Praise then darkness, and creation unfinished

I went to pick up prescription refills today, and they tried to charge me a lot more than last month, because the health insurance coverage isn't showing.

cattitude's last day at Microsoft was April 30. We filled out the COBRA* stuff as soon as they told us how, and then sent in the check as soon as they sent us the paperwork so we could. (Starting next month we can do it online, but they want a check for the first month.) "As soon as we could" means the check was mailed this morning, so of course it hasn't arrived and been processed yet.

They're supposed to backdate the insurance once they get the payment (that's in the COBRA law), but the pharmacist didn't know whether we'd get reimbursed for that $99, let alone how long it would take. So I told her I'd go home and count pills and come back when I need to, and we will call the insurance company. Extremely modified rapture.

Meanwhile, I cancelled my physical therapy appointment for Thursday morning; they'd been charging me something like $11.73/session, until the most recent paperwork from the insurer which said I owed nothing because we'd used up our deductible (dental surgery is expensive). The no-insurance fee would be $200/session. If I was sure I needed this appointment, I'd chance getting reimbursed much later or even not at all, but we're at the tapering off stage where it's mostly strengthening exercises (and basically the same ones the last few weeks), with some stretches, a quick diagnostic check beforehand, and then ice and ultrasound after. If we were still doing traction, I'd probably take the chance of not being reimbursed.

As a side note, apparently there's very little evidence that the ultrasound makes a difference.** My theory on why everyone keeps doing it, other than inertia, is that it's the only part of standard PT that's basically pleasant for the patient, so we all want it. (It's pretty definitely harmless, so if I'm there anyway and the therapist thinks it might help I want it.)

* Explanation for residents of more civilized countries: COBRA is the law that says if an American loses employer-provided health insurance, they have to be allowed to continue for up to 18 months at their own expense, for no more than I think 2% more than the employer was paying. So continuing coverage, and the price advantage of buying in a group. (This is separate from and earlier than Obamacare.)

** The lack of evidence is specifically with regard to low-energy ultrasound as part of physical therapy. The stuff they do to break up kidney stones is also called "ultrasound," because they both use very high frequency sound waves.

I just got a call back from a woman named Ginger at Cigna. She told me that the negotiation department has confirmed that Dr. Geller signed an agreement to accept the smaller total, and that they will be "following up to educate him" on this. I owe nothing. Allow one billing cycle for them to get that cleared up, and then call Cigna back if there is further trouble.


I don't think I need to call the doctor's office again right now; if I receive a future bill I will, and explain all this. And possibly, as mentioned last week, tell them that I will be contacting the attorney general's office.

This is no fun. Then again, nothing else about the gall bladder surgery has been either. Why should this be any different?

Another billing/financial update: I just called Cigna, and talked to another helpful woman, who again assured me that I do not need to pay the $1275 the surgeon is asking for. She got their billing office phone number, and said she's giving the information to a specialist, who will explain to the doctor that I don't have to pay them anything. She said it would take about 48 business hours, and that if I don't hear back from them in that time (which I'm going to treat as end of day Wednesday) I should call again and give her the confirmation number, which is surprisingly short: 4382. I gave her my office telephone number, because my cell phone was acting up over the weekend (though it seems to be okay now).

ETA: Even that sort of phone call with the insurance company, about large amounts of money, is stressful.

More insurance stuff: the automated system says that the $8,000 claim for the surgeon has been processed. Specifically, they paid $6,725 and I am not responsible for any additional amount. This is all well and good, but the payment date given is July 25. That, I think, is the date it was processed the first time as out-of-network at a much lower rate. I didn't want to sit listening to hold music, and am going for now to wait until I get the paper statement, or have some time earlier in the day.

I just got off the phone with Cigna. This time I spoke to a woman named Kimberly.

She agreed that the certificate of credible coverage had been received on May 30. Oddly, she said there was no record of my second phone call, after I got their second letter, or of any activity on this particular claim.

The current situation (in addition to her apologizing for the confusion) is that I have a service request number, 1-2108647621. That service request is her attaching the information about the certificate of credible coverage to this claim. I also stated that this was not a preexisting condition and asked her to include that information.

She told me that I will receive correspondence within 15 business days (that's by August 20) about their review and, I sincerely hope, payment of this claim.

Also, there are no other outstanding claims: everything else related to the hospitalization has been paid.

ETA: I have been to the post office, and sent a certified letter explaining the situation, their stupid form on which I also state that I had never been treated for the condition before, and another copy of the certificate of credible coverage. The post office was pleasantly uncrowded: my wait in line was a few seconds longer than I needed to fill out the certified mail and return receipt forms.

I am well exercised, and came home to an annoying letter from the insurance company. It's to do with one of the bills for the gall bladder surgery. Tomorrow they get one saying that (a) they've already agreed that I sent the certificate of credible coverage*, and this is sufficient; but (b) I had in any case never been treated for gall bladder anything, so it is not a pre-existing condition. Andy has advised me to send it certified mail.

One of the odd things about this is that they have already paid large amounts of money toward the surgery, hospitalization, and such; there's just this one bill they send this letter about, and this one says "third and final." After the second letter, I spoke to someone who agreed that they already had the certificate of credible coverage on file, and said he'd sort it out for me. I really had better ideas of what to do with my lunch hour than go wait in line at the post office.

( so, some gym numbers )

*a certificate of credible coverage is proof that you had insurance from some other company immediately before signing up with this one; with it, they generally have to cover pre-existing conditions.

My physical therapist's office left a message on the machine this afternoon; surprisingly, they (specifically, Diane, who had left the message) were still there to answer the phone three minutes ago.

They need another referral form: while I had eight visits on the first form, and four on the second, apparently the first form expired before I'd used all eight (Ghu knows why), so they've used all four of the visits allowed for on the second referral. Thus, she says, I have three visits upcoming, but need new paperwork.

I told Diane that there was no way I could get a referral, or anything else, from my GP before 8:30 tomorrow morning, so I'd have to skip that visit. She said to come in tomorrow, and then get her a referral.

I was fairly sure I had two more visits left, not three. After I got off the phone, I checked my spare brain, or rather, the "Palm desktop" version thereof. It confirms that I've had ten appointments, all of which I've used [the one rescheduled because I was delayed getting back from Montreal was rescheduled in the PDA, so counts on the day I went, only].

What's fairly clear is that I need to extract more paperwork from my GP's office, which will annoy them and me, I suspect. I don't object to an extra physical therapy session--but if I'm going to wind up paying for it because someone discovers I have had ten already, not nine, I'd like to know how much it will cost, and be reasonably sure it's going to help.