Why I Hate Health Insurance Companies

I apologize for the way TMI nature of this post.  I just couldn't think of a way to tell this story without being vague and possibly making you all worry even more.  Since so few of you know me in real life, I don't mind talking about this.  Also, I really want to call this insurance company out by name, but The Lawyer said not to.  They have yet to pay for a single claim without me having to contest it.  They deserve to get called out on the internet!

My study partner, Alissa, was the first one who pushed me to see another doctor.

I had been having pelvic pain since August, but as most medical students are wont to do, I ignored my own health and kept going.  I wasn’t bleeding or immobilized, so how bad could it be?  I scheduled an appointment with an Ob/Gyn, but couldn’t get in for two months.  No big deal, though.  I didn’t have time before then anyway.

Except…

Sometimes medical school lectures can be terrifying.  A certain well-timed lecture in September sent me running to Student Health. 

The doctor there began to dismiss me as being “extremely low risk” for anything of substance, until I could identify my pain very specifically during the exam.  

“Right THERE,” I could tell her.  “It’s…THERE.”

She was surprised at how acutely I could identify the pain and not being able to do a better exam in the Student Health Center, she ordered me to an Ob/Gyn immediately. 

“I have an appointment for next month,” I explained to her. “Well, tell them that you’re in a lot of pain,” she encouraged. “Exaggerate what’s going on to get in sooner.  The receptionists aren’t going to know the difference.”

I probably should have done this, but I didn’t have time for an earlier appointment anyway.  So, I waited another month and on the much anticipated day of my visit, I was ready to present my detailed history to the provider.  I told her what the doctor at Student Health had said and waited for her to work her magic.

But, she didn’t.

She didn’t even examine my area of complaint.  Instead, she laughed me off and said that because I’m not sexually active, it was probably nothing.  She said that if it was serious, we’d know, because serious things are “painful and persistent.”  Except…was I not presenting with pain?  With a duration of two months?

That night, when I rejoined Alissa to study, she was horrified. 

“You need to go see someone at the hospital!,” she told me.  And, I planned to during Christmas break.

Last week, though, the pain reached its highest level since the summer.  I had stopped by The Lawyer’s condo on my way home and during the course of conversation, I ended up telling him.  He knew that something bad had happened with the last Ob/Gyn appointment, because I had alluded to Alissa’s anger, but up until this point, I hadn’t told him the specifics. When I told him the details of the situation, he was visibly upset.

“I want you to see someone tomorrow,” he said sternly.  “This is important.”

I don’t know if I rolled my eyes or just looked away, but he took my head in his hands.

“This is really important,” he said again.  “More important than school.”

I skipped my classes the next morning to call around and see who I could coerce into an emergency appointment.  I let his words echo in my head as I cursed my truancy.  “This is more important than school.”

The Lawyer had to fly to NC for business the night after I talked to him, so he was keeping in touch with me via text throughout the day.  When he called after my appointment to hear the verdict, I accidentally started crying.

The doctor had found something, for which she couldn’t identify, and had ordered a CT scan.  Although she was sure that it wasn’t endometriosis, her mention of a condition that could compromise my fertility had set me bawling right there on the exam table. 

The one thing that I want in life, more than to be a doctor, is to be a mother.  I didn’t realize that I’d still be emotional even after leaving her office, but within seconds of answering his call, I was crying again.  There I was on my way home:  scared, panicked, and tearful.  And, there he was two states away:  cursing the timing of his business trip and telling me that he was sure that it would all be OK.

This morning, I called to make the CT appointment.

What happened over the course of an hour was:

1.        An outpatient radiology facility near the hospital denied me an appointment, because I am allergic to penicillin.  They said that “people with allergies tend to have reactions to IV contrast.”  Of course, since I’m a medical student, I made the receptionist put the nurse on the phone.  People with what kind of allergies?  What is in the IV contrast?  Are we talking a Type IV Delayed Hypersensitivity or anaphylactic shock?  There’s a huge difference.  The nurse said she had no idea what was in the contrast or what the range of reactions were, but if patients have had any sort of allergies, they send them to the hospital.  What?  Seriously?

2.       So, I called the hospital.  After navigating the spider web of departmental offices, I finally got connected to radiology.  I relayed my life history, even though it should be in the system already, only to have them tell me that my insurance has been denied and that they can’t make an appointment without insurance.  My insurance ISSUED BY THE HOSPITAL was denied BY THE HOSPITAL WHERE I AM A MEDICAL STUDENT.

3.       I called the insurance company.  After four attempts to speak with a representative, I spoke to someone for 5 seconds before getting cut off.  I called again.  And again.  And no one has answered or returned my call.

Internet, this is how people end up with acute crises in the ER.  One of the reasons I was so reticent to deal with this problem is because my insurance company pays for nothing.  Currently, I owe over $1000 out of pocket, for an unpaid claim to my ENT for this and for the first Ob/Gyn appointment, in which the provider didn’t even examine me. 

I am a young, almost entirely healthy person with only a few minor issues.  If my insurance company is paying for none of my claims, what happens to people who are legitimately ill?  I used to think that doctors who ran cash only practices were just money whores, but you know what?  I get it.  I totally and absolutely understand why they do this.  Aside from the fact that I am currently a poor medical student with no other options, I also get why people would opt to see these physicians and pay out of pocket to avoid dealing with insurance companies.

It’s the worst feeling in the world to have a real medical issue that needs further investigation and then, to not be able to schedule an appointment and use the insurance coverage that you’re paying for.  When you can’t even communicate with the insurance company denying you the coverage, it’s enough to make you wonder why you’re paying for insurance at all.  (I will confess that the only reason that I do pay for health insurance is fear of the worst.  What if something really, really bad happened?)

Next time some derelict wanders into the ER, I’m going to ask if they ever had health insurance.  Because let me tell you, aside from The Lawyer trying to find a cash only radiology place where he can pay for my CT scan out of pocket (Not a joke.  This is what he’s doing right now, as a backup plan), that’s exactly where I’m going to end up.

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UPDATE:  I finally got through to the insurance company this afternoon, who said that I don't need pre-authorization for radiology visits.  While I was working on insurance, The Lawyer found a doctor's office willing to get me in ASAP.  Unfortunately, the doctor's office disagrees with the insurance's pre-authorization claims.  They said that they need pre-authorization from the company that processes the insurance claims, not the insurance provider itself, and this will take 48 hours.  I don't know enough about this to comment, but the first outpatient clinic said something similar, so I guess that there are multiple levels of authorization.

Total time lost dealing with this today:  2-3 hours (me); who knows how long (The Lawyer).

Thank you for all of your helpful comments.  I was so frustrated that I didn't know what else to do, besides spew my rage onto the internet.  You guys are awesome.