Insurance rant

I just spent forty minutes on the phone with a fine representative of the insurance company. I am appealing their decision to deny my prescription drug coverage for a medication prescribed to me to help me sustain my pregnancy in the first trimester. At least, that was why I called. I became further alarmed when as it turns out, he has no records for me for the entire year last year. None of the medications that they paid for, none of the attempts by the pharmacy to process this particular prescription, none of the prescription numbers, NOTHING. He searched by my ID number, by my SSN, by my name, and found not a single entry. There were no notes from my last call in October. There was, frankly, nothing there to indicate that I was a member of my insurance company's prescription drug plan. He reboots his computer, hoping to find something brand new when he logs in again. There were suggestions that I must have changed my name, registered under the wrong SSN, was covered by multiple plans, had called the wrong company for reimbursement. There was not even a record of them denying my claim to begin with. He couldn't even find the medication in his database. His solution? Have my HR company call them and request an override since my plan does not cover this medication.

(Is it a good time to point out that this same medication has been covered by the plan THREE TIMES in the past? Once by the same pharmacy, same prescription number? Yes?)

I carefully explain to this shining example of helpful service that perhaps I am quite concerned that calling my HR department, explaining my medical needs and requesting that they call the pharmacy line back would be perhaps, unsuccessful, if indeed there was NO RECORD OF ME EXISTING IN THEIR SYSTEM other than an empty database record. I mean, what? Our HR department is lovely, truly lovely, but if they call in a request for an override, they are going to say "Kisha who? What the heck are you talking about? There was no claim denied! This person isn't in our system!"

He did not understand the growing note of hysteria in my voice. I am, at this point, becoming less concerned with the fact that they're keeping a hundred dollars from me than I am the fact that THEY HAVE LOST MY MEDICAL RECORDS. I mean. Hello. HIPAA? Why is this man not alarmed?!

So, he puts me on hold to "talk to another department" about this. When he returns, he fill me in on a big secret.

He was unaware that he needed to look back at 2006 for all of these transactions that I'm referring to.

Because, you know. Just because I gave him dates from last year, and just because it is the eighth of January and therefore, there hasn't been TIME for me to submit any sort of claim form and get it denied in the four business days last week... how could he have known how to look at the records for last year? That's crazy, man.

(The end result, because I hate being left hanging on these things, is that I need to write an appeals letter. I was so worn out by this time that I gave up and agreed to write the letter just to STOP TALKING TO THIS GUY.)

I have utmost faith that they will properly handle my medical needs in the future. Yay, health care!

Interview Meme, part two.

Questions from totte. ;) Exchanging interview questions with the spouse was fun, but difficult, btw. (Grammatically, if nothing else. Do I address M, since he asked the questions, or everyone else?) As before, if you want to play, just ask.

1. What are you most looking forward to about the upcoming motherhood, and are you dreading the most?
I am looking forward to snuggling up with a teeny tiny cute baby, and watching it grow and change and learn new things and become a real person. I'm looking forward to seeing what the M and I look like when put together. I am really excited about seeing M as a dad.

I am not so much looking forward to the feeling of responsibility and worry over the safety and health of a tiny person that means everything to me, because...bad things happen to good people. Accidents happen to good parents. I am also not really looking forward to everyone having commentary about our parenting skills because we don't do things just like they did.

2. If it was all up to you, what would you name Ducky if it was a boy? A girl?
Ack! Am I even allowed to answer this? I thought we were keeping prospective name choices a secret until the big event. Perhaps I should use this space to launch a campaign about why we should name Ducky what I want to. :) Of course, I am getting feedback from M that my previously proposed name choices will not be the ones that we go with. Honestly, I don't know even if I did want to answer this. I have a boys name semi in mind, but it's not carved in stone in my head, even, so I hate to put it out there. As far as girls go, I don't think I have a single name fighting for prominence except for two impractical E names. (One of them is Emily. I think it's really cute, but it's also the most common girls name of the year, and I don't want to give my kid a name that common. The other is.. impractical, can we leave it at that until we make a decision on it? ha!)

3. If you could change one thing about yourself, what would it be?
Oh, this is hard. I could go two ways--a physical thing or a personality thing. Physically, I'd like my lady parts to be less broken, please--but do I use that one thing up on that? Said brokenness has caused me a lot of drama over the last eight years, so maybe... especially if said fixed lady parts--the root of which is probably insulin resistance--allowed my other parts to function as designed, and hmm.. actually, wouldn't that ensure that I don't end up with diabetes, if my insulin issues were fixed? Which is an extremely high risk for me with my family background? Suddenly it feels somewhat less frivolous, so I think I'll go with that one. My personality has no flaws anyway. ;)

4. If you could change one thing about me, what would it be? And no cheating!
...and this one is even harder! Watch, as an established LiveJournal couple airs their marital grievances! Oh, wait, I know! I wish he was RICH.

Okay, I know him well enough to guess that he will count that as a cheating answer, but I have no idea how to answer this. It would be easy to be flippant, and list a bunch of things that drive me crazy. (Leaving the toilet seat up, refusing to put the vegetable brush away properly, leaving dirty clothes on the floor in front of the closet, etc.) Those things just don't matter, though, and if he stopped doing all of them tomorrow, I'd probably just find something else to get under my skin because that's how people are. We're different from each other, and we like finding things to complain about. Honestly, I guess I'd change his background. He is a born programmer, and it drives me crazy that he doesn't have the school education to prove me right. His brain works like a freaking flow chart and yet, I'm the one earning money for programming. It's dumb.

5. If there were no computers, what would you want to do for a living? For entertainment?
Uh... no computers? Would life actually be worth living? Actually, if there were no computers, I would probably have a degree in sociology and be doing something... sociological. See, that right there is why I don't actually have said degree. (Non-M people might be somewhat surprised to know how extremely close it was--I'm only missing one core class, actually, and I'd signed up for it in order to get my masters a few years ago, but I chickened out because as much as I do love it, what the heck am I going to DO with this degree? No one could ever really tell me.) As far as entertainment goes, I have a vague memory of life before computers in which I did things like read books and watch TV and be semi-social. Without computers in my life now, I guess I'd be doing some of the same things. And now I am going to have nightmares of such a horrible, horrible life.