Friday, September 19, 2008

Humina Swajusay Huh?

I'd like to take comic license on a recent conversation with our insurance company. The conversation isn't entirely true, but the gist is here:

We had found out in the summer about a program where another insurance company was offering grants to help pay for therapy expenses not covered by our insurance company. We applied for a grant to cover Liv's occupational therapies, since they don't consider covering 'chronic' conditions. The deadline for completion was September 30th and we submitted around the 4th of July. We received notification in the beginning of September that grant needed amongst other things, a denial letter for Liv's apraxia, since that is how we worded the application, we only had a denial for autism.

NEVER throw down the gauntlet in front of my wife. Less than 30 days, getting the required paperwork. Coordination and insurance document acquisition is her specialty. Got the info from the Ped Neurologist, from the therapist; got a package of all the info needed to send to the insurance company and sent out the fax; probably took less than a week. Now comes the fun part; the call from the completely baffled clerk who wound up with this on her desk:

Ins Clerk: Hello, yes I'm calling about the fax we received yesterday regarding your daughter, Olivia
Linda: Yes
Ins Clerk: I wanted to let you know that we have to send this in for review, but occupational therapies are not usually covered for chronic conditions.
Linda:Yes, I know that I was looking for you to deny it.
Ins Clerk: I'm sorry, you want us to deny this? (Clearly, 'thank you sir, may I have another' is not covered in the "How to screw the Client" manual)
Linda: Yes, I am 99% sure you will deny this, we need a denial letter in order to apply for a grant for non-covered insurance expenses. We need it quickly as we have a Sept 30 deadline to apply.
Ins Clerk: We I uh....the review process has to go to another department and it usually takes 10-15 business days.
Linda: That's if you are evaluating it on whether it is going to be covered, I'm asking that you DENY it. (I mean, this is something that they do with deadly efficiency normally; it's page one of the playbook: DENY)
Ins Clerk: I'll see if I can get the adjuster to look at it, you DO want it denied, right?
Linda (somewhat exasperated, but remaining cool): Listen, you can either PAY it or deny it. Since I'm almost certain you are going to deny it, I only ask that you do it quickly (Lady, I'm painting a target on my chest and yelling 'KILL ME NOW', just do it!)
Ins Clerk: Well, uh, alright, I'll give you a call back

She gets the call back yesterday to say that indeed they were denying it (sorry, I don't have the strength to try and reproduce the conversation between the clerk and the adjuster). We're awaiting a fax copy of the letter. Of course, it's delayed, you couldn't expect them to have reprisocity ( I have to leave that bad spelling of reciprocity in, it made me laugh!) and make OUR lives easier after giving THEM such a slow pitch!

My wife is currently reviewing back issue of Soldier of Fortune Magazine, in case these yo yo's screw this up. It's bad enough that they don't give me THEIR money, but if they deny us the ability to get money from others WATCH OUT!

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