I really don’t get it.  Ok, I understand, they are an insurance company, and the only way they make money is by not actually paying out on claims, but seriously.  Weeks ago I went to the Orthopedist for a follow-up after I had the MRI.  If you didn’t already read about that saga, you might want to read this post and this post.  At that follow-up the doctor prescribed and gave me a brace for my knee.  It is specially designed to help hold things in the right place.  When I say prescribed, I mean that I literally have a copy of the scrip in my folder of paperwork for this injury.

Well, I got home last night (after over an hour of wasted time at the theatre) and opened the mail to find a bill from the supplier of the brace.  This was an actual bill, not just a statement saying that things had been taken care of.  Since I received the bill I was at first thinking that WCF must have denied that claim.  This seemed a little strange to me as they had not notified me of the fact that that was the case.  Since one of the first things that WCF sent me upon filing my case was a prescription card, it seemed very strange to me that this prescription would be denied.  I mean, in the grand scheme of things, the brace is significantly less expensive than many pharmaceutical prescriptions so why would this be denied.

Then it occurred to me that since I had heard nothing from WCF about this claim being denied that I really have actually no idea if the supplier even contacted WCF to event try to get them to pay.  So, despite the late hour and all the other things that I have been dealing with (like planning a wedding) I sat down to write to both WCF and the medical supplier.

I have come to two conclusions which I outlined in the emails both ending with the fact that I am not going to pay this bill until some of my questions get answered.  I conclude that WCF needs to actually tell me that this claim was denied and must do so for any future claims.  I also conclude that I have no proof that the supplier talked to WCF at all.  Therefore I won’t pay without further information.  As I said before, I don’t see any reason why this would be denied at all.

There is one other thing that I outlined in my email to WCF, and that is that if the claim was actually denied, it an be submitted to my personal insurance.  However, I can’t make that claim to my insurance without proof of denial.  Also, I don’t want to have to deal with anyone else, so I want the WCF people to deal with talking to my insurance.  Since this case is supposed to fall under their purview I shouldn’t have to be the one stuck in the middle.  I don’t have the time or the patience for it.  Besides, it is what these people are paid to do, fight with eachother over money, I have more important things to deal with.

Needless to say, I am sick of bureaucracy standing in the way of my recovery.  I would just like to be able to walk without limping or hobbling and I would like to it to be comfortable to bend my knee.  It is such a great thing that our healthcare system works

So, if you follow mw on twitter you may have noticed a couple tweets about my dealings/frustrations with Workers Compensation (WCF) regarding my injured knee.  Here is the scoop.  As I mentioned in a previous post, I injured my knee at work on the day after Thanksgiving.  It has been a real bummer since then.  After my initial visit to the doctor, he wanted to get an MRI to determine what is really wrong.  Well, WCF has spent the past two-and-a-half weeks “reviewing” my case.

During that time I have been limping around with an OTC knee brace basically undiagnosed let alone treated.  Last week I had been doing OK, but when I got up on Monday I didn’t feel as good as I had been.  not sure what I did (if anything), but I was getting the feeling that I certainly wasn’t getting any better!  So, I spent a good portion of the day on the phone with the doctor, WCF, and my personal insurance.

WCF had my claim wrapped up in bureaucratic red-tape and there I was, not being able to move forward.  At this point, after being on the phone all afternoon I wrote an email to the WCF people outlining my disappointment with the way my case was being handled.  My personal insurance said that in such a case they would cover me (less any applicable deductibles and co-pay) even though it happened at work.  They said that I should go ahead and get treated and then if WCF came through we could get reimbursed.

As I was about to go through with this line of procedure, I got an email from WCF saying that they wanted to schedule a follow-up appointment with my doctor before they gave the OK for the MRI.  By the time I got to calling the doctor’s office to schedule this appointment, they had already talked to WCF and told them that they wouldn’t be able to schedule me until next week sometime.  At that point WCF caved and just OKed the MRI.  They then called to tell me this after I had learned it from the doctor.  They also informed me that their company would contact me to schedule it.

Well, after a day of waiting for them to call, it seemed like it was not worth the time.  So, I sent another email to WCF, and what do you know, when you get mad enough and threaten to slap an insurance company with more bills they get their act together.  I told them that If I didn’t have an appointment scheduled by the end of friday that I would do it myself and they could foot the bill.  Well, within minutes I had the number and information I needed to call their company and set up my appointment.  Go figure that they actually used the imaging people that the doctor wanted!

