Sometimes, I look at other bloggers and I think, “Man, she has really got this stuff figured out.” I am not one of those bloggers. I blog in hopes of one day figuring it out.
What I’m trying to figure out right now, is what I could have done differently to have not been taken by this much of a surprise. Here’s a little recap of the surprise phone call while I was at the park with the boys last week. It was from a very nice woman whose name completely escapes me because my memory could barely take in the latter half of the conversation.
Me: Hello, this is Tatum
Her: Hi, I am [insert name here], I work in billing at Pediatric Home Service (PHS) and wanted to let you know that Owen’s invoices have begun getting rejected from insurance because they say you have reached your DME max for the year. I just wanted to make sure you’re aware that we are going to start sending you some invoices. We don’t want you to be surprised.
Me: Oh. What exactly falls under DME? (See, I’m still trying to figure this out!)
Her: DME is Durable Medical Equipment, it’s everything we do.
Me: Everything?! So, his oxygen, oximeter (monitor), all the oxygen tubing, feeding bags, feeding pump, nebulizer equipment…and everything else? (It’s a three page order list)
Her: Yes, everything. Did you know that your insurance dollars ran out?
Her: I was afraid of that, that’s why I wanted to call to see if I could answer any questions.
I was at the park with the boys and another mom, who is also a customer of PHS (a great company, by the way) so, I cut the conversation short, but obviously had to go back to it later because I had a-whole-lot of questions.
The next morning, I called the insurance company first. Another really nice woman was very reassuring as she begin to pull up our account that, “something must be wrong because oxygen and feeding supplies are medically necessary” and then she paused and said, “oh…you have a $Xthousand per year maximum”
So, I asked, “when did that run out”.
“The first couple days of August.” Was her reply.
So, here we are, two months into it, finding out that we are going to be paying 5/12 of the year on all of Owen’s oxygen and feeding equipment and no, it does not go towards our annual out-of-pocket max.
Let’s just say, we hadn’t budgeted for it.
Really deep breaths!
All I could think was, what did I do wrong?! No, I never read our insurance policy, but even if I had, I didn’t know what DME was so I’m not sure it would have helped. I guess, I never imagined a scenario where oxygen and feeding equipment wouldn’t be covered. I knew to call on the helmet and therapies, but oxygen and feeding equipment … I mean, the alternative is being in the hospital? They prefer us at home, right?
Our conversation ended with me politely asking the process for filing an appeal. Wish us luck!
I know that’s an abrupt end to the post, but that’s as far as the story goes. I’m writing about it now because I hope that others can learn from our mistake. I can promise you, the 2013 insurance manual will be read and I will be on the phone with the customer service person until I understand every possible out-of-pocket expense. As one of my grad school professors used to say, I will know that manual in “excruciating detail”. (I didn’t like that prof much, but I don’t really like details, especially the excruciating kind).
Just a couple of things before I end:
1) I’m not sharing this to ask for money or donations of any kind. I’m only sharing, because I know I’m not the only person that’s been taken by surprise and if someone else can not get in this situation, than it was worth sharing. However, if you have advice on insurance appeals – I’m all ears!
2) Healthcare costs are a hot topic in the political landscape. I, personally, find politics fascinating and love to debate them. However, this blog is not a political blog. It’s a blog about Celebrating, Connecting & Healing in relation to premature births and special needs. If a comment is made that is politically minded and goes against Celebrating, Connecting & Healing, or even sort of suggest telling others who to vote for, I will delete it. That’s not because I don’t think healthcare costs or this election should be discussed, it’s that I think there are better venues than this blog to do it.
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