We all spend too much time fighting insurance coverage battles, am I right? This humongous time-sink can be one of the worst things about living with a chronic illness. But don't take my word for it. Take a read on fellow D-blogger and journalist Mike Hoskins' latest row:
Special to the 'Mine by Mike Hoskins
Like most of you, we spend thousands of dollars in diabetes supplies and meds every year.
Thankfully, our insurance coverage provides a Flex Spending Account (FSA) to help us not have to eat through this money on the front end. It's a simple concept: money you earn goes into a pot to be used during the course of a year to pay for certain medical supplies. Submit receipts to prove that all is legit, and personal money spent is reimbursed forthwith.
At least, that's how it should work.
Not for us, with the newest FSA company we're dealing with.
The evil villain of a company known as Aflac has kicked of a three-month battle that we've yet to win. Rather than getting reimbursed, we're on the receiving end of hair-pulling, teeth-clenching, curse-inducing thoughts of violence for what we've had to endure. These days, I certainly don't feel like I have a stock-pile of D-supply cash ready at the swipe of a plastic card. In fact, I'm truly starting to believe that the whole Flex Spending Account initiative is a scam — just a way to coax people into putting up money that's supposed to help them save on healthcare bills, but in reality will disappear into the abyss of company double-talk and lousy record-keeping.
Luckily, I've resisted the temptation to throw my phone against a wall — mostly because I know I'd be less able to make the calls that are still on the horizon.
Aside from that, about the only other thing I have to be thankful for is that I've managed to avoid a mental breakdown because my wife (the faithful policy-holder via her job) has been navigating some of the Flex Fiasco. I deal with most of the insurance coverage calls, because I've been dealing with these people for most of my life. But since her name's on the Flex plan, she takes the lead initially. When they won't play nicely, the ball gets knocked into my part of the grassy field.
That's where we found ourselves early this year. The company wanted more documentation about some particular receipts we'd sent in for reimbursement. A root canal. Monthly medications from the pharmacy. Insulin. Some office visits with my endo and my mental health counselor. To the tune of $1,200.
Somehow they decided the already-submitted info was not good enough, so they suddenly deactivated our Flex card, forcing us to pay for everything up front and then go back to them to fight for reimbursement.
So I started calling, to get to the bottom of this mystery and apparent communication failure and find out what they specifically needed to restart our card — and start offering the promised payback (from money we saved ourselves, no less!)
The first conversation was doomed from the start.
First of all, when I provide you with the policy-holder's name and account number, please don't tell me that the account doesn't exist or that I must be mistaken in thinking we have a Flex Plan. No, you just need to correctly key in the information.
And then when you cut me off, and I call back, don't tell me that you can only provide information to my wife, the policy holder — when she's already approved. This doesn't help the customer's faith that you can perform simple tasks, like reading and comprehending what's on a computer screen.
Me: So the receipts from each provider listing the services aren't good enough?
Flex Lady: No, we need individualized receipts.
Me: That's what I sent. Receipts, showing the reason for the visit or medicine I got from the pharmacy.
Flex Lady: No, you didn't. That's not enough.
Me: I don't understand. The receipts we sent are from the pharmacy we use, and each item says "pharmacy" with the cost of the medication purchased. Or the doctor's office that says why we were there. What else do we need to send?
Flex Lady: A more detailed breakdown of everything.
For every other Flex company we've had through the years, submitting a receipt from the pharmacy was adequate. But not this time. Apparently we need to send in a list detailing every medication, dosage, patient name and cost breakdown of each item.
We've never had to do this before, and at first I thought it might be some new policy mandated by (*gasp*) that big bad health care reform that's causing the sky to spit glucose. Apparently not. Aflac says this has been its own policy for years.
So basically, rather than relying on simple receipts as I've always done, this means I must contact each individual doctor's office or provider for more detailed itemized receipts. If they don't break everything down exactly the way Aflac wants, then I need to circle back, re-submit a request and follow up on each one, or sacrifice the money we've invested in medical reimbursement. Ouch!! As if work, life and diabetes didn't keep us busy enough!
