![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
Reason why I'm in favor of a single payer system #2648
So ricevermicelli has breast cancer, and at her last appointment they helpfully suggested that she call her insurance company to ask if they cover the treatment center. I was a little surprised to hear this, I figured that they would know whether they took Cigna or not, but no, there's variation from plan to plan. So we call. And get hung up on by the automatic system. Repeatedly.
After 5 PM Monday I thought to just say "Operator" until they put me in a queue for a human. It took over 20 minutes (to be fair, the system did tell me it would be over 20 minutes). Anyway, I talked to a human who was as helpful as her system would let her be. She couldn't tell for sure. She'd like us to ask the treatment center. The official Cigna line is that you have to be an advocate for yourself. I think that their business model is based on hoping we don't get the treatment, or don't discover until too late that we're somewhere that hasn't contracted with Cigna.
So yesterday, while we were actually at MGH, with the help of a friendly Dr (RV's mom (very helpful that)), an MGH billing specialist, and a conference call with the Cigna people that took over half an hour, we now know that MOST of the things that HAVE to happen are definitely covered. There are some things that HAVE to happen that we're still unsure about, but very good odds. Among other things the surgery might change billing codes during the surgery, and Cigna can't just tell us "All of the possible billing codes are covered.". They have to go in and check one by one, and there are evidently hundreds of possibilities.
If the insurance companies did their jobs adequately, I wouldn't be quite so gung-ho for a government takeover of the system. But they seem to consider customer service to mean buttering up the HR rep who decides which insurance company they're going to provide to employees. Consideration as to people who then have to use their system does not seem to be their primary focus.
After 5 PM Monday I thought to just say "Operator" until they put me in a queue for a human. It took over 20 minutes (to be fair, the system did tell me it would be over 20 minutes). Anyway, I talked to a human who was as helpful as her system would let her be. She couldn't tell for sure. She'd like us to ask the treatment center. The official Cigna line is that you have to be an advocate for yourself. I think that their business model is based on hoping we don't get the treatment, or don't discover until too late that we're somewhere that hasn't contracted with Cigna.
So yesterday, while we were actually at MGH, with the help of a friendly Dr (RV's mom (very helpful that)), an MGH billing specialist, and a conference call with the Cigna people that took over half an hour, we now know that MOST of the things that HAVE to happen are definitely covered. There are some things that HAVE to happen that we're still unsure about, but very good odds. Among other things the surgery might change billing codes during the surgery, and Cigna can't just tell us "All of the possible billing codes are covered.". They have to go in and check one by one, and there are evidently hundreds of possibilities.
If the insurance companies did their jobs adequately, I wouldn't be quite so gung-ho for a government takeover of the system. But they seem to consider customer service to mean buttering up the HR rep who decides which insurance company they're going to provide to employees. Consideration as to people who then have to use their system does not seem to be their primary focus.
no subject
My sympathies on having to deal with this system. Pygment worked in insurance billing and knows a bit of the ins-and-outs from being on the other side of the telephone. I'm sure she'd be happy to offer advice/assistance if that would be useful.
no subject
no subject
no subject
But the heath insurance industry has filled me with rage and disappointment for a long time now, so I may just be bitter. :-/
no subject
Also, I shudder to think what this is like for people who are not as privileged as we are. Imagine if you weren't a native English speaker, or were working two shift jobs and didn't have time or energy to track this shit down, or didn't know someone who was a doctor...
no subject
no subject
no subject
Please let me know when I can take the kids off your hands for a few hours or bring food or clean your kitchen. Seriously.
no subject
no subject
#
no subject
no subject