Oh good grief

It’s a funny old world we live in.

Back in September, Henry knocked a table on his hand while at our local church building. I took him to an urgent care place where they diagnosed a hairline fracture and gave him a splint to wear.

Some time later, I received a bill for the full amount of his care. It said there was no insurance claim pending. I didn’t pay it because it seemed high for being insured and didn’t seem to have been submitted to my insurance. I waited a while because sometimes the provider will send a second, smaller bill after sending it to insurance.  That never happened, and then I received another bill, by now past due, and every time I would call the billing department it turned out to be before or after hours.

Today I remembered to call during business hours, and got someone who told me that my insurer had denied the claim because of “third-party liability.” I said it didn’t seem like the Church would be liable since Henry knocked the table on his own hand, and I told her that in the past when another child of mine had a similar injury, my insurer has sent me a form inquiring about third-party liability, but that I had received no such form. She told me to call the insurer and ask why they’d denied the claim and ask them them to re-process it.

So I did, and my insurer said they never received any claim at all for the services. They said to call the provider back.

This time I spoke to someone else, who told me that the first person had told me wrong, and that in fact they had never actually billed the insurer, because usually when an accident happens at a “facility” such as “a park, or a church,” the insurer is likely to request more information, deny the claim, or ask the patient to pursue the claim through the third party. Well, OKAY, but none of that will happen until my insurer is billed in the first place, right? And it’s not as though the bill we were sent gave any of this information or suggested making a claim to the Church.

So, now the provider’s going to send the bill to our insurer and get the ball rolling on the rest of the process.

The thing that makes this all even sillier is that Dean works for a church-owned school whose insurance company is also owned by the church, so if the insurer does end up asking us to make the claim directly to the church, it will be a particularly apt example of robbing Peter to pay Paul.

This entry was posted in Me? Opinionated?, Meanwhile in the real world. Bookmark the permalink.

4 Responses to Oh good grief

  1. Trina says:

    Don’t even get me started on insurance ridiculousness. I’ve spent the last couple of months jumping through all kinds of hoops to try and prove to my insurance company that my appendicitis was in fact NOT a pre-existing condition, so that they will pay the one last outstanding bill (and the provider’s office is threatening collections unless we at least make a token payment). The insurance co. has payed the other claims from the surgery (well, after we met the monster deductible, that is), but this one is “under review” while they try and get my 5-year medical history from every medical professional I’ve ever said “hello” to! What a colossal waste of time and money, and what a source of grief and frustration for me! (By the way, I would NEVER recommend Humana, and if there were another economically viable option for private insurance in Utah, I’d drop them this instant. They have been ridiculously impossible to deal with every step of the way–way back to the application process).

    So, all that to say, I feel your pain, and I’m glad you can find the humor in it (most days the “funny world we live in” attitude eludes me). Here’s hoping t’s all resolved soon.

    • zstitches says:

      You had appendicitis? I’m so sorry for your insurance misery on top of the misery of the condition itself.

      I’m able to have a sense of humor about this one, sort of, since it only wasted about 20 minutes of my time (so far) (plus the nuisance of receiving an incorrect bill and getting around to dealing with it) but whether I’ll be able to continue being lighthearted about it remains to be seen.

  2. Lis says:

    Ahh the insurance nightmare. Is there medical insurance company that DOESN’T do ridiculous things? I’m skeptical.

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