Archive for the ‘bureaucracy’ tag
Insurance and Anaplastology
I was recently asked about a comment I had made in another post regarding insurance policies and their coverage for anaplastology. The other post wasn’t really about that, but the truth is, this is something I think a lot about. It isn’t really something I know much about though. I mean I’ve certainly kept my ears open for snippets of information here and there around our clinic, and the clinics I’ve visited over the years. Most of what I’ve gathered from all of that though, is simply that dealing with insurance companies is going to be a royal pain if I should ever open my own clinic. And given my own skill set and history with handling bureaucracies I’ve pretty much decided well ahead of time that I am not someone who should open a private practice until I believe that I can cover the costs of hiring someone else to handle that aspect for me. I’m more the type who has spent large swatches of their adult life without any health insurance because I find such bureaucracies so challenging to navigate.
But here I am, author of this little blog, and it occurs to me that maybe I should do a little looking into just what kind of coverage is available out there for anaplastology cases. So I called a couple of places with questions. Now, my first attempt at this was late on a Friday night (which sadly probably does speak zounds about my personal life these days.) I tried to reach Blue Cross Blue Shield, but found myself on hold for roughly half an hour. It was at this point that I came to the conclusion that I was likely waiting on line with people who had real emergencies and not just a curious streak, so I decided to call back later. The following week, I found myself thinking about it again during regular business hours and I decided to try again. This time I started with Medicare.
The number I called to reach Medicare was 1-800-633-4227. I was on hold less than six minutes, but then when I did reach someone, it was impossible to get any real answers. First, the woman answering had never heard of anaplastology. She was very nice about looking up as much as she could for me though. Eventually she was able to tell me that they covered the replacement of arms, legs, eyes, and orthopedic braces for the back, foot, or neck. She suggested that I call individual clinics to ask about whether Medicare was accepted or not. After a 25 minute conversation she attempted to connect me with another branch, but there was no hold music this time, and after 15 minutes I decided that the transfer must not have gone through and hung up. So that was disappointing.
Next I went back to Blue Cross Blue Shield. The number I called was 1-800-633-4227. They were much trickier to even get to the hold part, with a lot of push button questions, none of which offered an option for questions about anaplastology coverage of course. And then when I did get to the hold part of the call, I couldn’t help but write down the phrase “discussing policy benefits is not a guarantee” which was actually part of the recorded loop playing while you were on hold. I mean I guess I get it, but hearing it over and over again while I waited just played into some pre-conceived notions I already have going about these guys.
When I finally did get through with someone, he was very adamant about how there were no over all options or plans. It got me wondering about how much negotiation is really involved in setting up an insurance plan. I tried to use the example of seeking coverage for visits to an anaplastologist regarding two missing fingers. I thought that would make things easier, and also should let me know if there are differences in the way facial and somato cases are handled. I was told that the question didn’t really make sense, because coverage packages vary, and as an individual seeking to set up a service plan, you wouldn’t be able to get care for a pre-existing condition anyways. So basically it could only ever come up if someone with a coverage plan in place was to loose those fingers while insured and they would then have to check their plan for coverage at that point. I was shocked. I didn’t think discluding coverage for pre-existing conditions was even legal anymore, but I guess it is. The man I was speaking with then tried asking me about the code for the service I was trying to ask about. It sounds like there are ways to look up specific procedures if you have the right insurance code to search under, but I didn’t have anything like that. In the end, the most information I was able to gather about BCBS’s coverage was at the following link which describes prosthetics coverage, discluding lower limb prostheses.
*On second review, I realize that to get to the intended page you must first click to agree (I believe the agreement is not to hold them to anything they say), and then perform a search for the word prosthetics, search all, and then select “Prosthetics, Except Lower Limb Prosthetics”
I was also given a number to dial for providers, 1-800-972-8088, and I tried that but it was after hours when I did. I did notice that the initial phone options were limited to the categories, medical, pharmacy, dental, and behavioral health. So I think that even if I had caught them in their regular hours I might not have been able to establish much.
Honestly I think I’m more confused now, having attempted to clarify information than I was before making these calls. I’d made the calls in an attempt to understand how anaplastology was covered by the major insurance providers. I was interested specifically in if there is a difference between how facial and somato prostheses are covered, or if that idea is just a misconception I picked up by not having the full story. But in the end, I think I just learned more about why no one likes dealing with insurance companies. And I once again spooked myself about the prospect of ever needing them with regard to my own health. To be fair, I spook easily about that particular topic, but really, I have yet to understand how anyone ever gets treated for anything in today’s day and age. And I find that terrifying, both as a human who sometimes needs medical care just like anyone else, and also as someone learning to be a clinician, who at some point will need to understand the system from the side of the care-givers as well.