Tuesday, November 11, 2008

My Fucked Up Fairy Tale

Once upon a time, 13 years ago, an independent, strong woman married a policeman. The policeman had a good insurance plan through his employer and the couple decided to use the highest form that offered 100% coverage of insurance available to them for their growing family.

Their premiums way back when were $300 a month and gradually increased to $400, $500and the $650 a month. Though, at times, the premiums would break the bank, they knew in their hearts it was better to be safe than sorry. The only time the insurance was ever used was for birthing babies and well child visits.

Flash Forward to last Saturday (following a 6 day stay in the hospital by 'Papa Bear")- in the mail, Mama Bear discovers a new insurance card. The new insurance card reads "Inpatient and Surgical care- subject to deductible and 10% of total bill"!

Mama Bear immediately grabbed for the Klonepin and has not stopped crying since. This children, is what we call a nervous breakdown- can you say nervous breakdown?

After many calls to Papa Bear's employer we realized that this statement on the enrollment form was the one that mislead us:

If you do not fill out this form and return it to the benefits section you will automatically be placed in the $250 Base Medical Plan with the same coverage you had prior

Confused Mama Bear, no, we didn't have the $250 base medical plan BUT we wanted "the same coverage we had prior!" Not to mention, for the past 13 years, protocol has been, if you don't want to change your current coverage- just leave it alone.

Mama Bear did not fill out the forms and thought she was doing the right thing (Dumb Ass). As a result and a horrible coincident that Papa Bear was hospitalized THE DAY the lower insurance plan was activated, Mama and Papa Bear find themselves screwed!

Furthermore, the premium has not even been deducted from Papa Bear's paycheck until Friday. Mama and Papa Bear started frantically calling ANY person that would listen to them- explaining the misunderstanding- begging for resolution before Friday.

Even the INSURANCE COMPANY was on our side! They said "pursue your Human Resources Department". But Papa Bear's Mother fuckers in charge of benefits wouldn't budge!

Mama Bear is close to being institutionalized from the bad breaks, horrendous timing, thought of paying 10% of a $200,000 hospital bill after having 100% coverage for 13 years and the lack of compassion and understanding she has encountered in the last 2 days. She still has a cold and is taking NyQuil to keep from coughing up a lung through all of the tears and hysteria.

So, just in case you were wondering where the hell I've been... if this makes ANY sense at all... that's where I've been! If you don't hear from me soon, it may be safe to assume that I have taken up residence in a nice warm place with bright white padded walls with a straight jacket.

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37 comments:

Annie said...

Oh, Tena! That sucks on every level. I'm so sorry. Whose ass should I kick for the Bear Family?

Soxy Deb said...

Tenakim that is fucked up!! Do not give up, if you can't keep making calls - let Papa Bear do it. But someone needs to keep going - to the highest level you can. It makes no sense to assume that after 13 years you would suddenly want a cheaper plan (read = less coverage)than you've had. Someone HAS to be able to do something to rectify the error - Someone somewhere. Don't give up.

KimandCo said...

Tena, do NOT give up! I am an ex-Human Resources Manager and this can be fixed. Keep on them like a pit bull. They will try to outlast you, but don't let them. If the HR Manager won't help you, ask to speak to the insurance agent that sells the company the health insurance. If the insurance company is on your side, ask them to help you with the HR department. Keep going and eventually it should work out.

mommablogsalot said...

That is just absurd! I really hope you guys can work something out. ::hugs::

manic mariah said...

It is fucked! Insurance companies and their lingo. SHIT! I have gotton out of medical bills before, don't give up

Jen said...

Insurance companies are the DEVIL!! I'm sorry you are going through this.

Renée aka Mekhismom said...

Oh Tena, I am so sorry to hear that. I know you are going to get a positive resolution to all of this.

amelia bedelia said...

I agree with Deb. Keep calling until you get the answers you want. I would call the hospital, too. Explain to them the circumstances. Hopefully, they will work with you. So sorry. It sucks.

Honeybell said...

I am so sorry. In my experience insurance companies are the embodiment of all that is evil, and there is a special place in hell for those that don't make the renewal perfectly clear.

Something very similar happened with the birth of my oldest. When he was two months old I was informed that HR hadn't added him to our insurance. So I was responsible for EVERYTHING. Added to that his birth was a difficult one and he had problems after delivery, so the the bill was almost triple what a normal delivery would be.

When I sat down crying hysterically in HR's office they miraculously found a 'loophole'.

jill jill bo bill said...

Remember the squeaky wheel gets the oil. Pester the shit out of them and like everyone else has said, DON'T GIVE UP!!!! I am so sorry that you have to go thru all of this. Have the same attitude our kids have when they really want something...pick the decision-maker to death until they say, "FINE! Whatever!!!"

georgie said...

I say we get an AK-47 and go all dirty harry on their asses...
Hang in there and keep calling

The Mom said...

I fucking hate insurance companies, the one my kids and I have sucks balls. I can go on with my cursing rampage (i'm sick with a sinus infection so i'm letting it all hang out), but i'll stop and offer a hug.

Dorsey said...

Request the pink padded room and sparkles on your jacket. That's what I'd do!

BacktoBarnwell said...

That sucks! I sure hope you figure out how to make them ante up. If it's any consolation, I don't have ANY insurance whatsoever, so if I have an accident, I'll have to file chapter 11 before I even turn 23! It's a situation though, and all situations have many solutions. Just have to find or come up with the right one!

Sabrae said...

