my daughter needs a tonsillectomy and to have tubes put in her ears because she has almost completely lost her hearing.
she has needed this for a long time but we have deferred surgery because we wanted to be sure it wasn’t going to work itself out without intervention.
now, that we have finally made the choice to have the operation the insurance joy kicks in.
our ent physician can perform the surgery in two centers. we can’t go to the center we would like to go to because it is out of network. but while the second center is in network, they won’t guarantee that all the service providers, like the anesthesiologist, in the second center are in network.
this week the insurance company sent us a threat letter stating that we had better know all the fine print in our insurance plan or have our checkbook ready. near the top of the letter, i guess to delude themselves, they wrote:
treatment decisions are made between you and your physician or health care professional.
i guess if i’m good with paying for everything a la carte, they are correct.
of course this letter is doubly annoying because natalie has been in a months long fight with the insurance company to pay for her routine annual exam. the physician didn’t use the right code originally when submitting the claim (even thought anyone with a brain could have seen it was a routine, covered procedure). when the physician’s office resubmitted the claim as directed by the insurance company, the insurance company rejected the corrected claim as a duplicate.
i really can think of no worse way to manage health care than the system we currently have in place. and we allegedly have “good” insurance and are in good health.