Frustration With Insurance

So, how does this make any sense?

I had a pulmonologist see me in the hospital when I was there for the week I was admitted and having all kinds of problems. The physician’s bill was paid by my insurance as “in-network”. This pulmonologist is affiliated with my hospital.

Is my pulmonologist in or out of network?

I went to his office for a follow-up appointment shortly following my discharge from the hospital. I received a bill from the doctors’ office. I called my insurance.  He is considered “out of network” for office visits, but “in-network” if I am seen in the hospital? This completely sucks.

My insurance gave me misleading information

Because of the first in-network, out of network debacle, I called my insurance company for a dentist referral. They gave me the name of the office near me that is covered. I went to the appointment and had some expensive work done to my teeth -- nobody tells you how awful cancer is on your teeth! Even the office told me “no payment needed, all covered with no deductible”. Great!

Well, not so great! After a few weeks, I get a rejection letter from my insurance company. The dentist OFFICE is in-network, but the dentist is out of network.

Wait. What? You gave me the location. You sent me to this place, now you are not paying for it?

Yup, the insurance companies get to pick and choose, even after giving you the (not so) helpful information. Now I have another bill for $1,800. When does it end?

A consistent source of frustration

I am now in my fourth year of survival. I have seen all kinds of doctors. It is a full-time job to go to all my appointments. Anything new that comes up, I must call the insurance company, give them the address of the doctor, give them the doctor’s name. They let me know if they are covered or not.

But are they sure? I have had this happen before. Insurance tells me yes, covered. I later receive a rejection notice from insurance. It is frustrating the insurance company gets to make the call of what medical treatment I can receive.

Who really makes decisions about my care?

Again, here we go. Insurance companies deciding whom I can see, where I can see them. This does not make any sense to me. Shouldn’t this be my doctor’s decision?

Have you experienced similar frustrations as Ronda with your insurance company? Tell us in the comments and offer any valuable lessons you've learned from coordinating your care with your insurance company.

Editor’s Note: We are extremely saddened to say that on May 7, 2021, Ronda Beaty passed away. Ronda’s advocacy efforts and writings continue to reach many. She will be deeply missed.