Seriously, if it wasn't for their talking duck mascot, I'd have nothing positive to say about these people... Then again, I don't. I kind of want to wring my hands around the duck's neck right about now...
For each drug or supply, they want a pharmacy receipt with a signature at the end. Even though we sent three pages of information with a signature following on the last page... I guess reading through all the pages isn't as easy for them as just demanding a new fax. But then again, who cares what's easy for them? What about us customers?!
Then there's the whole song-and-dance of justifying the reimbursement I'm asking for, which I'm not even sure is legal.
One receipt was for blood glucose test strips. This different Flex Representative wanted to know not only how many, but that my doctor has signed off on the amount of strips requested (duh, he wrote the prescription!).
Me: I'm sorry, but why do you need to know that?
Flex Lady 2: We have to make sure you're not listing thing that you don't use, or in amounts that aren't necessary.
Me: That's a discussion between my doctor and I, and possibly my health insurance people. Not you. This is about getting reimbursed for covered supplies that I've already paid for!
Flex Lady 2: We still need to confirm it.
The thought of stabbing myself in the eyes with blunt lancets danced around in my head, but I resisted. Colorful catch phrases were on the tip of my tongue, a la Marcus Grimm's "Sh*t Diabetics Say."
Tact prevailed, and instead I clenched my fists and eyes and shook my head silently.
This whole Flex Fiasco has gone on for weeks, with each situation leading to what appears to be a solution but later turning out to be wasted time. Minutes and hours I'll never get back...
They've wanted more proof that I saw my dentist for the listed purposes, rather than — I don't know — a foot exam or stress test... or maybe just a chat?!
They've refused to take my word that my visits to a mental health counselor, a Licensed Counselor and Social Worker, is for actual mental health evaluation. Apparently, the credentials aren't good enough and it might be possible I'm paying $35 a week just to meet for a weekly game of poker, rather than therapy.
Hmmm... This brings a question to mind: Is this even allowed??? Doesn't a little thing called HIPAA prevent them from asking me for all these details? Seems like it should. At least I think so. I'm tempted to contact my past flex providers just to see if this current situation is something out of left field. But that would take more hours I can't afford to give away...
Meanwhile, after all the conversations we've had on the phone with these people, they've knocked off way too many trees by sending us waves of statements in the mail. They deny our reimbursement claims, telling us that we'll lose our untapped money if it's not claimed by May. Yet they won't let us claim it...
YOU'VE GOT TO BE KIDDING!!
(Sigh, again. Face into palm.)
You wouldn't think that health care providers and insurance companies would need advice on how to run their businesses, but apparently they do. So here's what I'd suggest:
1. Hire people to answer the phone who actually know what the heck they're talking about and can offer correct answers to their customers, who are simply trying to get what they need to be healthy.
2. Provide care that actually helps people, not just your bottom line or other companies and insurance carriers.
3. If you cover someone with insurance or provide them with a FSA, then COVER us or allow us to get that money when we follow the rules. Please don't assume we're trying to cheat you (we're NOT guilty until proven innocent). We pay you money for a reason.
4. Stop asking to confirm our information every time you breath. Seriously. Look at the computer screen in front of you. Use the information already recorded. We shouldn't have to repeat ourselves ad nauseum simply because you can't comprehend the concept of teamwork.
5. Talk to me like another human — not a person with a condition that you think is evil and not worth covering or providing (OUR) money for.
6. Don't tell me what you want me to want. I called you, not the other way around. Please listen to me and do your job. Honestly, I'm not trying to needlessly take up your time.
And so, the Flex Fiasco continues... Hopefully some remedy can be found before the end of May, when our benefits reset and whatever money's left in that account actually does go down the drain.
We shouldn't have to fight these battles. But apparently, that's just the way it is. Because apparently, listening to us patients isn't an option. And logic must fly in the face of... common sense.