Wednesday, January 02, 2008

Health Net Follies

To be fair, this is not a health insurance horror story. It's not even a bad dream. For one, I have health insurance. It's more just frustration with insurance bureaucracy and I'm sure I'm not the only one.

It hadn't even occurred to me to blog about this and I think it was mostly out of a stubborn will to not let this become a hassle. It's like writing it down will give it power and I don't want it to have any more power than it has.

Another reason that I haven't written about it is that the story is just too dern complicated, so I will summarize. (You're welcome).

My co-pay for my MS medication is expensive. It's now over $500/month. But the total amount that I am obligated to pay per year is $1500. Once I've past the 1500 I file a form with an appallingly long name called Maximum CoPayment Liability Notification, and my copayment goes to 0. Sounds simple right? Well it should be.

I've done this dance for 3 years and this year has by far had the most snafus. First hiccup was me sending it to the Kentucky claims processing address and not the Van Nuys address (My bad, but you would think they would be capable of sending it on to the correct dept - nah). Then I sent it to the Van Nuys address, heard nothing. Called. No record of it. Sent it again. Nothing. Discovered that I could send them email so I sent them email to check. Still no record. Argh. I asked if I could fax it. They said I'd be most welcome to fax it (phew.)

This time it finally got scanned into the system and when a rep looks it up it shows it. Great! That should be it and they will "process" it and send me the now large reimbursement check. In a month I called to check and it said still processing. Then next time i called the person I talked to said that the claims dept needed verification from the Medical Group and she'd call them but wouldn't be able to get back to me for a week, but she'd call me then.

Stupid me let a week pass and no call, so I called and made the person answering call them while I waited on hold.

So now we're up to more hoops to jump through. The Medical Group says that I have to be the one to fax the request in and then they'll fax it to me and then I have to fax it to health net.

And you wonder why health coverage is so expensive?

So I faxed off the request and this is where it stands right now.

Health Net owes me about 4k so this is really starting to bite.

Stay tuned (or not).

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