Approval

Millbarge's trip to the specialist was largely uneventful.

The issue that had been the subject of many bedside visits by somber toned Pediatricians, the one that had been called a Congenital Whatsit of the Doohickey and scared us all to death, is now considered insignificant.  Eventually, it will just be a few lines buried in her medical record and a few pictures that we'll have to explain to her.  The bandages are off and we've been assured that they won't be going back on.

What was slightly more eventful (and in retrospect, hilarious) was Evil Insurance Company, Inc.'s fumbling efforts to approve the trip to the specialist, no, wait, deny it, hang on a minute, approve or maybe deny it, or...uh, we're all confused, can we sit down for a minute?

The Big Fancy Perinatologist Place arranged for Millbarge to see the specialist before we were released from the hospital, even contacting Evil Insurance Company, Inc.'s referral department to ensure that EIC, Inc. would give their official blessing.  You'd think this would be enough, but I've found that there is nothing so simple that it can't be effortlessly fucked up by massive layers of bureaucracy.

Four days before Millbarge's appointment, the specialist's office called to advise us that the referral had not gone through and EIC, Inc. was currently denying the appointment.  I was sure this was a mistake, so I called EIC, Inc., where a minion informed me that no referral had ever been submitted, that Millbarge did not have permission to go to the appointment, and that if we took her against their wishes, the appointment would not be paid for, not even retroactively if the referral was eventually approved.  I took a deep breath.  "The Pediatricians at TBFPP told us that our daughter has a birth defect," I said quietly.  "She needs to be seen by the specialist this week.  How can we make that happen?"  The minion was unmoved.  "TBFPP doesn't have any authorization to make a referral.  You'll have to take her back to her EIC, Inc. Pediatrician.  They can submit the referral, then it will go to a committee, and if the committee approves it, they'll send you a letter." 

A letter. 

Here is what I did not say: "Is this really what you want to do today?  Do you really want to be a party to denying healthcare to a potentially sick newborn and sound like you don't give a shit while you do it?  Are you prepared to answer to your supervisor over this issue?  Aw, fuck your supervisor, are you prepared to answer to your God?  Are you?"

Clearly, I was feeling a wee bit brittle.

Here is what I did say: "Yes, but the appointment is in four days."  The minion was still unmoved.  I was clearly wasting my breath and patience.  "You know...nevermind," I said, silently offering up my standard curse for the unmoved minion: "May you someday be the recipient of the same caliber of care you currently provide to others."  I began calling the Pediatrician's office every hour on the hour, talking to the receptionists and the nurses and explaining the situation a dozen different ways.  Within six hours, a representative from EIC, Inc. had called me at home to apologize and explain that the referral had already been submitted and approved (not once but twice) and ask if I would I like to take down the referral number for my records?

We went to the appointment, where the specialist declared Millbarge's problem to be a result of simple uterine crowding that was unlikely to have any long term impact, and there was much rejoicing.

Then the letters started arriving:

"Dear Millbarge Buttmansion,
Your referral to The Specialist Hospital has been approved.  This referral is active from (birth until one day before the date of the appointment) and covers initial evaluation and treatment."

"Dear Millbarge Buttmansion,
Your referral to The Specialist Hospital has been approved.  This referral is active from (the day of the appointment until August) and covers six appointments, treatment, and surgery if needed."

"Dear Millbarge Buttmansion,
We are writing to let you know that the service specified below (The Specialist Hospital, office visit) is not covered.  Patient does not have active Evil Insurance Company, Inc. coverage.  EIC, Inc. will not pay for these unauthorized services.  You will be billed for these services.  You have the right to appeal this decision, although it might be a tad bit difficult for you to read the directions for filing an appeal, since you are in fact a tiny little baby and communicate mostly through grunting and the expulsion of bodily wastes."

As tempting as it is, I have decided not to smear the denial of service letter with Millbarge's chief means of communication and return it in the enclosed envelope.

Comments

[Patty]

1. SO SO SO SO glad Millbarge is okay!!!

2. OMG, insurance companies after babies SUCK ASS.

We still get freaking NICU bills and collections calls for NICU stuff 20 months after the boys' birth. It's ridiculous, and I know your insurance has given you shit FOREVER. I'm so glad the girls didn't have to stay.

