You know those tasks that you do every day and some days you do it without a thought and other days you do it while grumbling quietly and other days you hate yourself and your life and you would prefer to abandon your spouse and children and live life in a yurt on a remote island than remove ONE MORE TIME the daily mass of hair from the shower drain? Well, I have reached the latter stage with changing the toilet paper rolls, which seem to ALL THREE need changing simultaneously, only by me, and at an alarming rate of turnover.
Of course, my irritation is on the level of hair strands burrowing in a drain, which is a near infinite distance from the level of My House Just Got Leveled By A Hurricane or My Backyard Is Burning And Has Been Since July or My Country May Or May Not Be In The Imminent Path of Nuclear Disaster. But rather than spend $1,000 on all the gas masks and emergency rations that are in my Amazon cart at the moment, I am turning my thoughts instead to the minutiae of life’s drain-hair-nest of irritations in hopes that it distracts me from The End Times for a while longer.
Something that is high on my list of unimportant-in-the-grand-scheme-of-things irritations lately is my eye doctor. Not him, per se. But his office and their apparent COMPLETE INCOMPETENCE with submitting charges to my insurance company. (Let’s acknowledge all the inherent privileges in this source of exasperation: access to health care, access to eye doctor, access to funds to pay for the services in case my insurance company denies the claims, house standing in a hurricane-free area, backyard absent of fire and smoke, etc.)
My eye doctor – whom I’ve seen for nearly a decade, and therefore do not want to leave, not so much out of loyalty as out of desire not to meet a new person – just joined a larger practice. He used to be part of the University Health System for which my husband also works. Now, he works for a practice called, confusingly, University Ophthalmologists. This is important to my plight.
After the eye doctor joined this new practice, my husband and I each went for our yearly eye exam. (I actually had several additional appointments, but that’s another story and I’d rather not fret about my steady march toward sightless doom at this time.) We got a bill several months later.
The bill says clearly, “If there is an asterisk next to the thing we are charging you for, we have submitted a claim to your insurance for that thing.”
The bill had zero asterisks, and it looked as though – unsurprisingly – none of the items had been covered at all by our insurance, despite the fact that our insurance covers yearly eye exams in full.
Since the bill said we had to pay by X date or face a collections agency, I called the number for the billing office.
The woman who answered – let’s call her Doris – said she could help me. I told her it didn’t look like our appointments had been submitted to insurance. She asked me what our insurance carrier was, and I told her. Recognizing the carrier, she asked, “Is your husband employed by University Health System?” and I confirmed that he is.
That’s when her brain shut down tight like a toddler throwing herself on the floor in prone, immovable refusal to wear the perfectly reasonable pants she already agreed to wear. Doris said, “Well, if you have the employee insurance, we don’t take it. We aren’t PART of the University Health System. We’re separate. Even though our name is University Ophthalmologists, we are NOT part of the University Health System. We are out of network to that insurance because we are not part of the University Health System.” She repeated this information several times and in a variety of ways, lest I misunderstand what she was saying.
When she finally ran through all possible variations on “we are not part of the University Health System,” I brought out my trump card (which no longer sounds as pleasantly triumphant as it should) and told her that we had in fact emailed our insurance company prior to our appointments to make sure that our eye doctor was still an in-network provider. The insurance company had responded that he was indeed an in-network provider.
Doris was still on toddler tantrum mode and this information did not sink in.
At some point she paused long enough for me to finally ask the question I had been intending to ask from the beginning, which was, “Did you actually even TRY to submit the claim to our insurance company? Because the bill says you did not. No asterisks.”
That got through somehow – her brain toddler must have spotted a soothing My Little Pony or something – and she said, no, it didn’t look like they had submitted the claim. So she would do that. BUT MARK HER WORDS, she said, it wouldn’t make any difference because they were out-of-network for my insurance company, not part of University Health, yada yada, the sound of my blood pressure drowned out her words at that point.
Internet, we have since received at least a dozen bills. Some of the claims have been submitted to our insurance. Some have been PARTIALLY COVERED.
One bill showed that part of my routine annual exam was covered… but my husband’s was not. Same exact service. Same exact insurance. So I had to call again. And Doris answered again. And we went through the SAME EXACT RIGAMOROLE.
Perhaps you are well aware how maddening it is to tell someone a fact and have them completely ignore that fact as they steamroll right over you with their own agenda. She was so completely caught up in this “we are not part of the University Health System” thing that she could not see that my insurance WAS IN FACT COVERING THINGS. Nor could she take a breath and look at the identical appointments my husband and I had, and note that there was no earthly reason for our insurance to make a payment on MINE and not on HIS.
The call ended with me asking, again, for her to re-submit the claim (which, again, had NO ASTERISK on their own form which said clearly that an asterisk means it has been submitted and ipso facto LACK OF ASTERISK means it has NOT been submitted). And again, we got a bill with incomplete asteriskage and mismatched claims information. Exhausting.
I am seriously considering leaving my eye doctor because of this! It is not worth going through this every couple of weeks! I never want to speak to Doris again!
And listen, I can empathize with Doris. I can. She probably has to talk to a billion people a day, many of whom are probably confused/enraged by the fact that University Ophthalmologists is not part of the University Health System and therefore doesn’t accept their insurance. That would be confusing and enraging! And so she probably has to shut off the part of her brain that listens so she won’t be bombarded by insults and profanity from angry, frustrated clients. And probably there is a limited number of variations on how insurance companies respond to claims so she likely thinks she’s seen it all. And maybe she’s worked there for fifty years and HAS seen most things and has a good grasp of her job and what can and cannot be done. She’s probably a very efficient, hard-working woman who maybe has too many things on her plate and might be a wee bit exasperated by all these patients the new doctor is bringing into the practice with their associated ignorance about what the word “University” means when it’s part of a practice name. Maybe she hates her job and goes home each night and cries. I try to think of all these things every time I speak to her, with limited effect on my blood pressure.
When the most recent bill arrived, I waited as long as I could. Then I gritted my teeth and geared up to deal with Doris. But! Lovely, reasonable, fresh-voiced Heather answered the phone! Heather, who trotted out the same “we are not in-network for University Health System insurance” line, but then listened as I pointed out that a) our insurance told us our eye doctor is in-network and b) our insurance had been covering some of the claims. And then she agreed that it was odd! And that she would look into it!
I have no doubt that I will be back on the phone with Doris in a couple of weeks, because insurance matters take YEARS to untangle. (Surely I’ve complained here in the past about the insurance company that had “University of City, Name Memorial Hospital” on their list of in-network providers, but the hospital itself put simply “Name Memorial Hospital” on the claims it submitted, so the insurance denied them all? That was a fun one to deal with.) (No.) But maybe, knowing Heather is around, I won’t have to leave my eye doctor altogether?
