Still 33w4d: Insurance Madness

Well, given that Thursday afternoon is really pushing the "sometime next week" thing, I decided to call the billing people again.

This time, I spoke to another woman, who was also not the manager, and who also didn't seem to know a lot. But after reading "the notes" on my file, she came to the conclusion that my insurance was, in fact, billed (on December 16th) and that coverage had been denied because the MFM group is not in our network.

Excuse me?

I said to her, "You told me you were."

She said, "Well, I'm with the billing office, I don't know what the medical office told you."

"They said you were in network. They said this to me, and they said this to my OB. They also collected my insurance, photocopied it, charged me the initial $25 co-pay to see a specialist, and told me all was good."

(My maternity is/was covered 100%. I have one single co-pay to my OB, one single co-pay to any specialist I see, and one single co-pay to the hospital. No matter how many times I see the OB, specialist, or hospital.)

"Well, ma'am, I don't know what to say about that except it's the patient's responsibility to know what their insurance covers. Would you like me to connect you to my manager?"

Why yes, I would. The manager, of course, was out of the office. So I asked for her personal voice-mail and left a somewhat hysterical message.

I then called my OB's billing office, and they weren't in either, so I left them a message, sobbing this time, because seriously: $5,599.00 for 3 ultrasounds, and I had an additional ultrasound and NST all under this insurance and with the evil MFM group which had not yet been billed.

Finally I called the number on our old Aetna card. At this point, I had very little hope. I mean, assuming that the MFM group truly was out of network...Aetna had no responsibility. That's part of our (old) plan--zero out of network unless there is no in network provider within 50 miles. But I figured, you know, what the hell. It turned out that number wasn't for Aetna itself, but rather for my husband's company's benefits as a whole. (They're a huge national company.)

The woman I spoke to deserves a raise. I plan on telling them this, once things are settled. Anyway, I was able to outline all of my appointments for her, including the Aetna ones at the evil MFM, the Aetna ones at the 2nd-opinion MFM, and the Blue Cross ones back that the evil MFM. The second opinion ones had been filed, approved, and paid. The evil MFM has not yet billed for the December u/s and NST, or for any of my January stuff under Blue Cross.

However, the evil MFM group is not called by their actual name (MFM of Utah.) They are also not called by the name that was on my bill (Obstetrix Medical Group.) Instead, they are called Pediatrix something or other. Pediatrix Mountain group or some nonsense. So in other words, they're a large corporation that apparently deals mainly with pediatric care (note to self: avoid once children are born). And didn't ever think to reveal that to anyone.

I asked Ms. Awesome to verify that Pediatrix/Obstetrix/whatever was actually covered by Blue Cross, as I have an appointment tomorrow. She was unable to find them by any name on the Blue Cross information, including looking up departments at the hospital. Just who the fuck are these people? I gave her their phone number, and she called and spoke to the receptionist, who said they were. She called me back, and we agreed that that was cold comfort at best.

Ms. Awesome then proceeded to (all while being very polite and apologetic, despite this being in no way, shape, or form her fault or the fault of my husband's company or either insurance company) investigate every avenue. She came to the conclusion that I had two options, but wasn't sure about one of them. She asked if she could call me back. In the mean time, she would call Aetna and see if either option could work and would call Blue Cross to verify in-network status.

After hanging up with her (and calling my husband and making him extremely angry--he hates these people more than I do!), I got a call back from my OB's office.

Guess what? I am not the only person this Obstetrix/Pediatrix/evil MFM group has lied to. Or, I should state, has been given false information, since maybe it wasn't a lie, maybe they're just really fucking stupid.

My OB's office has only discovered this over the past few weeks, as apparently this evil group only bills in December or some nonsense. I was speaking to the billing and office manager. She personally assured me that, in no way, shape, or form would they take this sitting down. She would be calling the evil MFM right away, and then possibly my insurance companies. We hung up.

I then got a call back from Ms. Awesome. She said Blue Cross was also unable to find this stupid group (so how, exactly, is a normal person supposed to find out if they're covered, when the office provides false information and then somehow hides themselves from being listed as either in or out of network? From major health insurance providers? WTF?????). So she and Blue Cross conference-called the evil MFM, who said once again they were in network with Blue Cross. And that I could act on that information in good faith. She also said that one of my options with Aetna is not an option. But that I can attempt to get coverage by providing proof that there was a valid, medical reason to send me to the evil MFM over any other provider.

HAHAHHHHHHAHAHAHAHAHAHAHAHA.

No really.

At this point, I can think of about 4,000 reasons to see any provider but Obstetrix.

We decided to focus on the reasons I was referred there in the first place, mainly that they are in the same hospital as my OB, the hospital I'll be delivering at, they said they were in network, etc.

I updated her on the info from my OB's office, and she was kind of taken aback. We agreed that we would let things play out with my OB and the Evil MFM, and she would call me in 2 weeks if I haven't called her first. She gave me her personal line.

And then, finally.

The Evil MFM group themselves called.

The manager began by informing me that they had never sent me a bill.

I was like, "Umm...yes, you have."

She suggested that it was instead an explanation of benefits from my insurance company.

"Then why is the return address for Obstetrix Medical Group, have your phone number on it, have a due date, have the S1 code ("your insurance has denied benefits or we have no insurance on file"), and so on?"

"Well, then maybe sending it was a mistake."

If I had been near a glass object, it would have shattered.

I can't even remember the rest of the call, as I'm still furious. But the short of it is: they fucked up, they don't want to lose me as a patient (I just bet they don't, greedy bastards), and they will bill me as if I were in network. As in, I will only be responsible for what I would have to pay (with both Aetna *and* Blue Cross, as I told her we had only their word that they were in network) what I would pay if they were in-network. So ZERO for all of 2011, and now an 80/20 split.

I'll believe it when I see it, frankly.

And if I ever get pregnant again, I will avoid them at all costs.