Do Insurance Companies Have Any Sense?

I love this.

The insurance company sent another of those "This Is Not a Bill" forms that are basically a warning of what benefits are or aren't being properly paid for. This one says the hospital will be charging me five thousand dollars.

Huh?

A lot of people who have this surgery are self-funded. Many others...no chance Hades can they afford it. I wouldn't be surprised if a lot of people who self-fund the surgery can't really afford it but do it anyway, hoping they will survive long enough to pay the hospitals and doctors back. More insurance companies are starting to cover the surgery because apparently the people that can understand their own complicated paperwork system and stackloads of billing procedures somehow figured out that the money spent on paying for complications from obesity is less than paying for weight loss surgery among their insured clients, on average.

Did I say they understand their own complicated paperwork system? Ha!

Where was I? Oh, yeah. Insurance covers the surgery more often now. I belong to an insurance company group that now covers, with pre-approval and a checklist of hoops to jump through, bariatric surgery.

But what I save in money is killing me in aggravations. They've screwed up paying for pscyhotherapy, which they mandated I undergo. They nearly turned down approval for the therapy because I wasn't getting psychotherapy...days after they sent a "this is not a bill" telling me they just paid the therapist. That's just two screwups along the way...

...Now they're telling me I owe five grand.

My copay is two thousand dollars. I tried paying that to the hospital...a month later I got a check in the mail for two grand. Huh?

I called the hospital, they said the insurance company paid them. I called the insurance company, they told me they paid the hospital. But they didn't pay the surgeon yet. They're separate? I always assumed doctors kind of work in the hospital, but...um...no?

They told me to wait until the surgeon's billing goes through. This was about a month after the operation...isn't getting paid the kind of thing people put their paperwork in relatively soon after making sure their patient survived the procedure(s)?

So another month later...I get billed for five grand. I think there's a discrepancy.

And because it happened to arrive on a Saturday, I have to wait until Monday to get any of it sorted out. Again.

How is it that we have technology that allows the police to track your whereabouts, including an approximate speed you're traveling, if you have a cellphone...police can track down where you last used your credit cards...the military has satellites that can take photos that can identify, roughly, make and models of cars...but your insurance company to whom you give so much information can't seem to figure out that they paid for XYZ prerequisites, okayed a procedure that will require ABC bills, but then forget that they even okayed the procedure in the first place?

Isn't that a sign that, as a business, you are kind of screwed up?

Hospitals are trying to cut back on some of their redundant paperwork through computerization. Poorly implemented, this can be a nightmare, and I don't know what it's like "on the inside" for doctors in the hospitals I have to work with. But from the patient point of view, the customer point of view, it makes a little more sense now when I'm ordered to have labs performed that instead of getting a piece of paper and walking down the hall to hand it off to a tech I simply walk to the lab and give my name and doctor who ordered the tests and they punch it up on the computer system. Handy, huh?

Insurance companies have the power to bankrupt us, as do hospitals. It's funny that when they want to get paid you better pay up or it's implied that a large man named Guido will be paying you a visit sporting a large baseball bat and shiny sunglasses. But when THEY screw up, what recourse do you have but to hope they don't order a colonoscopy as punishment?

Thanks to various government rules corporations are treated as if they were people. I have to wonder...because of the view, would insurance companies ever have to have colonoscopies?