A site of satirical musings, commentary and/or rhetorical criticism of the world at large.

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Location: Southeastern, Pennsylvania, United States

Tuesday, May 18, 2010

Fighting Sickna

The following story is an example of what goes around comes around, or possibly a case of the chickens coming home to roost. Either way, I try not to use this space to vent about my personal problems, but I hope you’ll allow me to do that today, dear readers. If you allow me to do this, then I’ll reveal why it will be worth your while, but you’ll have to wait until the end for that payoff.

I should first start with this note of irony: I have worked in the health insurance industry for over twenty years, and for the first time in my career I am having trouble getting my own claims paid. My health care carrier is one of the big companies. I don’t want to embarrass it by citing the name here, although I feel I have earned the right to do that. I will, however, state that the company name rhymes with the word Sickna.

My previous experience with Sickna has been very satisfactory. For example, when I was hospitalized twice in 2008 for my heart surgery, the facility bills alone amounted to over $180,000. After a steep discount negotiated by Sickna, the hospital accepted a payment of less than $50,000. My responsibility was a co-pay amount of $300. This amount was a large chunk to pay out all at once, but, when I considered what other policies may have paid, I was grateful for paying only $300. During the course of my career, I have seen other policies that would pay only 90%, which in this case could have added up to $18,000! I could only have paid that by taking out a home equity loan, but seriously, how many financial institutions are giving those out these days?

Anyway, that was then and this is now. Yesterday Sickna’s service was exemplary. This year, it sucks!

Supposedly, the issue began when my company’s payment for the premium was late. I haven’t confirmed this with anyone in human resources yet, but it does sound like a very plausible explanation for what has happened. Unbeknown to us, the late payment resulted in the cancellation of our policy. Nothing unusual here, it’s standard business procedure, no tickee, no shirtee, blah, blah, blah. In most cases — and I assume this happened here — the coverage is reinstated once the premium is received (most likely with added penalties) and the actual insured are none the wiser.

The problem with my situation is that Sickna is soooo big, that one side of the company doesn’t know what the other side is doing. When I call the customer service center – which I believe is still located here in the good old USA — they tell me that my coverage is current. The same information is on the Sickna website. My HR office is told the same thing - coverage fine. However, when the people who really need to depend on accurate information on this subject submit claims – i.e., the doctors and hospital where I have had services performed — they are told that my coverage has been terminated.

If I thought this whole situation through, I believe I could easily blame this on George W. Bush...somehow.

My greatest fear is how the repeated denials by my health insurance company will affect my credit rating. On the plus side, the providers I have contacted about the denials do not seem to be concerned about sending my bills to collections yet. As far as they are concerned, this is just another business day as usual when dealing with Sickna. For some reason, I’m not comforted by the fact that my insurance company has a reputation for being difficult to work with.

As I write this, a number of people in my company are working to resolve my claims problems and the similar problems by others in my office. If nothing else, this episode shows that people working in the big bad health insurance industry are not immune to the crazy, mixed-up whims of the big bad health insurance industry. So, if you are one of the millions who over the years had a procedure denied because it wasn’t pre-certified, or you felt you were overcharged for coinsurance because of some usual and customary charge discrepancy, or you were denied service for a condition which you could have sworn was a covered expense, then please read this with either compassion or exultation.

Really, I don’t care if you empathize with my situation and an “I feel your pain” attitude, or if you high-five another victim of the big bad health care industry and rejoice, “Yes, there is a God!” I wrote all this with you in mind. Please enjoy!

(Thank you for reading. Please remember life is not subject to pre-certification, but common sense is not always a priority!)


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