If you go to the looney bin and don't post my bible on a daily basis I'm hunting you down! LOL Just kidding! But I will bring you a file in a cake to bust you out! :)

Smart A$$ Mom said...

sucks so hard.

Legal Diva said...

Bless your heart! Don't give up though- someone will have compassion and do the right thing. Keep your chin up Mama Bear.

Dawn@Embracing the Ordinary Life said...

Oh my...I hate having to deal with crap...and everyone seems to be pointing the finger at someone else.

Work on hubbs work...keep calling keep bugging them...

We had a similar situation with our bank and charging us...I yelled that it is not fair to request a signature to KEEP WHAT I HAVE...it's misleading and they know that...that's why they do it.

I hope you get it worked out!!

sltbee69 said...

I hate insurance companies too, however' it's not her insurance company its the HR dept., people. In any event, keep at them (or better yet, have hubbo contact his HR dept.) like stink on shit. Someone has got to cave eventually and don't let it be you. Lots of positive thoughts your way. ((HUGS))

Eudea-Mamia said...

Hide for the next 24 hours, build up your strength, and then go after the HR department!!!!

I have to fight every single year for my son's medically necessary formula to be covered. They just hope you give up and go away.

Don't give up! Don't go away!

I know you can do this.

Em

Amy@Bitchin'WivesClub said...

I agree wit the other posters.... Stick on them ALL like a pitbull. I went through insurance issues a few issues ago (denied b/c two of my kids have asthma! Ridiculous cherry-picking!!) and even though it took countless hours, letter writing, scanning of documents, letters from doctors, meeting with their "board" and many, many bitter tears of frustration. We got what we wanted from them. Don't give up and don't lose hope!!!

Heinous said...

Ouch, So sorry to hear that. Keep working on them though. You CAN get it straightened out. Just try not to let it get you down.

Scary Mommy said...

That is WAY fucked up! I'm sorry you are going through this, but I have to say, I'm so glad to find another mom who curses as much as I do. :)

The Daily Blonde said...

Get an advocate right away from the union...he must be in a union, no? And call the ins company back and ask them to lean on the HR dept a little. Tell them you'll call the local news....that will not go over well. Be proactive and fight like hell. Story of my life...it works but not without exhausting you.

Amy Amy Bo Bamey said...

I would call until your arm falls off. That sucks big balls. I could not imagine having to pay for that bill. I am sure you can get it fixed you just need to become a major pain in someones ass. CALL CALL CALL

I hate insurance companies too!

Kristi said...

ok, I just stumbled on your blog from my sister Michelle's blog and I am so sorry this happened! I have been an Accounts Manager for a healthcare company for many years and I can tell you one thing - bug the SHIT out of them!! I have seen some crazy (and miraculous!!) things happen for the families that I represent simply because they were on the phone with anybody and everybody that would listen at both their insurance as well as their company.

Don't give up!!!! Call them 5 times a day if you have to!

Lottifish said...

Call your local news station and tell them about this screwy wording and your story. They just might air a story on it and it might help.

Deb said...

it's gonna be a fucking death match fight to the finish, but you have to stay on them. this is a fight i have had, in one form or another, for 15 years. things are really great when your son has a little thing called a genetic disease they lovingly call a pre-existing condition. we're here for you. keep venting.

oh, and the good news is i heard congress just passed some sort of law where mental health care is now covered just like any other illness. so we should be living large in our padded cells!

J'Ollie Primitives said...

Pester Pester Pester Pester each and everybody in the HR office, the insurance office, your faithful blogger buddies, ALL of them.
I used to work in a self-insured hospital. They'd send a COLLECTION notice before sending the insurance coverage info.
Get em Bulldog! Er, Mama Bear!

Tena said...

ACK!!!!! This sucks monkey's ass! Hopefully if you ride their asses enough in the next few days those jerks will come to realize they are at fault!
{{{ Tena }}}}

Deb said...

Oh Tena,

I just have to echo everyone else here...keep fighting, keep bugging, do what has to be done. Oh, and stay on your Klonopin while doing all of this.

Denise said...

Oh I feel bad for you but have some advice. I was a medical claims process for a major insurance company in my former life (before kids, lol). Dont be afraid of that big $200,000 figure from the hospital stay because your insurance company has a negotiated rate that they pay. After that rate, which is generally WAY lower than what they bill, then they take your deductible and the 10%. Please let me know if you want more info....I will be praying for you and Papa Bear

Piece o' Coconut Cake said...

Show up at the HR office with all four kids-and let 'em run wild. Go while you're sick, too. They'll just LOVE all the sneezing you'll be doing. I used to go to the Building Dept. to get permits signed with my baby right at feeding time. Those people will do ANYTHING to get you out of there with a screaming child. And tell them you're NOT LEAVING until this issue is resolved-in your favor!

Tiffany said...

That fucking sucks! Do you want me to come over with my gun and huntin dogs? Cuz I will. I ain't skeered of no human resources person. Oh wait they're cops aren't they? Nevermind.

I can mail them a skunk if you want.

And I think you should keep on their asses and get that shit fixed.

jaime said...

ohhhhh boy. insurance companies just straight out suck ass. SUCK ASS. i'm sorry you are so stressed...and hope you figure things out and feel better.

Sully Sullivan said...

Yikes that is absolutely horrible. Best of luck to you.

Nice new banner (can you tell it's been a while since I've had time to do commenting?)

How long ago did you get that? Very sexy.

Paige said...

Nothing drives me to drink faster than insurance issues.

I am with you