Insurance...

**Warning - this is an all out rant - proceed at your own risk!**

I'm fighting a battle with our insurance right now. I saw the eye Dr. in March. I tried to get them to submit for the materials portion of my benefits, but they said that they couldn't since no one else has the materials portion administered through their health insurance directly. My appointment was right before we went to Taiwan and it slipped past me to submit the claim, so I submitted it in August when I remembered. I heard nothing.

In NOVEMBER when I called because they were continually sending me emails about new EOBs when there were none, I happened to inquire as to whether or not they got my claim. "Oh, yes, it says right here that we are waiting for further information." Well were you going to inform me of that? It's been THREE MONTHS! "Well you should've gotten an EOB." I didn't. What information do you need? They needed the taxpayer ID of the doctor and the diagnosis code, etc. How would I get that information? "It should have been on the claim that your doctor provided you." My doctor didn't provide me a claim. I filled it out via a form I got from my husband's HR department. "Well it should've been on there." It wasn't. "It should have been right on the form your doctor gave you." My doctor DIDN'T give me a form. I only had a receipt from my visit. "Well why wasn't it on the receipt?" I don't know, but it wasn't, and nothing on the form I filled out indicated that I would need that information. How can I get it? "It should have been on the form your Doctor gave you." SERIOUSLY?! Okay, if I can obtain this information, how would I submit it. "Hold on and I'll get you the address." click. And I was calm that entire time. I wasn't even verbally incredulous at this ridiculousness (although surely I was thinking it). And she disconnected me.

Anyway, I called the eye Dr. and got what is called a "super bill" that has all that info on it. I resubmitted. I was rejected. Why? Length of time for the claim exceeded the allowable submission timeframe. So I call. I talk to a customer service rep who says that subscribers have a year to submit their claims and that it must've been processed as though it were submitted by a provider - and they only have 90 days to submit. She assures me that a resolution specialist will have this cleared up for me in a jiffy. I'm skeptical but hopeful. The resolution expert has me explain the entire situation over again (of course) at which time he tells me that he sees that my vision provider does have a contract with them, so therefore I would need to have submitted my claim pursuant to their contract. WHAT??? That makes NO sense. NONE.

He suggests that I file a formal appeal and politely tells me where to find the form. He says I should definitely explain that we were travelling and that's why I couldn't file my claim on time. NO, what I should explain is how asinine a policy it is that a consumer should abide by the terms of the contract with the PROVIDER of which said consumer would have no details!! I find the form and go to fill it out. The first line asks whom is filling out the form. I fill in my name. Three lines down it asks your relationship to the patient. The choices are "subscriber/member" (Steve), Parent/Guardian, and "other". I check "other" and then notice that it goes on to say that if you've checked "other" you should be sure to have the patient fill out the authorization of release of information form. WHAT? I have to authorize MYSELF to have access to MY information? Trying to cover my bases and somewhat in disbelief, I call to find out whether or not I really need this form. The phone tree asks for the subscriber ID. I enter it. Then it always asks for the birth date. I always enter Steve's as he is the subscriber and I have been informed on many occasions that I am NOT the subscriber. But then when I finally talk to someone they always think I will be Steve. I vowed to resolve this issue as well. The customer service rep immediately determined that I was an idiot for asking the question about whether or not I needed the form. "Of course you don't need that form - you're filling out the form for yourself." I agree - it should be obvious that you wouldn't need to authorize yourself, but then again it should be obvious that I shouldn't be bound by the terms of my vision provider's contract, right? They should just put a "self" box on the stinking form and then it would be easy!! So I ask her about the birthdate thing and she is again a little astounded at my utter stupidity. "Well you'd enter your birthdate of course since you're calling about you." Well yes, that would be logical if the phone prompt indicated that you should enter the PATIENT'S date of birth. But it doesn't. So now I've written a well thought out and only slightly terse letter of appeal all to get my mangy $100 that I'm now after on basis of principle. I'm certain that since the check will be issued (IF it's issued) this calendar year, they will count it against my benefits for THIS year and I won't be eligible for glasses for another TWO years.