On July 1st, my wife had surgery. It was not the end of the world, but they did have to knock her out and, well, it was surgery. Afterwards we stopped by the pharmacy to pick up medication and almost everything was denied. Not “pending decision” denied but “Nopenopenope” denied. It turned out the issue was that our health insurance had, at the end of June, changed something-or-another and so we had to fill out a completely different form and had a different account number.

Our problems only started there. As it happens, the surgery itself was no longer covered at the hospital where it was performed. We live in a tri-state area where a lot of our services are provided across state lines. New policy is nothing non-emergent can occur across state lines under any circumstances. We can’t go to the hospital that’s twenty thirty minutes away, or the one that’s thirty minutes away. The nearest major hospital in the state is actually three hours away. This new policy of course took effect July 1st, the day of the surgery.

We will grant that the policy was not necessarily tailored around denying us coverage. Most people don’t live in the odd geographical nook that we do. We would even be understanding if we weren’t already sitting on about eight thousand dollars of medical bills that they are either evading or outright denying. Some of them we knew would be a long shot. For example: Not only is one of my wife’s doctor’s not covered because they’re across state lines, but they are also denying coverage for the prescription that doctor wrote. They are, in fact, doing this mid-prescription.

Every insurance company and insurance plan we’ve had seems worse than the last, but this one is really ambitiously bad, and it’s getting worse every year. We’re at the point where if we could, despite our significant medical expenses, we’d just get a high-deductible plan and pay out-of-pocket just so that we know what our outlays are. PPACA makes that difficult, unfortunately, and more expensive because I am still considered a smoker.


Category: Hospital

About the Author

Will Truman (trumwill) is a southern transplant in the mountain east with an IT background who bides his time taking care of their daughter while his wife brings home the bacon. You will probably be relieved to know that he does not generally refer to himself in the third-person except when he's writing short bios on his web page.

5 Responses to The Ambitious Insurance Company

  1. fillyjonk says:

    I bet there are more people in that “nook” than the companies think. I kind of am: the “best” nearby hospital is across the state line, and several specialty-practices for certain surgeries are better done the other side of the river.

    The nearest highly respected hospitals in my state are 2 1/2 hour drives from me.

    So far, my insurance will cover crossing state lines for certain hospitals – I checked that last fall when re-enrolling because the option I *had* been using went up considerably in price and I was deciding to drop down to a cheaper option, but wanted to be sure that, for example, if I needed eye surgery, it would still be covered if I decided to go to a more-respected place with better doctors but across the state border.

    I would not be at all surprised, though, if that changes come this fall enrollment period.

  2. John Seiffer says:

    Paying out of Pocket is no guarantee you’ll know the cost. I’ve never been able to determine cost ahead of time.

  3. greginak says:

    Sorry to hear about all this crud. Through my wife and my son i’ve gone through a ton of bizarre medical insurance stuff. Well over a million dollars worth of insurance insanity.

    Since you brought up the ACA it is noted that there are good reasons why insurance based around states instead of the entire nation is a bad idea and insurance companies have always been in the business of limiting care. That is in their interest yet somehow people screamed about the ACA was going to be pushing gramma into the wood chipper. There are valid reasons why people hate insurance companies which led to a lot of the intense heat from the left for getting rid of them or adding a public option. Those people didn’t come out of no where and they weren’t’ just business hatin commies.

  4. kirk says:

    Back in ’01 I got an angioplasty. For a total bill of about $30k, I had to pay about $600 out-of-pocket.

    Last year, I needed a hernia operation. Like my angioplasty of ’01 it cost about $30k, but I ended up paying out six grand, my maximum out-of-pocket per year.

    I can’t speak for everyone, but my insurance is definitely getting worse. About ten times worse.

    • fillyjonk says:

      My deductible has gradually crept up over the 17 years I’ve been at this particular gig. Granted, we changed providers midway through my tenure here (to a MUCH better one, in terms of how they operate/how quickly they pay providers), but still: it’s crept up. And they’ve dinked with things like co-pays off and on. And my understanding is that the cost for dependents (kids or spouses, neither of which I have) has really skyrocketed.

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