Before I start completely bashing my current health insurance experience, I do have to say that we are very lucky to have had the best possible insurance coverage in place before all hell broke loose with this last pregnancy. They came through big time with the out of state coverage and the whopping million dollar hospital bills. OK, niceties out of the way...
For the past 6 months I've been dealing with an annoyingly small refund issue. While in the hospital, I was encouraged by the lactation consultant to rent a hospital grade breast pump for 3 months. This baby had serious industrial strength pumping ability, and probably lengthened Ava's time on breast milk. As I filled out the paperwork I was informed that I would get a letter from the NICU stating to my insurance company that this was a medically necessary item for our baby's well being. Shortly after coming home, I submitted the letter, a claim form, and the receipt for the rental. 30 days later I received a letter stating that they didn't cover another item on the receipt, which I didn't include in the claim. An hour in waiting on the phone and a frustrating conversation took place, and I resubmitted the letter and claim, sans receipt--as ordered. 30 days later I received a letter saying that I needed to resubmit with changes to "line item" such-and-such. There is no "line item" so another hour or so in waiting and another frustrating conversation later, I resubmitted the claim form, letter, AND receipt--as ordered. 30 days later I received a letter stating that such-and-such code was invalid. I didn't make up these codes, they were provided by the hospital. Another hour or so in waiting and yet another frustrating conversation later and I'm informed that the insurance company had updated the codes 1 month ago and they were no longer relevant in their system. The person on the phone was unable to change this in the computer and had to submit to another insurance employee. I would hear back with my refund in 30 days. 30 days later, no letter and no refund check. I called to find out what was going on. I was told they couldn't find my claim in their system. I started to get pretty annoyed. After giving all reference numbers I guess the claim magically appeared and I was informed (after 30 minutes on hold while discussing it over with his supervisor) that my hospital was responsible for reimbursing the money. Um, does this make any sense? So long story short, I did what they probably expected me to do in the first place. I got so frustrated that I gave up. And then out of the blue, random checks started appearing in random amounts for an "oxygen respirator" refund. I still haven't received the full amount, but hey it's better than nothing. But man, the insurance company is so screwed up. Is there a moral to this story? I guess I would suggest never pay anything out of pocket and expect to get a refund without a fight.
