Category Archives: insurance

This Electronic Life

Have you ever called a company and been frustrated by the phone menu? Ever tried to login and forgotten the answers to your security questions? Ever wondered if we might not be better off having personal relationships with the people we do business with?

Square the phone menu, add in a quadrupled set of websites, all with their own login, password, security questions, and blasted captchas.

And what do you get?

A REALLY LONG TIME on the phone, navigating the very complex phone menu, entering digits and passwords and account numbers, waiting on hold, finally reaching a person, and then confirming all of the same digits and account numbers, and then ending up with answers like: “Your husband will have to call us or write to us to grant permission for us to discuss your account.”

I admit I find this whole thing exasperating. I don’t see it as an opportunity, but maybe it is. An opportunity to write down every last detail there is for every account we have ever had?

The irony here is that my very capable husband has NO interest in talking with the XXXX Insurance Company about this claim or that coverage, and is so very happy that I am able to and interested in handling these details.

As much as I try to simplify things, the sheer vastness of the internet just makes it very challenging to stay on top of the details. I always thought of myself as a detail-oriented person, but the volume of details has increased to the extent that I dread trying to call someone, especially the insurance companies, to solve a problem or get information.

And then there are the places that require authorization EVERY SINGLE TIME from my dear husband. Not that he is working or otherwise busy or anything. Aargh. I love how they ask if he is right here with me so they can get approval from him. Ha.

Do you have any tips for how to simplify things? Because I’m all ears, here.

The Egg is Not Yet Fried

Although we do not have any insurance coverage to fix the Good Egg, we are getting the windshield replaced on Wednesday. That will render said Egg driveable. We then will take the other cracks one at a time, starting with the sunroof. Our neighbors (they of the bashing tree) know a lot of people who do a lot of things and they said they would put out the word that we are needing the sunroof fixed. And they had the tree company come out today and clean up the mess.

The moral of this story for me tonight is “It costs something to see clearly.”

Into Each Life A Little, Er, Tree, Must Fall

or What I Learned About Insurance Today

Did I know that it was going to rain today? Did I know that it was going to rain horizontally today? No, and not only did I not know those two things, I also did not know that my beloved Previa (The Good Egg) was going to get mooshed by a big stupid tree branch from our neighbor’s tree. And, not only THAT, but I didn’t know that events such as the one I have just described — remember, the NEIGHBOR’S tree broke and smooshed the Egg — who gets to pay for it? Yes, WE do!

I was shocked, I tell you. His tree falling onto our property — seems like a clear-cut case of his homeowner’s insurance paying for the damage. But, no-o-o-o-o-o-o. That falls under our responsibility.

Bad news, for sure. But, worse news. We dropped the comprehensive and collision on this car awhile back ’cause it’s really old and I guess we figured it wouldn’t be worth it to fix the car.

First, we saw that the tree branch had fallen. Then, we noticed that the Previa was entwined in the branches. Then, we noticed that the windshield was big-time broken. So far, not too bad. Then, we noticed that the back sunroof was broken. And, after the branch was removed, we discovered the body damage.

I haven’t gotten around to telling all my blog readers about the Previa. It was made the day Valerie was born (1/27/93) and she’s been looking forward to driving in it just about a month. The middle row of seats in the Egg (as we call it) turn around and have seatbelts you can wear while facing backwards. It took us a lot of places with the kids facing each other, playing games, and occasionally kicking each other. There are two sunroofs in the Egg and I always have loved the amount of light that comes into the car.

I don’t know for sure that we have lost the Egg, but it for sure is a Cracked Egg at the moment.

Interesting Insurance Info

So, I thought this is the way insurance worked: You pay your premium, along with a big bunch of people. From that money, the insurance company pays out the benefits. I figured one month they might come out ahead, another they might not. At any rate, I thought that is how it worked.

IMAGINE MY SURPRISE when I found out today that Greg’s company is a “self-pay” company. That means they pay admin fees only to the insurance company, and then when I incur an expense, Greg’s company actually pays that expense. OK? See where I was going wrong? I thought Anthem paid it out of the money they got in premiums. But, no. The company itself pays for all of those expenses.

Somehow that made a big difference to me. Since I thought it was Anthem making the decisions on whether or not to pay, I was tapping into that societal consciousness that sees insurance companies as the bad guy. Not that there aren’t some problems with health insurance in our country, but I finally got some clarification today on why and how “normal and customary” payments are determined.

And since I think Greg works for a REALLY great company, I am even more willing to incur the additional expense I am having to incur. We have great insurance coverage and I appreciate the company’s decision to take such good care of their employees.

Just thought you should know.

Blogging about Insurance

You hear it all the time. So-and-so needs an operation and the insurance company decides not to pay for it. The insurance companies are painted pretty black and with a pretty broad brush. However, our experience with our insurance company has been just incredibly good. When Kepler was in the NICU, his hospital bill was $42,000 and insurance covered all but $200. We have excellent customer service, excellent benefits, and clear paperwork.

The only tricky part is when I decide to utilize a provider who is the dreaded “OUT-OF-NETWORK.” Out-of-network claims always seem to take two or three tries, and I do get different answers from different customer service reps about these claims. But, still, overall our insurance company does a great job.

I’ve mentioned my fine therapy group I attend. The cost is $40 per session. Our insurance covers this service 70-30. That is, they pay 70% and I pay 30%. I went into this group planning to pay $12 per session, once I received my reimbursement.

Oh, how easy it is to adopt a sense of entitlement. For some reason, in 2007, the sessions’ “allowed amount” was $40. Once January rolled around, apparently, the “allowed amount” became $25.89. So, finally in June, I am having time to get this figured out. My very helpful CSR told me today that it looks like the pricing changed at the first of the year. She assured me that the coverage is still 70-30, but the company decided to pay 70-30 of a lower amount. To confound matters and compound the problem, my provider used a different (wrong) code for my February charges, so they still went through as $40 amount allowed.

I started getting a little frustrated on the phone (28 minutes) because I can’t get an answer as to WHY the allowed amount would change. If this procedure is worth $40 in 2007 surely it’s not worth less in 2008. The only explanation she gave me is that the company is reining in out-of-network providers to more closely match in-network providers. This seems arbitrary to me, although I can understand that there have to be some limits. After all, you could go to an out-of-network provider who decided to charge 2x or 3x the going rate in your area, and then that probably would be a problem for the provider.

So, the bottom line is this. I am so thankful for our health insurance. And having 70% of $26 paid is better than having 0% paid, which is the case for a lot of people. So, I will adjust. I would just like to understand how such changes come about. Did the fact that I had several claims of this sort in 2007 put up a red flag? Are there people who work for insurance companies who do nothing but figure out how to pay less benefits? As it is, our health insurance costs already went up at the beginning of the year, so it’s a double whammy to also have the benefits reduced.

I will adjust. But I don’t like the fact that I have absolutely no input nor recourse about my health insurance costs and benefits and coverage. Ultimately, the fact is, we have better health insurance than the majority of people, so I need to remember that. But it was just a shock to find out that things had changed so drastically. My payment will go from $12 to $22, which will add up over a number of weeks ($500 for the year).

A supervisor is supposed to call me early next week to give me more information about how this process happens, so I hope to take some time to think about some clear, concise questions to ask if and when the super calls.

Upon further consideration, I have NOTHING to complain about.

Go Anthem!!