The Daughter Chronicles

Friday, February 25, 2005

Hey Brother, Can You Spare Some Durable Medical equipment?

So, I've been spending my time at home battling our insurance company over every aspect of Mia's care. This is nothing new. The saga began shortly after Mia's birth, when we received an EOB (that's Explanation of Benefits for all the lucky uninitiated) stating that payment for her routine 4-month old well-baby checkup had been denied. My subsequent conversation with the insurance company went something like this:

Me: "I received an EOB denying my daughter's well-baby checkup. Can you tell me why?"
Customer Service Rep: "Please hold while I look this up."

**It is helpful to add, at this point, that the call center is located in India. I deduced this after every single person I spoke with had a heavy Indian accent, and sounded as though they were reading from a script.

CSR: "Mrs. Bour-gas?"
Me: "Yes."
CSR: "Yes, I have found the problem. We do not cover pregnancy benefits for dependent children."
Me: "Excuse me?"
CSR: "Yes. I'm sorry. Your dependent children are not covered for pregnancy care."
Me: "My daughter is four months old."
CSR: "Yes, I'm sorry. Your daughter's pregnancy is not a covered benefit."
Me: "I don't think you understand. My daughter is four months old. It is physically impossible for her to be pregnant. This is a well-baby visit. Did you look at her date of birth?"
CSR: (defensively) "I'll need to speak with eligibility on that. Please hold." **four minutes pass** "Yes, it appears that there has been a mistake."
Me: "No kidding?" Sarcasm is lost on foreign CSR.
CSR: "Yes, we're very sorry. We'll get that corrected right away."

Our insurance provider has changed, but the red tape continues to be a problem. There are some improvements. Our current provider's call centers are in the USA--unless they're teaching the Indian call center workers to speak with regional US accents these days. I keep picturing a woman who resembles Indira Ghandi learning English by watching reruns of "The Jerry Springer Show."

Our most recent battle has been over an AugCom for Mia. This is an augmentative communication device--a small machine with pictures and buttons. Mia chooses a button, based on the picture, and a recorded voice tells us what she wants. Mia had her evaluation in October, and her speech therapist was hopeful that we'd receive the device by Christmas. Well, it's February and still no AugCom. So I call the insurance company:

Me: "Hi, I'm trying to find out the status of an augmentative communication device for my daughter. She had the evaluation in October and we still haven't heard anything."
CSR: "Let me look that up for you. ... Yes, we just received that request on December 20th."
Me: "Well, it's been quite a while. Can you tell me the status?"
CSR: "Well, it was sent to the Medical Department for a decision."
Me: "That was in December?"
CSR: "Yes."
Me: "Well, it's February. Wouldn't they have made a decision by now?"
CSR: "They have 60 days to make a decision. I'll give you the claim number and you can call back in maybe a week."

I call back in 2 weeks, foolishly believing that since we are only five days away from their 60 day cut-off, they will have made a decision...

CSR: "Well, that claim is in the Medical Department."
Me: "So I've heard. They still haven't made a decision?"
CSR: "No. It doesn't look like it."
Me: "I'll call back tomorrow."
CSR: "I'll put a note in the system."

Next day...

CSR: "Well, it looks like they decided that they couldn't make a decision, and the claim was sent to a manager. There should be a decision in 24 hours."
Me: "I'll call back tomorrow."

The next day...

CSR: " Well, it looks like the manager has not yet made a decision. Let me try to call her & I'll call you back."

No phone call. I call again...

CSR: "Let me try to call her. Please hold." ***several minutes go by*** "Mrs. Burgas, it appears she's gone to lunch. Can you call back?"

Later that day...

CSR: "Please hold while I try the manager..." ***minutes go by*** "Mrs. Burgas, she said she'll definitely make a decision on that today."
Me: "Ok. I'll call back tomorrow."

The next day...

CSR: "I'm sorry. The manager is still looking at that one."
Me: "I'm calling back in a few hours."

A few hours later....I get a major bonehead who can't even find the claim, let alone tell me the status. She keeps telling me to be patient in her heavy Texas accent, and I just want to leap through the phone, grab her by her undoubtably Flo-like beehive hairdo, and throttle her (no offense to Texans or people named "Flo" intended)... My frustration of the last few weeks becomes focused like a laser beam on this one individual.
Me: "You realize that this is equipment for a disabled child? They have been delaying and delaying for two months now. My daughter needs this equipment." I can hear my voice getting shrill and I'm trying to stop it.
CSR: "Yes, ma'am." I can tell she hasn't even heard me. "Oh, here it is!" She's excited now. She proceeds to read me every single note attached to the claim in sotto voce before telling me that it has gone to "Processing".
Me: "So, it's been approved?"
CSR: "Yes, it looks that way."
Me: "So, the approval got sent to the equipment provider?"
CSR: "Yes, it will be faxed over today."

As tedious as those conversations sound, I did leave out the part where they verify your name, address, and phone number every single time you call. These experiences are also less tedious than a former insurance company we dealt with (before Mia was born). Co-workers would gather around my desk when I'd call them. My famous line "Look, I'm nine months pregnant, it's 115 degrees outside, and my feet are swollen. I've got a lot of anger. Don't make me direct it at you!"

I have since learned from our therapists, and more recently a letter from the editor of Exceptional Parent magazine, that insurance companies bank on people just giving up. They figure that you'll just get tired of calling and go away. They hold on to claims as long as possible, because it saves them money. You'll notice that no action was ever taken until I started being a real pain in the ass. I was only able to be a pain in the ass because I suddenly have a lot of time on my hands.

I would not have even been upset if they had denied the claim in a timely manner. Sure, we would have had to pay for the AugCom ourselves, but we could have had it months earlier. Now, I have to go to sleep and save my strength to nag the equipment provider.