Frustration Sets In

Warning - this is not about Rebekah's health but a rant/rave into what my day has been like dealing with Insurance Companies - Lifewise Health Insurance.

More than 2 weeks ago we asked what we needed to do to schedule a second opinion on the need for radiation given the positive progress Rebekah was experiencing. They said that second opinions are definitely covered but that only a case manager at Lifewise could set that up. That mirrored what the other hospital said - they would need to have a conversation with the insurance company before we set up an appointment.

Unfortunately we did not have "all the forms" done for a case manager at the insurance company; we had asked for one during our very first hospital stay but the insurance company says they had never heard that. Finally today (1 1/2 business days before radiation begins at 6:15am on Monday) we get a phone call from the case manager - she has all the paperwork done. "GREAT," I exclaimed, "Can you help me set up a second opinion at the "other" hospital in town (Doernbecher/OHSU)?" The short answer was "no, case managers do not do that." Hmm, we were told we couldn't do it without their help and now they don't do it.

If we could set it up (out on our own here) she would present it to the medical director of the insurance company to get it approved and they would then pay the 80% of the consult fee they pay in network providers. His answer: "No, the other hospital is out of network and we have in network providers in Portland."

We are already seeing the ONLY in network provider and need a SECOND opinion. Their only suggestion was that "we could go wherever we wanted but they would only pay an out of network rate unless there were no other in network providers available..." "Ok," I asked, "so WHERE can I go for a second opinion that you will pay the contracted amount for since we are already seeing the ONLY in network providers in town?" The answer: "University of Washington..." They would pay for us to go hundreds of miles away but not to go across the street.

It completely eludes me that they will gladly pay out $30,000-$50,000 for radiation without batting an eye but balk at paying for a second opinion to make sure that is necessary.

Only through God's intervention we were able to get an appointment set for tomorrow morning and an agreement from Doernbecher/OHSU that we didn't need the money up front. We are grateful for that! I guess we will fight the insurance company again when the bill finally comes. Stand in line.

I knew it before but never lived it - reading the fine print as to what your insurance company actually covers or doesn't cover is scary and getting them to live up to their own agreement is even scarier.