So, We are finally moving forward with finding out what is wrong and fixing my knee.  I am sick of dealing with the insurance people, but now that I understand how to motivate them hopefully things will keep moving.  I will finally (after 3 weeks) get the MRI that I need and even have the followup appointment to get the diagnosis.  I may not get the knee fixed by the holidays, but hopefully I will at least have whatever I need scheduled.

The impetus for this post comes from a discussion on the topic over at 20SB that was started by Heather over at A lust for Words.  Also of note, I wrote this post yesterday and held it for today, just because.  Much of the text is is the same as the response that I posted in the discussion linked to above.

By now I would imagine that most Americans know that the Health Care Reform bill was passed.  The question on most people’s minds seems to be: “Is this a good thing?”  While I am pretty sure that this bill does not fix all the issues in the current system I do think that it is a step in the right direction.  It is unfortunate that we have not made the dramatic changes that really need to be made (like just throwing out the current system all together), but maybe we will get there eventually.

People are concerned with a number of things that this bill may effect.  One being the drive for medical students to become general practitioners going away.  Why?  Well, as with all things American, money.  Heaven forbid our doctors can’t have their second homes and sailboats.  Another concern is the cost to the public.  Isn’t that cost worth your health though?  It has to be less than needing to go to the doctor when you don’t have insurance.

We, as Americans, have dug ourselves into this hole.  Healthcare is expensive because of the insurance companies.  Doctors and hospitals make lots of money because they know that the people are not paying for it, the insurance companies are.  In some cases there are clear double standards where the people who are uninsured get larger bills than the people who are insured for the same procedures.  It will ultimately cost you more to go without insurance if you ever need serious medical treatment that it would to buy government subsidized insurance.  Of all the things that my tax dollars could be used for, keeping people healthy seems to be on of the better choices.  Certainly better than fighting pointless overseas wars simply on the basis that the USA has a bigger penis.

The real question is this: “Why are we so resistant to actually changing to a universal health care model?”  I mean seriously, it seems to work very well in the countries that do.  Would it really be so bad to kill off some of the insurance companies and HMOs who are guilty of creating the issues that plague the system now?  I suppose one of the questions is whether people in this country think of  health care as a right or a privilege.  Frankly I think that people should have the right to lead a healthy life no matter what their financial status.

Reforms like this have some of the same principles as the health care benefits offered by many of this nation’s [labor] unions.  Many unions offer a health care pool, every member of the union pays in X% each month and is therefore covered.  Every member pays the same percentage no matter how many jobs they are working or how much money they make.  On the flip side though, a member of the union cannot forego the union coverage in favor of private insurance even if the private insurance is better coverage and cheaper because of the obligation to the other members of the union and the communal pool.  So, the union would let you get private insurance as long as you still paid your insurance percentage to the union pool.  As I understand it, this is pretty similar to how most universal health systems work, you can elect to get private coverage to make up the deficit in what the government covers, but you are still required to pay into the communal pool.

I happen to have been lucky in that I got a job that has great benefits, but I see many of my friends who are worried about getting even the slightest bit sick because they can’t afford to see a doctor let alone buy a prescription drug if they needed to.  How is this OK?

If you don’t currently carry insurance, what value do you place on your health?  Without insurance I would imagine you probably don’t regularly visit the doctor or go to the dentist.  So, is your health only worth something to you when you are ill or injured?

As a member of the 20SB community I think that it is important to recognize that this reform does a lot for the twenty-somethings who are in college or just trying to star making it on their own.  It mandates that non-dependent children can continue to be covered under their parent’s health care plans until the age of 26, which is three more years than currently available.  This is a great thing for people, especially right now when it is hard to find a good job with good benefits.

So where does this leave us?  The system is still not perfect.  In the end it sounds like it won’t really affect people like me who have good coverage at a decent price already.  Some argue that the people on the low end of the totem-pole may be “tricked” into thinking they are covered for things that they are not, but maybe a little education for such people would be in order.  In fact I am sure that a little education for the American populace as a whole on the subject of health care would be a good thing.  I believe that most Americans blindly stumble through life in this country without really having an understand of what is going on.  I probably fall into that category myself every now and then.

It may not be the best step or the best foot forward, but it is a step in the right direction I think.  Change can’t happen overnight, we are probably one of the most stubborn nations on the planet.  It is that stubborn-ness that founded this country in the first place.  I suppose we shall have to see how it goes and if we continue to make some progress.