Without giving you all the gory details, I’m having a few medical tests. One of them was supposed to be CT scan of my pelvis. I’d recommended an ultrasound to the Doc but he said that wouldn’t be deep enough – he couldn’t see everything he needed to see while the CT scan would allow him to go deep.
Good enough for me.
Today the nurse called and left me a voicemail. She said the Insurance company had denied the CT scan, and that I should have an ultrasound.
Wasn’t that exactly what the Doc said he didn’t want?
I dial up Cigna. Yell that I’m a “C-U-S-T-O-M-E-R” into their automated system and wait. Now, I have to yell at them that I want medical, dental or pharmcy. I yell “M-E-D-I-C-A-L.” Then, it asks me to enter my member ID number which I so kindly do.
I hit zero hoping it’ll take me immediately to a customer service rep. It doesn’t. I continue to wait.
She comes on the line and asks my name and for my customer ID number (isn’t that what I just entered in the system?) My first question to her is when does the insurance company get to decide what type of test you need if the doctor says you need the more sophistocated test?
She says it’s done by medical review board. I ask her how a medical review board can possibly be making a decision about my health when they’ve never seen me. Well, they have your file.
She now tells me that my Doc (who probably averages 1,000 patients) will have to call them back and ask for a peer-to-peer review. This one almost sends me ape in the frozen bread aisle of the supermarket. I decide to leave the store because this one’s getting heated.
I tell her my Doc doesn’t have time for this.
She also gives me an 888 number for Med Solutions (a third-party provider) who has made the decision that I don’t need the CT. Now I get the real story. Cigna isn’t even making their own decisions…they’re farming them out to a third-party so they can let Med Solutions take the heat.
She also tells me that if I call the 888 number first, then my Doc calls, that I won’t be able to appeal a decision if they turn it down again.
I ask her who’s really minding the store over at Cigna? I pay Cigna for my insurance every month but they farm it out to someone I don’t even know to make decisions about my health. I’m sure the paperwork tells a really good story without the patient there.
I also relay that I spent a good while of my career doing marketing for insurance companies and I know that their business is about one thing…profits.
Next, and I know this one is a bit much, I tell her I’ll just wait until I get something like cancer and then my survivor husband can sue them for $1-$2M for malpractice. She tells me that’s the worst thing she’s ever heard anyone say.
I tell her I hope they’ll be using this one for training because their system is so ludicrous.
I end our conversation uttering a cuss word and she informs me that I’ll need to conduct myself better as this ‘is a business call.” I tell her the only way to get their attention might be to cuss.
I burst into tears, call my husband and tell him I’m going to forget the whole procedure. I’ll take my chances. God’s in charge. Oh yeah, him and the insurance company.
So here’s the 3 reasons to hate the insurance company:
#1: Health is about health, not insurance. They’ve forgotten that. I’m not a hypochondriac who runs to the doctor every week. I’ve had 3 babies, 2 broken elbows, a spinal leak and a female procedure in my 50 years. Other than that, I try to steer clear of doctor’s offices. I do the best I can to use their services as little as possible.
#2: They’ve forgotten that people are people, not systems. We deserve to have our concerns handled without being told we ‘can’t’ and they ‘won’t’. When we feel like our choices have been removed, we fight back.
#3: Doctor’s are now the insurance companies puppets. If I were a Doc, I’d run as fast as I could from the profession.
Oh, and the 4th reason I hate the insurance company is their stupid voicemail system. Whatever happened to a nice receptionist?
Never quit fighting for the right thing! Don’t let the bureaucrats run your life. Don’t let the bureaucrats win. Even if you have to find a buddy to do it.