Health insurance: now it’s personal
I’ve heard the news stories on NPR about how ridiculous the private health care system is when it comes to insurance and billings. I’ve heard about how much time and money is spent just on getting billing figured out – teams of people at the doctors’ offices figuring out different billing codes to different insurances; more teams at the insurance companies to figure out different bills from different providers.
It never really meant a lot to me personally, because I’d been on Kaiser Permanente all my life – a private HMO. I was born at a Kaiser hospital, and was with Kaiser through my parents until I graduated from college. Then I got a job and stayed with Kaiser through my employer. You don’t worry about billing when you’re with Kaiser, because the doctors, billing and insurance are all part of the same entity. But at the end of last summer, I got married and switched jobs – so I needed to get health insurance through my husband’s job, which doesn’t provide Kaiser as an option. Instead, I’m now on CIGNA.
I needed to find a doctor fairly soon, since I could no longer get my birth control shots through Kaiser. So I went to the CIGNA website, found a recommended provider – a doctor at OHSU – and signed up for the standard introductory appointment. I had the appointment in January, and everything went fine. She gave me a prescription for Depo, got me an appointment at the office for my next shot, and everything was fine. Take note here that CIGNA recommended this doctors office as a partner on their site.
Fast forward to April, when I get my next Depo shot. I’ll just briefly mention that even though I had an appointment – the very first appointment of the day, so there was no one before me – they were still running 45 minutes late, so I had to wait 45 minutes to spend about 90 seconds in a room getting a shot.
Fast forward again to a couple of weeks ago. I get a bill from CIGNA saying that they won’t pay the $117 for the shot because I haven’t met my deductible yet. I also get a bill from OHSU saying the CIGNA hasn’t paid the $221 for the vist. So I call CIGNA, and ask why they’re saying I have to pay $117 for a Depo shot, instead of the $20 co-pay that it should be. They say that OHSU billed it incorrectly. So I call OHSU, and (after getting hung up on once) they say no, the billed it correctly, and I should have CIGNA call them. So I call CIGNA back, give them the number and they call OHSU. Then they tell me that OHSU refuses to change the billing, CIGNA refuses to pay for it, so I’m just out of luck.
At this point I give the phone to my husband, because he is very good at being aggressive in these situations – but in a constructive way, not in an “I’m really angry and going to shout at you” sort of way. He spends a while on the phone with CIGNA, without much luck, then spends another while on the phone with OHSU. The current state of things is that OHSU is going to try to work something out – but I still have no idea whether we are going to be expected to pay $221, $117 or the actual $20 deductible that our plan says a Depo shot should be.
Two of the most routine office visits possible, with a doctor that is a preferred provider for my insurance, and already I’ve spent more time working on straightening out payment than I ever did in 26 years with Kaiser. And the issue isn’t even resolved yet! So now this whole health insurance issue is personal to me. This system does not work. If this is how the private health insurance system works in what should be ideal circumstances, things are very, very broken.
In the mean time, I’m going to Planned Parenthood for my next Depo shot. They will charge me less than $221 (or $117, for that matter.) And the instant one of us gets a job that offers Kaiser as part of the benefits, we’re switching back.
I’m sorry you had such a frustrating experience. If you would like, email your contact info to SCR_isolve@cigna.com and I be able to assist you with this.