health insurance plan I have through my work processed the claim for my emergency room visit and gall bladder removal surgery. They approved everything, with one exception: a $780 charge for general anesthesia.
Ouch!
According to the first footnote on the Explanation of Benefits:
Your plan benefits do not cover all services. The service noted above is not covered. Please read your plan booklet for details.
Naturally, this made me want to read my plan booklet, because it seemed to me that not covering anesthesia during surgery was a rather large thing to leave out of a medical plan. But I don’t have a copy of my plan booklet. So I asked the local HR person at my office. No plan booklet. I called the corporate HR office. They don’t have a copy of the plan booklet, either.
Apparently, no one at my company knows exactly what is covered by our medical plan.
But it gets better. There was a second footnote regarding the denial of the claim:
Your plan excludes coverage for services related to weight control, including surgical procedures primarily intended to control weight or treat obesity, including morbid obesity.
Riiiiiight. That’s the primary reason why I wanted the anesthesia — to lose weight. The whole being-unconscious-during-painful-surgery thing was merely secondary.
I called the insurance company about the denial of the claim, and the customer service representative burst into laughter. Fortunately, it was the good kind of laughter, rather than the evil, maniacal laughter one generally expects from an insurance company. She said it was clearly a mistake and that they would reprocess the claim.
LOL. At least is has a happy ending. I hate insurance companies.
Fortunately, it was the good kind of laughter, rather than the evil, maniacal laughter one generally expects from an insurance company. LOL! We’re very glad that you were able to straighten out the confusion with your insurance agency!
Your experience reminds me of when our health insurance processed my claim for expences involved in my emergency Caesarian operation at the time of your brother Jonathan’s birth. We were living in England at the time, and over there they refer to the operating room as a “theater.”
Our U.S. based insurance company was willing to cover all my hospital expenses (including general anesthesia) except for the charge listed as “Theater.” We were informed that “entertainment” while in the hospital was not covered.
Your father informed them that what I experienced in that particular “theater” was hardly entertaining; and once the vocabulary misunderstanding was cleared up, the company paid up.
I have just been corrected, as one’s memory seem to fade with time. Your father wrote to the insurance company, stating that “the theatre charge was not for a command performance of Macbeth”, but rather for the operating theatre.
They approved the charge.
Eric,
That is really unbelievable! I\’m glad that you followed up with that so you didn\’t have to pay for the insurance companies mistake.
Sorry I haven\’t responded earlier. i appreciate your updates! I feel now I am adjusting to having to kids, I can actually email a little more!