Thursday, November 19, 2009

Do you have health insurance?

We have the standard corporate employer provided health insurance.  Lynette's employer is the plan subscriber, a coverage which has remained in place during her illness. Over the years we have been happy with our coverage, paying our copayments and deductibles for office visits and minor medical procedures.  Before I changed jobs, I used to carry our health insurance. I was surprised to find out at the annual reenrollment meeting that my company was paying twice the monthly premium on my behalf that I was.  My medical insurance premium per month was nearly $1000 for my family, including mine and my company's contribution.  I was surprised to learn how costly it was for my employer to provide me with health insurance.

I'm sure it's not a surprise to most of you reading this that we have had a recent increase in our medical expenditures. If you have health insurance, you probably feel some security in having this coverage.  It's comforting to know that when you go to the doctor or take your child the doctor that your visit will be covered by your health insurance.

Lynette received a detailed statement of charges each time we went to see Dr. J.  Most of her visits over the summer included charges for a generous supply of pricey IV antibiotics. Since Dr. J was out of network, all insurance claims had to be file by the patient.  Lynette gathered up the supporting documentation, filled out the necessary forms and mailed the claims off to Cigna. When the first claim came back underpaid, Lynette realized that they had paid on the unit price for her antibiotics and not on the extended price.

Lynette contacted the insurance company to let them know of their error.  We figured this was an isolated event and it would be quickly corrected.   The next time Lynette made a similar claim, the same problem was encountered.  Lynette contacted them once again to let them know that they had incorrectly processed the claim. The next time Lynette had a similar claim to post, she took special care to annotate the supporting documentation to help the claims processor correctly encode Lynette's claim. Once again they filed the claim based on the unit price instead of the extended price. Even with extra direction, they still filed the claim based on the unit price rather than the extended price.  Lynette filed more appeals, and today we have finally received a benefit check for these claims. 

The cost of Lynette's Lyme disease treatment is approaching $50,000.  At this point I feel somewhat happy that our insurance has covered 60% percent of this cost.  We figured the insurance benefit would stop at one month of IV antibiotic therapy.  But they have not denied any of the claims once we let them know where the right numbers were. The level of the benefit has been higher than what we expected.

The Academy of Motion Picture Arts and Sciences has pared down their choices of documentary of the year to 15 movies.  One of those movies is Under Our Skin.  This is a movie about Lyme disease and the political and medical controversy that surrounds it.  I surely don't expect Under Our Skin to win the Oscar for best documentary, but I am so excited to think of the attention that would be drawn to the Lyme plight if Under Our Skin was one of the 5 nominees for best documentary. 

This is the part where I usually write about Lynette.  She's not all the way better, but she's doing pretty damn well.

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