Who’s on First?

With this blog, I rarely find a need to rehash previously hashed material.  This is in large part due to the fact that cancer never seems to stop providing me with new and unexpected (not to mention unwanted) subjects to occupy my mind and, consequently, this corner of cyberspace.  Nonetheless, there is one area that I feel as though I must revisit as it is seemingly harder to kill than the cancer itself – the comedy routine that passes for insurance in this country. 

For those of you who may not have read – or just may not remember – a few posts back I wrote about my most recent frustrations with my insurer (https://itsinmyblood.blog/2019/06/27/incompetence-by-design/).  In that post, I discussed how my then-insurer was refusing to pay a small bill – by small I mean approximately $45,000 – because, it claimed, it was not my primary insurer.  Thus, until the insurance company that it alleged was actually my primary ponied up its share, this insurance company was happily going to do absolutely nothing. 

I am a big enough person to admit when I have made a mistake.  And, as painful as it may be to do so, I have to admit that I actually did not make a mistake.  I was, however, unwittingly complicit in the well-intended mistakes of others.  You see, unbeknownst to me, on August 1 of last year – a day when I was busy enjoying a cocktail of three highly toxic chemo infusions – my wife’s new employer’s insurance kicked in.  This despite the fact that the insurance from her old employer was not set to expire for another two weeks.  So, despite my claims – which were heartfelt – that I only had one insurer at the time (whom I won’t name other than to say that it shares its name with a world-famous university, which is not my famous alma mater of West Virginia University) apparently I did, on the date in question, actually have two insurers. 

Stepping back for a moment, this seems like anything but a problem.  At the risk of sounding political, the issue so many Americans face is not being able to obtain any insurance.  And yet here I was with an embarrassment of riches – of sorts:  Not one but, albeit briefly, two insurers.  How could this be an issue?  Well, let me count the ways.

For starters, the reason that the “university” insurance plan was still being paid for by us was that it did not require me to have my chemo within the ambit of those words that no one wants to hear (and few really understand) – in network.  This was relevant as the facility at which I was receiving my month after month of nausea-inducing, cell-killing poisons was not “in network” for the new insurer.  And since the new insurer of course only pays for the magical “in network” providers, the $850,000 worth of chemotherapy I endured would not be covered.  Melissa and I have tried to establish a rainy-day fund, but our fund does not cover Noah-like events. 

But because we were still shelling out money for the “university” plan, it should nevertheless cover these costs, right?  Well, maybe.  The next issue is one of who is paying first.  Because we did not even know that the new insurance plan was in effect, we similarly were unaware of the fact that under some cryptic rules known only to the insurance companies there is an automatic reshuffling of which insurer is first and which one is the secondary.  Despite asking politely – more or less – for an explanation of these rules, which are about as clear as when the infield fly rule is invoked, all I was able to comprehend was that somehow it has to do with the subscriber’s birthdate.  Melissa is the subscriber, but the fact that she is an Aquarius – and I just a Taurus – does not seem to elucidate much for me.  Also, apparently, since the new insurance is, well, new, there seems to be a presumption that it gets the dubious honor of first dibs on paying new bills.  Thus, the non-collegiate insurer is, somehow under these arcane rules, first at bat. 

All of this matters because the university-named insurer won’t pay a penny until it finds out what the non-academic insurer will pay.  The answer to that is, as we all know, of course $0.00 (or close to it), but on we go with this game.  And rather than just say, “We aren’t paying – you were out of network”, we instead must go to committee.  Since going to committee – which in this case is euphemistically called a “Coordination of Benefits” conclave – is the absolute least efficient way to ever resolve anything, we will continue to allow these bills to sit unpaid. 

I realize that I should not worry.  But, to be fair to me – which I consider of supreme importance, laboring through the post-chemo world in which I now find myself, I have difficulty taking comfort in the knowledge that this should get worked out.  There are just too many things that can go wrong.  In addition, and perhaps I am overly-sensitive, but whenever I get a piece of mail or a text in the middle of the night stating that I owe someone thousands of dollars, it makes me a bit edgy.  Until I get something in writing – always, always get it in writing – stating that the bill has been paid and everyone is happy, I will not be able to rest easy with this issue.  At the rate these organizations are moving and “coordinating” – wink, wink – this could easily result in my provider starting a collection action against me.  And it would be sort of hard to blame it.

If they don’t get this resolved soon, I may have to go nuclear on them and call a local TV station’s consumer protection reporting division.  I think they might find it interesting that someone who has cancer can’t get his bills paid even though he has not only one but two insurers who are on the hook.  Oh, and one more thing, both insurers are owned by the same company. 

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