“I’d be really irritated at the insurance company,” I told the administrator at our speech therapist’s office today, “if only I had the energy. But I’m fighting the school right now and just don’t have much energy.” She nodded as if she understood, and as if I wasn’t the first parent she’d seen in that plight.

I called our lovely insurance company this morning, because I knew they had not responded to the claim I filed back in January on the Fast ForWord and speech therapy associated with this intervention. Our “personalized” password-protected nightmare on their website listed the claim as “pending”, yet several others after it have cleared.

The whole insurance system is designed to make you lose track of the claim, forget to follow up, give up when denied or not ask questions period. The “convenient” website doesn’t tell you a @#**$%#%$*$** thing about your claim, really. I am not exaggerating. Insurance companies exist to make money, not to pay claims. Forcing your insurance to pay the claim is part of life. Don’t take the claim denial process personally and don’t take “no” for an answer until you’ve gone clear up the ladder.

(We received last fall a check for nearly the full amount of the biomed testing we did in the summer of 2005. Eighteen months later! It was such a surprise it made me cry!)

First off, apparently, it was time to change our password. I logged on, knowing full well what the correct password was, but kept receiving an error. After three attempts it sent me to another screen to verify who I was (which required me to find my wallet and pull out my insurance card for the member and group numbers). I passed the verification and was told to create a new password. I did, but only after three unsuccessful attempts did it tell me that I had to have an 8-15 character password with at least two numbers in it. Last time our 6-digit password worked just fine.

Ok, once on the site, I got the incredibly detailed news that the claim in question was “pending” – no explanation. Then, I stupidly began searching the site for an actual phone number to call and check on the claim status. Insurance companies don’t put phone numbers on their websites…confused, angry, upset customers might actually call them.

But, because I had earlier retrieved the insurance card from my wallet (there’s their mistake – putting the number “conveniently” on the card), I had the customer service number.

Of course this isn’t a real person, mind you. This is one of those high-tech voice recognition answering systems owned only by the insurance companies and telephone companies (no one else can afford them.) It puts me through several more questions, including asking for the member and group number multiple times and telling me it can’t understand me before telling me in it’s computer-generated voice:

“The claim has been denied, but I bet you have questions about this particular claim.”

You bet your patootie I do! So now, 30 minutes after I started this quest I’m finally placing me into the “hold from hell” for an actual customer service representative. The hold today was only 12 minutes long. Then, I was greeted by the gruffly voiced Sharon:

“Name, please.”
“Julie”
“Full name.”(said with exasperation)

Then we go through the whole routine of is this for me or another family member? Asking for my birthdate, her birthdate, the last time either of us ate veal or shopped at Nieman Marcus…the routine I’d already repeated both on the website and into the phone system computer.

“What can I do for you today?”
“You can find out why the company hasn’t paid a claim we’ve filed.”
“Claim date.”
“December 12, 2006”
“The claim for $550?”
“Well, I don’t know how you’ve broken it down – I have a multi-day claim for a total of $1330.”
“We’ve asked the provider for more information.” (This is the standard stall step # 1.)
“Well, I’m headed to that provider this afternoon, can you tell me what information you’re looking for and when you requested it?”
Long pause…”We requested it on February 5. Let’s see…I’m going to put you on hold and be right back.” (Standard stall step # 57).

I patiently wait. Another 6 minutes. Heck it’s been nearly 60 minutes at this point, why blow a good thing!
Grouchy Sharon returns

“Was this therapy provided as outpatient or in an office?”
I wasn’t totally sure I understood the question, but answered, “They have an office.”
“That’s all we needed. We can process your claim.”

(I have two conflicting thoughts: “That’s all you needed and you waited two months to ask?” and “yea right, I won’t totally believe that until I see the check!”) The icing on the cake is that this is a claim the sent us a pre-approval letter on in November.

“In fact,” less-gruffy Sharon said, :”I’ll put a rush on it, so you should hear something from us in writing in 15 days.”

(Meaning they will send, or claim they’ve sent, a request for even more information, like my therapist’s favorite color, in the next three weeks.)

I acted as if she’d pleased me immensely with this news and marked on my calendar to call back on April 11 (15 business days from today – the day count you get from insurance companies is NEVER calendar days, unless it’s a deadline you have to meet, so don’t’ even bother calling early.)

By this time LuLu desperately needed my assistance on her school work, so I couldn’t ask about the two other insurance issues I have – neither of which are as pressing or about as much $$. So, guess I’ll get to do it all again another day, real soon!