“I’m sorry, our billing person is out for a few hours. You’ll have to call back,” said the administrator at the imaging lab.
“Thank you for calling _____ Insurance. Our systems are down, please call back again later,” said the recording at the health insurance company.
“I believe the doctor is in your network. The lab is in the same medical group as we are, and we’re in your network. But I’m not sure. Did you check with the insurance company?” said the nurse at our primary care physician’s office.
I could hear my husband’s voice rise with frustration. He was trying to make sure that the doctor at the imaging lab shown on his referral form was in our health insurance network. See, we have an HMO plan, and there’s no coverage at all for out-of-network care (except emergency services).
I looked over the referral form and reminded him, “You’d better make sure the doctor is in our network or we might have to pay for this out-of-pocket.” I thought of our friend who had a baby. Even though her OB/GYN and her hospital were both included in her HMO network, the anesthesiologist was not. She got a surprise bill for $1,800 on top of her deductible. Ouch!
I could see my husband was growing more and more upset and the appointment at the lab was just a few days away. We had to get some kind of answer soon, or cancel that appointment and start all over again with a new referral – hopefully to a doctor who is in our network!
I thought, “I know! I’ll check the health insurance provider directory on-line.” I got online and there was a menu tab “Provider Search.” Cool! A pop-up appeared, and I selected our plan year and put in our zip code and a 15-mile radius. Then I had a choice to put in either the name of the doctor or the type of plan we had.
I put in the name of the doctor, but then I had to choose the kind of specialist he was. There were over 20 specialties listed and none of them seemed to apply! I took a couple of guesses but “We’re sorry. No Providers were found” popped up. Uh oh. This is exactly what I was afraid of – looks like the doctor isn’t in our network.
Then I checked the name of the imaging center. A new window popped up, “Select a Type of Provider.” And the choices were Doctors, Urgent Care & Walk-In Clinics, Hospital, Medical Group, Other Facilities, Ancillary Services.
I tried “Medical Group,” and a couple other choices. Again, “We’re sorry, No Providers were found.”
I went back to the first screen. This time I went to “Filter by Plan Type.” Ok. There were 5 choices (Covered California, Standard Medical Plan, Medicare, State Health Plan and Medicare/Medicaid.)
The only possible option was “Standard Medical Plan.” We hadn’t gone through Covered California because my husband’s doctor does not accept any of their plans. (Scary. How many doctors don’t?)
Next, I had to select our specific plan. There were 39 to choose from! So I narrowed that down to just the HMOs. There were only 20 HMOs. I eliminated the HMOs with Spanish words in the name, the Medicare one, the ones that appeared to be employer-provided plans, the one that had school colors for a local university in the name, and finally I ended up with a plan called “Individual and Family Plan.”
While those words did not appear anywhere on our paperwork nor our insurance cards I did see “IFP” on our card. IFP = “Individual and Family Plan?” It’s gotta be! I’m a genius! But again, I got the message “We’re Sorry. No Providers were found”
I thought “If this is so hard for us – people who have worked in insurance (not health insurance, but still), completely fluent in English, with college degrees, and computers and Wi-Fi, and hours to spend trying to figure this out – what about people who have fewer resources than we do?”
I started over again and this time the little spinning circle thing starts spinning. I realized the same computer problem that shut down customer service at the health insurance company was probably affecting the online provider search too.
Between my husband and I, we had already spent several hours on this little project, so why stop now? Let’s check the website for the imaging center. Our insurance company was not listed on their site as one that they accept. It looked more and more like we needed to get a referral to another lab. I took a painkiller and a Yoga break. And I wrote down the names listed on the website of the doctors at the lab – none of which were the name of the doctor on the referral form, of course.
I decided to give the insurance company website one last shot, and check the names of the doctors I got off the lab’s website. The site was back up and functional, and amazingly, the names of three of their doctors were in our network!
My husband tried calling the imaging center again to see if the billing person had ever showed up and she had! She assured him the imaging center IS in our network, for sure! She couldn’t explain why it didn’t show up in Provider Search.
And, she said, even though my husband would consult with the doctor named on the referral form, they would bill the insurance company under the name of one of the in-network doctors in their practice.
I see. So he is consulting Dr. “K” but they’re going to bill the procedure in the name of Dr. “B.” What if we tried to do that? Wouldn’t it be “insurance fraud?” Our doctor is covered but only if his services are billed in the name of a different doctor? Really. What if this little “switcheroo” doesn’t work? Will we end up with a big bill anyway?
It’s more irritating when you realize we have all these hassles and headaches just so insurance companies can make more money. Studies show that if you make health insurance complicated enough, people won’t use it. And if people don’t use their insurance, the insurers get to keep the premiums, and continue paying obscene salaries to their top executives and buy other insurance companies and so forth. Well, that works great for the insurance companies!
But not for me. What I want is health care that is easy to use, easy to afford and that gives me a feeling of security! If you, too, want the security of knowing that every qualified medical professional is in your network, join HEAL California! By winning improved, expanded Medicare for All, we can all truly enjoy peace of mind when it comes to our health!