Entry #11
~ The Insurance Nightmare
Begins
Most
people who work full-time manage to get somewhat affordable
health insurance. Ours isn't too bad. Dh works for a big
retailer and we have had the insurance over 11 years now.
Most of the time, it's okay except for a few small glaring
faults. One example of a glaring fault is the wellness
checks. ONLY women get a yearly screening, and they allow
only up to $60.00. Men and children are not covered by
any wellness checkups, so you can only imagine what we
spent for the baby this year!
Well,
I can add mental health benefits (it's a benefit?) to
that! If you have a mental health issue, 20 visits are
covered a year at 50% up to $50.00 a visit. Inpatient
stays, like the one I had, are covered at 40% or 50% depending
on whether it is a network hospital or not. Dh was advised
to go to the hospital about 27 miles away because it is
the only hospital that has inpatient services for mental
health in our area. As you know, I was there five days.
The
afternoon I was admitted, we were informed that they couldn't
tell us whether or not we were covered at 40% or 50% on
our insurance plan. There isn't much difference in the
two, so he said it didn't matter. The night I got home
from the hospital, we received a letter in the mail stating
that the place where I had been was not a network facility,
so only 40% would be covered. They gave us the name of
hospitals that are about 50 miles away from our home in
the letter. We still weren't too worried because we figured
I would have had to leave the hospital in an ambulance
or some other official vehicle since DH wouldn't have
been allowed to take me. We figured that the difference
would end up being the cost of a ride in a police car
or ambulance. We weren't too worried about it at that
point.
R
called the hospital the next day and found out the woman
who had seen me WAS told that it would only be covered
at 40%, but we were not told that. Imagine our sticker
shock when the bill came. My five-day stay cost $6850.25!
The mental health benefits are handled by a managed-care
company. What we also found out later was that the stay
would only be covered at up to $500.00 a DAY! Yikes!!!
At one point I told DH it would have been cheaper for
me to drive into the lake. He got pretty mad when I said
that... I was half-joking/half-serious... but he definitely
did not like what I said.
A
few weeks later, the claim was processed by our insurance
company and of the total bill, only $2000 was allowed.
The 40% of that was $800.00 which they gladly (sarcastically
said) paid. The math: $6850.25 - $800.00 = $6050.25 which
we are expected to pay. Now how are we supposed to do
that? I keep that much money in my back pocket... just
like everyone else! :( So, we called the hospital and
told them we would be appealing the amount paid. The managed-care
company should have paid $2500.00 total (the 50% rate
for an emergency admission in a non-network facility).
The main part of the hospital is a network hospital on
our plan, so that does not make sense. We have also applied
for charity coverage and are waiting to hear how that
will come out.
What's
the point of having mental health coverage if it's going
to be so stingy? Why should depression or anxiety be less
of an illness than diabetes or a heart attack? It's not
like I have tried to live an unhealthy lifestyle. I didn't
CHOOSE to be depressed. I want feelings. I feel half-dead
without them. When people are sick, they are supposed
to go to the doctor. I did, and look what happened! I
still have not met my therapist, but I am beginning to
worry about how we will pay for all of this.
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