Tuesday, December 28, 2010

When Your Incompetency Becomes My Problem


Muffin has been in private therapy for going on 3 months now.

At his first evaluation with the Speech and Occupational Therapists we were told our insurance covered 50 appointments a year at our regular $25 dollar copay.

Two weeks ago it came to our attention that OT was a $75 copay.  What?  OK.  I guess we can deal with that.

A week ago I learned that the "girl" and I say that with as little respect as I can, that "verified" my benefits made a mistake.  Turns out, it's $75 every time I walk in the door no matter what kind of therapy it is.

I think my exact words to her were, "What?"

I'll never forget the way she said it.  "Sorry, your insurance company mis-quoted the copay."  She said it like it was the difference between $1 and $1.50.

I lost it on the phone with her.  I started crying and asking what the hell I was supposed to do about the unknown bill that I had been racking up.  Twice a week for 3 months and no one says to me, "By the way, do you know it's actually a $75 copay?"  3 months, $75 twice a week...you do the math.  I hung up on her.

I called my insurance company in hysterics.  The lady kept asking me to stop crying, I think she actually felt bad for me.  Turns out they record all the calls they have with those people that verify the benefits so they know exactly what was said.  She was quoted the correct amount but then called back 30 minutes later and then got the wrong info.

I'm waiting to hear back from the practice.  The whole reason for this increased copay is that the practice is owned by the hospital and not a physician.  Geez, I sure wish someone had mentioned that to me beforehand.  If it was your job to verify benefits, don't you think you would know to point out that the practice bills as a hospital and not a stand alone clinic.  Wouldn't you know that this makes a big difference in the amount that your clients have to pay when they receive treatment? 

The worst part...Muffin will never see those ladies that have worked such miracles with him.  Three months of getting to know him, down the drain.  He actually looks forward to going.  I feel so bad for him.  Now he has to start all over again with evaluations and scheduling and uggg.

Please pray that we don't have to pay this bill.  Please...

9 comments:

Shell said...

How incredibly frustrating! Saying a prayer that it all works out.

Ashley said...

Ugh I'm so sorry! I really hope it works out in your favor, that's just crazy!

dotcomkari said...

OMG sweetheart, I truly feel for you. I wish I had the money so that I could help you out I truly do. It is a joke how much these theraphies cost and how big of a killing insurance companies make off of us mothers. It isn't fair.

Someone SHOULD have told you months ago. YOU should not be responsible for this huge bill. :( I hope you get it worked out soon

Tezzie said...

Oh, wow...that's TERRIBLE! I feel so bad for you...and I can sure understand that you'd be incredibly upset by their incompetence! I truly hope and wish it all works itself out and you don't end up having to pay.

Rebecca said...

Oh my God...I'd be ready to wring that girl's neck! Given the fact that they have the recordings, maybe they could figure out some way to waive the fees??? Or list it as another code? I don't know...grasping at straws...ridiculous.

Clayton Thomas said...

I am really sorry for this- especially for Muffin. Hopefully you'll find someone soon who can continue his progress.

Clay
http://www.tantrumstroublesandtreasures.blogspot.com

Danifred said...

That totally sucks and I am so sorry. I can't understand how some people can continue to be employed. Praying for you!

*Jess* said...

oh hon, that is awful, just awful. You shouldn't have to pay for someone else's mistake. I hope something works out :(
Do you have Early Intervention programs in your state that will pay for therapy? Have you ever heard of TEFRA before? That's how we pay for therapy in South Carolina. Our insurance does not cover developmental delays at all, so we'd have to pay 100% out of pocket if we didn't have TEFRA.

Itsy Bitsy Spider said...

I found you through the SPD blogger network and I wanted to let you know that you are not alone in this kind of mistake. We had the same problem with my daugher's speech therapy and racked up close to $1,500 in just three sessions!

One thing that did work for us is to call the billing department for the therapy office directly. Explain the situation and see if there is some kind of payment plan you can work out together. Our clinic was willing to discount the total by 35% if we were willing to pay in a lump sum before a certain date.

It's not the best solution... the best solution is if people could just get this crap right in the first place. But it might help out a little.

My prayers are with you!