Unbeknownst to me, Anthem has taken over Blue Cross/Blue Shield.
When I first heard the news, I didn't give it much thought, as both Mad and I have insurance through BCBS of California (MTQ and 3DB are both based out of Southern CA). I thought it was only affecting people with BCBS of MO.
Prime example, NoBeatDebi.
Late last year, during the Christmas holiday, NBD started having some back problems. She initially thought she had pulled a muscle or something similar, but the pain didn't go away after the usual amount of time. She went to doctors, who referred her to specialists, and to make a long story short, she was eventually diagnosed with a degenerative disc disease.
Which sucks.
Essentially, this is an ongoing problem that will get worse (and already has). After a variety of tests, prodding, probing, MRIs, etc. etc., it was decided that she needed surgery to correct the problem. After mentally preparing herself for the surgery, she took all the necessary steps, making arrangments for work, for day care of her youngest child, and all the red tape and hoops you have to jump through for major surgery.
The DAY BEFORE she was scheduled to have surgery, she gets a phone call from the surgeon's office and a Fedex letter from Anthem. They have denied her surgery, claiming it isn't necessary. Sure, the surgery will cost in the $70k range, but she is at a point where she cannot stand for more than 30 or 45 minutes without being in severe pain. She can barely walk without assistance from a cane or a walker, and doing simple tasks like laundry or grocery shopping are just out of the question.
She is in the process of appealing their decision, and is now on her THIRD opinion. She is on extremely high doses of pain medication to just barely function, and is essentially a prisoner in her own home.
In fact, she is so bored and frustrated with life, that she has started her own blog
Photos from Isolation in an effort to bring some normalcy back into her world.
I hate that she has to go through this, and try to make sure to call her and help keep her spirits up. We'll be reaching that 25 year mark of friendship this fall (we met on my 13th birthday, the first day of high school). And to see someone that close to me be in such pain, both physically and emotionally, just hurts me. It's things like this that remind me that I should be having my own conversations with God much more often.
Back to the main story.
On 7/17, I had my annual physical. Yeah, I'm kind of a dork, and I get a physical every year. But I have an underactive thyroid, and being adopted I don't really have a medical background of my family, so I'd rather be preventative than find out one day (probably while laying on the floor with someone beating on my chest to keep me alive) that my heart isn't in the best working condition.
On Saturday, I get my standard Explanation of Benefits in the mail. First off, I notice that it no longer says BCBS of CA on the EOB, but states VERY clearly Anthem.
Shit.
Then I notice that they didn't cover the physical, as it isn't part of my coverage.
WTF????
Are you kidding me? They won't cover a $150 physical that could prevent them from covering a $15k illness/operation/hospital stay? This sucks.
So Monday I call Anthem to determine why the service wasn't covered, and to see what I need to do to avoid owing my Doctor $150. After countless minutes on hold (listening to the CRAPPIEST muzak EVER), I get CSRStupidtown on the phone.
EJ9: Hello, I have a question about an EOB and services that weren't covered.
CSRS: Ok. How can I help you.
EJ9: I noticed that the services on 7/17 were denied. Could you please explain to me why a physical isn't covered under my plan.
CSRS: That claim was denied due to a non-covered diagnosis.
EJ9: Yes, I can read that. I was curious why the diagnosis was uncovered. It was an annual physical.
CSRS: Well the diagnosis code your doctor's office used was V709.
EJ9: Ok. What does that mean?
CSRS: That diagnosis isn't covered.
EJ9: (growing slightly frustrated) I realize that. What does diagnosis code V709 stand for.
CSRS: Oh. It's "unspecified general medical exam".
EJ9: Ok. Does my plan cover an annual physical?
CSRS: I don't know. You'd have to check with the coverage department to determine that.
EJ9: Ok. Is there a diagnosis code for "annual physical"?
CSRS: Of course. If your doctor's office resubmits the claim with the proper diagnosis code it will be covered.
EJ9: (thinking why would you know this if you didn't know my coverage?) So, my doctor can resubmit and, provided the right diagnosis code is submitted, the claim should be paid.
CSRS: That's what I said, isn't it?
EJ9: (growing more and more frustrated) What exactly is the diagnosis code the doctor's office should use?
CSRS: I don't know that. The doctor's office will know it though.
EJ9: Really? Because I would assume that if they knew the correct code they would have used that to start with, rather than have the claim denied.
CSRS: What do you want me to say ma'am?
EJ9: Nothing. Absolutely nothing. Thank you SOOOO much for your help.
Of course, I contacted my doctor's office and advised them of the claim being denied, and that it could be resubmitted. I do NOT want to be charged the $150 for a service that should be covered. I do NOT want to deal with Anthem any more.
I can't even imagine the frustration NoBeatDebi's going through with these fucktards. Considering a simple procedure like a physical can't even get approved, I can't imagine how difficult her fight is going to get.
But she shouldn't worry. No matter how difficult it gets, I'll stand beside her, even if it's to act as a crutch so she can stand tall and bitch at them at the top of our lungs!