3. Hope you're feeling better. I've been thinking of you. Are they sleeping any better?

[Katrina]

Good lord! I'm sorry you have to deal with these schmucks. Glad Millbarge is ok.

[AJ]

Well Thank GOD it was just an overcrowding issue!! ( sounds like a prison ) ;)

I wish I could spell BYUR OCK RUH SEE.

Imagine the joys you will have on the day you take twins to the same doctor for the same kind of appointment and 6 months later your insurance company sends you some hate mail about the unpaid bill of twin A over 6 months AFTER the appointment that they had referral for and paid for for twin b.
....yeah , it happens with other insurance companies too.
WE FEEL YOUR PAIN.
I've made mental note of your curse and will put it to good use.

You should become a professional billing consultant. I'd hire you.

[Flicka]

I am glad that Millbarge is okay and that this is a simple thing that will resolve itself over time. Whew!

EIC....I don't even know what to say. All I kept thinking was "Are you SURE you're not in the military?" Because I've had those conversations almost verbatim with TriCare. And then I thought "Oh geez, the corruption is spreading! They're getting everyone!" And then I wished we were all rich and could afford to pay for private healthcare right out of our own pockets.

But your idea of returning the referral with Millbrage's special stamp of approval? I like where your head's at on that one. I really do.

[Slim]

My insurance company is quite good, but the area's Big Hospital that Specializes in Persons under 18 is administratively incompetent, to put it kindly. (The medical care is excellent, but we ended up going to regular specialists who were willing to see children, because aaaargh!)

WTF? We are parents with a sick or potentially sick baby, and they think it would be OK to f0rk with us? Has this worked for them in the past?

[cat]

sigh... well the best part is she's fine. eic, inc can go fook themselves. glad to hear it all turns out ok in the end.

[Jessica]

So glad Millbarge is ok. Life with a new baby or two is busy enough without dealing with crap like that. I am impressed with your ability to restrain yourself and simultaneously being so persistent.

[May]

Gee, this really makes me want to move back to Seattle and EIC, Inc.

I got a hospital bill for $92,000 yesterday, though. Maybe fleeing California would be wise.

[Shanna]

Oooh, oooh, have you had the "insurance companies cannot comprehend twins" problem yet?
"Our daughter does not appear to be on our insurance yet."
"Yes she is: Xxxx Yyyyy, born January 22, 2007."
"No, that's our son."
"What's your daughter's birthday?"
"January 22, 2007."
"We already have a child registered with that birthdate."
"Yes, I know, we have two children."
"What's the other child's brithdate?"
"January 22, 2007."
"No, the unregistered child."
"They're TWINS."
"Okay, I need the unregistered child's birthdate in order to process this..."

[electriclady]

Hilarious in retrospect, but I can only imagine how tooth-shatteringly stressful that must have been for you to deal with on top of hormones and everything. Glad it all worked out.

[Aurelia]

I'm very glad Millbarge is fine...and I'm incredibly happy all your democratic politicians are having discussions about single payer health care. In my entire life, I honestly don't think I've ever seen a doctor's bill. I actually get irritated when I have to pay for parking at the hospital or put money out for an extra item.

Next time I go to complain about the health care system in Canada, I'm going to think about you all and shut my mouth.

[vvictoria]

I'm so glad she's ok, sorry about your struggles with EIC. This post made me think about the movie Sicko. You're unusually well-educated, articulate, and a fighter, and if anyone is equipped to do battle with EIC on behalf of her daughters, it's you. But it's sad that you *have* to battle the insurance company. Also I hope you put a PayPal button up soon. (Wish I could help with the techinicalities.)

[vvictoria]

I'm so glad she's ok, sorry about your struggles with EIC. This post made me think about the movie Sicko. You're unusually well-educated, articulate, and a fighter, and if anyone is equipped to do battle with EIC on behalf of her daughters, it's you. But it's sad that you *have* to battle the insurance company. Also I hope you put a PayPal button up soon. (Wish I could help with the techinicalities.)

[Stacy]

Glad that it turned out well. EIC sucks!

