That's fine. I think it's the fifth time our TPA has changed names in the 8 years we've had this insurance. The forms still all look the same; the address is the same; I'm guessing the workers are the same.
But with this 21st century change of synergy to undoubtedly "serve you better," the first act of change is to automatically deny all claims by dependents unless we show proof that they have no other insurance. You know, in case the 4 year old has acquired full-time employment with benefits. In the 9 months since I last sent in birth certificates, marriage licenses, and all that other whatnot to prove that the children and I do indeed qualify for insurance coverage and don't have other insurance. Managed care outrage sure makes me lose track of the use of complete sentences.
Today, I got the first denial of coverage form which is undoubtedly is the harbinger of another form to arrive later this week. The form may simply ask Chris to affirm that we are his dependents, or it may once again for birth certificates, social security cards, and marriage licenses. Perhaps I should view this semi-annual endeavor as a blessing in keeping my important life paperwork organized and handy.
Regardless, it's time for me to put on the cape. It's time for Super Social Worker Mom.... Filler Outer of Forms! Greaser of Wheels! Comprehending of Jargon and Soothing (but Firm) of Voice to Harried Bureaucrats and BA's in Art History Who Really Didn't Want Their First Job to Be in Claims Adjustment/Data Entry!
Yep, that's me. My MSW has undoubtedly saved us more in medical bills than the degree cost in the first place.
And that's fine. That's good. But I'd really just like someone to explain how this annual dance of coverage is saving anyone money, least of all the taxpayers of the Great State of West Virginia. And how it's working out for all those folks who don't have master's degrees in TPA and HMO and PCP and and Medical Home and In-Network and Deductible and Maximum Out of Pocket.
1 comments:
When I was attending grad school out of state, I learned about "in-network" and "out-of-network" really, really quickly. It was all I could do not to burst into tears when the nurse explained "you're out-of-network because you're out of state, so your insurance will only cover 20% of the cost. That'll be $87 for the visit, plus the cost of any additional tests the doctor may need to run."
Never had I wanted my mommy more! My mom had even called the insurance company when I moved, but they didn't mention anything about having to send a letter showing proof that I was attending an out-of-state school. Your kids are particularly lucky to have a mom who already knows what to file and when.
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