danceboy

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.