On a totally different note do you know any reason why I am suddenly getting 10 posts (there were 11 total but one was your update on the trip to the specialist and EIC) on Bloglines unde your blog heading but the other 10 posts are all regarding music reviews and written by a "Prudence Vincent". When I click on the title of any of the oher 10 posts written by PV it links me to the Londonblog. Are you connected with them in any way? robably just a kink in Bloglines. Anyone else having ths problem?

[Lisa]

Ugh, that kinda stuff makes my blood boil. I went through a 9 month ordeal over a $400 doctor bill once. I was on COBRA and was paying my premium to Evil Insurance Company A who was to forward the payment to Evil Insurance Company B. Company B claimed for months that they had never received any payments from me (though I had canceled checks to prove I paid). After literally 20-30 hours over a period of almost a year on calls with the doctor office's, both insurance companies, and eventually a collection agency, I finally had to get Evil Insurance Company A on a three-way call with Evil Insurance Company B for them to finally realize that a simple bureaucratic error that had NOTHING TO DO WITH ME had caused the commotion -- although they did pay the bill finally, I won't get all the time and energy back. So frustrating.

[Vivien]

Wow - move to the UK, where people think this kind of problem is just an exagerrated myth - after all, you wouldn't REALLY turn away a person who needed medical care because of MONEY would you?
I must say, it doesn't fit with my world view at all.
Secondly - how DO you find the energy to argue. And argue. Hat's off to you, Akeeyu. Just reading it exhausts me!

[Libby]

OMG that is so typical EIC. I had EIC insurance through my job and then my company switched from them to Blue Shield. My OB was at VirgMason (who used EIC hospital on CapHill for L&D). While I was in labor at EIC hospital someone came into my room and said "we need to clear up your billing situation, I don't think EIC is covering you." I was like, I KNOW THAT, I haven't had EIC in almost a year, I have Blue Shield now. Oh, he said, well you have to sign here, here, and here to say you acknowledge that you are not covered by EIC. "Fine, sir, just let me get through this contraction first, ok?" Feck.

Then her birth certificate took forever to come - I mean several months. I finally called Vital Statistics and they said, "hmm, let me look that up for you, usually those are done sooner than this. What hospital did you deliver at? Oh, EIC? Yeah, those usually take a while longer."

So glad Millbarge is ok. I have been thinking of you guys.

[Alex]

I'm so glad Millbarge is OK.

I'm, as always, sorry that you have to deal with this bureaucratic garbage, but even more than phenomenally impressed that you are able to do so PP (and not just any PP) with two new babies. Kudos to you.

[Clare]

So glad to hear that your daughter was fine. Such as sorry you have to put up with the insurance crap. I don't think good people last very long in the job of answer phone calls for these companies, the people who tend to remain only make the experience worse. I would go crazy being the front line customer service person delivering all the crap to 'customers' and hearing the frustration in their voice. And all the higher ups who make these crazy hoops to jump through as so removed they can't possibly get it. Its a horrible mess and I'm so sorry it adds to the normal stress of taking care of newborns.

[Jill]

I'm glad you got some good news, though I am sorry the insurance nightmare continues.

Stacy, I am having the same problems with several blogs I subscribe to. Bloglines must be having all kinds of trouble.

[Shelley]

My favorite insurance story is how my best friend's insurance company tried to not pay a bill for a biopsy at Mayo, on the grounds that she must have authorized it on her own. Um, she'd had brain surgery and was thoroughly unconscious when that happened.

I hate battling insurance companies, but I'm thrilled Millbarge is OK.

[Nic]

Jeez- they are just complete fuckwads aren't they? Glad your sweetie is okay and I say go ahead and mail in the results of her time and efforts, just in a blank envelope, obviously they have zero sense of humor.

[Geohde]

Firstly, it's great that Millbarge is okay.

EIC, however, can sit on something pointy and rotate for a while.

Honestly.

J

[Sheryl]

Insurance companies suck. Mine denied a claim for neural monitoring when I had my thyroid removed. Without that monitoring, there is a very good chance my surgeon could have hit the nerves that control my vocal cords and esophagus. The reason they gave for denial is that that procedure could not be performed independently of another procedure. Like thyroid surgery. I said to them that its not like I decided after the surgery, "Well, as long as I'm here, maybe I'll have some neural monitoring before I go home." Sheesh. The doctor's office is actually helping me fight that one.

