Hi, my group number is XYZ123, HELP ME!

Never, never and I mean N-E-V-E-R pay for your medical bills until you have thoroughly grilled your insurance company. I can’t believe what a mess this has been. Back in September, as you may recall, Jacob had tubes put in his ears, and thank the Lord it is the most wonderful thing we have ever done, EXCEPT, the doctors, hospitals, anesthesiologist, and insurance company cannot seem to get it together. GRR!

I received a letter from Jacob’s anesthesiologist yesterday that “due to lack of payment” we will be submitting this bill to collections. HUH!? WHAT?! Wait a darn minute! I have been told, over, and over, and over again that not to pay anything because our ENT (ear, nose and throat doctor) has been trying to explain to the insurance company that they are “in network” and were “in network” before Jacob had his surgery. Now, the anesthesiologist is "out-of-network" but my ENT said it doesn't matter, you don't have a choice on your anesthesiologist and as long as I'm in network and the hospital is in network they should treat the anesthesiologist as in-network. Anyway, to make this incredibly long story short, I called the insurance company today and talked to “Jean”. “Jean” is a lovely woman, bless her heart, but only knows the canned responses to my situation and is telling me that the anesthesiologist’s bill is not “fair and reasonable” and that for our zip code the fee is “unacceptable”. The acceptable rate for being knocked out in our zip code, by the way, is $303.00. Now, I don’t know about your but I like to splurge on some things, and the drug that is going to keep my son asleep and pain-free during surgery might cost more than $303.00. . but who am I to judge. (please read that sentence with sarcasm). Anyhoo, I tell “Jean” thanks, but I’d really like to speak to her supervisor or someone else, anyone else, who might have more than these two answers for me, because I’ve already paid out of pocket this year $2,379.00 and I’d really like to be able to buy milk this week. (sigh) I am then transferred to “Mary”. Wonderful, sweet “Mary”! As I explain to “Mary” what the heck is going on a light bulb goes off in Mary’s head. She recognized the name of our ENT and said “Oh, wait hang on, I know you. . . I know Jacob, I know ALL about this claim.” Not only is the ENT in network, but we think the hospital is in network, AND if I have these two things going for me EVEN IF the Anesthesiologist is out-of-network they MUST treat him as in-network and give me my 80/20 split which would be the difference of paying $466.20 or $129.60. HUGE, HUGE Difference. I’m not a math major, but I can add and subtract and that’s a lot of scratch my friends. So ol’ “Mar” tells me to hang on. She’s going to pull all the stuff on Jacob and this “claim from hell” and see what can be done. If nothing else, it was nice to find someone who would actually look at the file and who actually did their job. So KUDOS to “Mary”, not for going above and beyond the call of duty, but just actually responding to her call of duty. . . her job, unlike “Jean”, poor, sweet, uninformed “Jean”.

I am sitting her on pins and needles waiting to hear from “Mary”. I’ll let you all know what happens. TO BE CONTINUED . . .