Thank you so much for calling Divided Health Insurance. Can I get your ID and group numbers, please? And your birthday? And your social security number? And every claim number we haven't responded to so far this year?
Haha! Just a little insurance humor! Obviously, that would take far too long! How can I help you today?
Okay. Well, questions on medical procedures we refused to cover will be a different department. You'll be on hold for at least 45 minutes before you hang up in an impotent rage, so may I help you with anything else before I transfer you over?
Ah, finding an in-network provider is tricky. Of course, none exist in your area and if they did, they wouldn't be taking new clients, now would they? Also, once you found someone, eventually, after several thousand hours scrolling through our list of supposedly in-network doctors who no longer live within 500 miles of you and/or lost their medical licenses, they would immediately stop being in-network with us because we lowered our “allowable” costs and now require them to get pre-approval for all prescriptions from our knowledgeable nurse hotline staff. (Psst it isn’t even a nurse that answers the phone! Isn’t that a hoot??)
Doctors get sooooo crabby when someone who hasn't met their patient, and has no knowledge of their medical history, questions their “medically-necessary procedures” or whatever. Haha, doctors with their egos!
What were we talking about again?
Right, in-network providers. So that's a no-go. We DO cover 60% of allowable costs. (What's 60% of zero!? Haha, JK as my daughter says! Okay, I don’t have kids because we all know that a succubus can’t procreate, but I totally feel like a mom in this job!) But anyway, that 60% goes into effect after the deductible gets met. So that'll be like September or something unless your kid is dying. Ha!
Oh, so sorry. Well, just call us in March. Or sooner. However that goes.
Also, medical and behavioral deductibles are separate, and each family member must contribute to the overall deductible. And in-network deductibles are separate from out-of-network deductibles, which are separate from claims and procedures and other medical-sounding words.
If that's all then… Oh my apologies. You had some questions about pre-procedure estimates? Just have your doctor give us a call here and- oh he called and was on hold for over an hour? Well, we are super swamped right now with the holidays just last month. We need everyone except us to be a little flexible here. Maybe he can just call back at a less-busy time? For us, I mean, of course!
No, we don't have any doctor portals or specific numbers for medical professionals to call. Why do you ask?
What if he just writes down a detailed list of every procedure, diagnosis, and a minute-by-minute cost analysis, and then you mail that to us? Make several copies first, because we will absolutely lose the first one you send and then subsequently scan the next two you mail to us “weirdly” and then deny the pre-approval because the numbers are blurry.
It's a good thing you don't have a day job and have unlimited cashflow from that inheritance, isn't it? This is like your full-time volunteer job! It's good to have a purpose.
Now, one bit of reassuring news: I have here in your file none of the notes that you say the last rep was supposed to have recorded and continued to work on. Also, it says she closed out your requests with a non-re-openable “FINISHED FOREVER” stamp? No wonder she never called you back! But it does say here that we found a psychiatrist for your teenage daughter. In-network, which honestly, shocks the hell out of me. Can you hear the other reps whispering behind me? Nobody can believe it!
But yes, we found a wonderful new psychiatrist for her to see. Dr. Jones is located downtown at the free clinic and sees paying patients on Thursdays from 10 AM-11 AM. I would recommend that you schedule well in advance because she mostly focuses on senior citizens with dementia. She is currently in-network, but call fast. We all know that could change by tomorrow.
Okay, so here's that number for your daughter and I will have to sign off now. I get a 4-hour maximum with each client per day and have reached the end of that time allotment! Thank goodness we got so much done, though! I’ll transfer you over to the “Why we didn’t pay for your medically-necessary procedure” department now.
Thanks again, and I look forward to not being available tomorrow, so you’ll have to go over all of this again with someone completely new! Have a great day!