[Diana]

Your insurance company sucks, but you know that.

I was reading (or rather,re-reading) over the first bit of your post concerning "somber toned pediatricians" and recalling my son's birth. Everyone was counseling me about jaundice. I understand this could be a serious condition, but I had a full term, 9 lb baby who seemed quite healthy in every other aspect.

The nurses and doctors let me know that his bilirubin was borderline and we MIGHT need to put him under the lights. I said, "ok, so put him under the lights." Apparently, it's not that simple. The next day comes and I get the same story...he MIGHT need to go under the lights. It was all VERY SERIOUS. I couldn't figure out the BFD; both my husband and I went under the lights. I have the baby pictures to prove it, and I amazingly lived to tell the tale.

So we get home from the hospital after a stressful breastfeeding night (or, rather, breastfeeding attempt) and find out we need to IMMEDIATELY go to the pediatrician to check on his jaundice problem!!! (seriously, the phone call was so severe I thought it must be regarding something other than jaundice.) Problem is, we don't have a pediatrician, we have a family doctor (thank GOD) so we call them and take him there. It is late October, cold, and rainy. We get a call the next day that the lab refused to test his blood because his name label was inside a baggie with the blood instead of being actually attached to the tube of blood (seriously, have you seen how small the tubes are??). SOOO they waited too long to test it and we had to bring him back in the NEXT day. We again find out that he is "borderline." At this point I am ready to shove him under the lights myself just so I don't have to keep dragging this poor kid in for blood work. It's LIGHTS. Not a series of painful injections or open heart surgery, for crying out loud! Finally, after the THIRD family doctor blood draw, they decide it's all ok! It's going down! Amazing! The family doctor had basically predicted this (after shaking his head at the whole situation) and suggested 1. feeding him and 2. sitting by a window. Since I had no milk in me (which the pediatrician knew but failed to connect to the high bilirubin levels), putting him on some formula seriously helped out.

My next kid is due April 24th. I swear I might start shining lights on my stomach now.

I can only imagine what it is like when a bigger issue is found. It's good to know things are well with you and your family now...

[Superstar]

Oh how I detest EIC, Inc. I have one just like it. They don't know their asses from a hole in the ground. You show great restraint in NOT sending them an envelope full of poop, attention minion and supervisors. I would probably send an envelope of poop. Might even wrap it up in a well used spit-up towel for good measure.

People suck.

Glad to hear Millbarge is winning her own little battle.

[Jen]

A few years ago I had an emergency appendectomy (is there really any other kind?). I was heavily medicated on anti-nausea meds in the er to stem the constant vomiting that had been going on every 15 minutes for 3-4 hours. I was woken up for blood pressure and my CAT scan, but otherwise was pretty out of it.
I had my surgery, recovered, etc, etc. Then I got a bill in the mail for the entire total of my anethesia bill. When I got my explanation of benefits, it said that it was due to using a non-covered provider. So I called the insurance company, and they told me that it was part of my policy and that I should have understood that procedures done by non-covered providers would not be covered. I explained that I was medicated, it was an emergency procedure, and he was obviously the doctor on-call, I had no choice. They told me it didn't matter, I should have requested another doctor. Eventually the surgeon, the er physician, and the anesthesiologist all wrote letters explained that I was medically incompacitated and incapable of making an informed decision and that due to the emergency nature of my surgeon, there was no other choice. They finally paid the bill. This was not my first or last problem with this insurance company.

[Kristin]

Oy - I'm so sorry about EIC, but so glad to hear Millbarge is OK.

I remember my dad having to speak very slowly and clearly to somebody at his insurance company about my twin sisters. "Mr. Dad, there appears to be an error here -- you have two children listed with the same birthdate." "Yes, it's called twins."

Hang in there -

[Jolene]

Hope all is well in Buttmansion-land. I bet you guys are sooooooo tired!!! Hope you're having a blast with those sweet little girls!

[Shari]

I really miss your posts, but I'm so happy for you that you're too busy taking care of your BABIES to keep the rest of us entertained!! I hope it's all going well.