Last summer, after much encouragement from my wife, I made an appointment to see my physician about my snoring. (I was sleeping just fine- thank you). I am on my wife’s health plan and we hoped that since we were on the top tier plan (that means most expensive), that perhaps any necessary treatment would be a covered benefit. After a physical we found out that I was pretty healthy but I needed to watch my cholesterol, and a sleep study was warranted. The sleep lab called and had approval for the study from my insurance. What you go through for this evaluation is fodder for another story but suffice to say that for me, the emphasis was on their study, not my sleep. At any rate, after the doctor reads the evaluation he tells me that yes, I do indeed need one of those night time breathing machines, but will require another study to determine appropriate settings. The study was ap- proved by Insurance Almighty and the study completed. My healthcare coverage even included the cost of the C-pap machine. We were told. At this point some of the claims started being rejected. I will save you the 6 hours of discussion that it took for me to finally glean what had happened. It seems that sleep disorders are not a covered benefit for my policy in 2007 (ironically they are in 08). My insurance “Claims Representative” was very helpful in telling me they should not have approved the work. At this point, the lab was paid but they were stiffing the physician. On my initial round of calls Cheryl in Chicago tells me that this was going to be called “an exception.” The mistake was theirs, and all associated work would be covered. Sounded good, but 3 months later, the bills are still unpaid, and the Supervisor I have appealed to tells me I never talked to Cheryl and I have never talked to Chicago.

At this point I find out that my wife’s employer actually has a contract with a negotiation company whose sole purpose in life is to argue with Insurance Almighty. Kind of a nice benefit isn’t it? What it tells me though is that this runaround we all get from the insurance companies is now standard practice and to be expected. The employer provides health insurance but only with a company that is not going to pay (at least not without hours and hours of arguing). This health advocate company also had my claims denied. I was left with one final appeal before lawsuit, and the insurance company finally paid. In this same time frame I have had lab work to check the cholesterol. The lab has not been paid because the same insurance company has told them that my wife and I have other health insurance so they won’t pay. I am up to the appeal process here.

In gaining pre-approval for a colonoscopy (yes I am that old) the medical office said they were told it is covered benefit three calls our of five, so we went with the assumption that it will be covered. (My doctor said they used to do two calls out of three, but lately have had better ac- curacy with three out of five).

My father died last year and one of the kindest things he ever did was line up his own burial. One of the features he paid for was a life insurance policy that would pay off the arrangements if he died before payments were finished. We got the bill last week that said since my father died, he must have had a pre-existing condition that led to his death so they are not going to pay off his note. Huh? The doctor says the cancer wasn’t diagnosed until a year after dad bought this contract but maybe the insurance company knows something the oncologist doesn’t. I am not sure dad is all that willing to pay the difference at this point. I certainly am not.

When the recent storms took it’s toll on my satellite dish I dreaded what I knew was going to happen when I called the utility company. I am amazed to say that I now prefer to deal with a utility company over my insurance company. My only offering to you is that when you see the battle coming, start with a fresh sheet of paper and log all that is said. Date, time, who you talk to, content of conversation and ask for the reference number of the call. If I had an easy way to do it, I would record all calls. When I used to get that warning that “this call may be monitored” I had begun to hope that it was. But then I realized they may be monitoring the call to chastise the rep for being too helpful or too honest. A physician client of mine says this is standard operating procedure now. I do not know where this insurance thing is going, but if our own insurance company has become the enemy of our health, what is the point of having insurance at all.

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Rev. Daniel Gowan, LCDC, LPC-S