Health Insurance Love

I don’t doubt that this will at some point be followed by an entry titled, “Health Insurance Hate” but for now, I am loving my health insurance!  I just started a new job in August, and with it came new health insurance.  I was already loving my lower co-pays (from $20 to $10) and the fact that all but one of my prescriptions is now free (the one I pay for is only $5).  That saves me a lot of money each month since I see several doctors a month and I have a lot of prescriptions.

I first initiated the live-chat with the insurance rep because it looked like they had denied coverage of my appointment with the breast surgeon a few weeks ago (by the way, that appointment, which was about a half hour long, was billed for $500!).  Even though the EOB said I didn’t owe anything and I haven’t received a bill, seeing the word “denied” on the form made me nervous – I’m seeing this woman again on Friday and she’s about to do surgery on me that costs hundreds of thousands of dollars.  So I wanted to verify that she is indeed covered under my plan.  The woman I live chatted with from my insurance company said that looked wrong to her too – Dr. Ahrendt is covered under my plan and the insurance rep was going to resubmit that claim to make sure it was covered.  Great.

I figured while I had this woman on the line, I’d ask her some questions about my post-mastectomy options.  By the way, I definitely recommend live-chatting with the insurance company – you can print a transcript of the whole conversation and then there is no confusion about what was said.

I had read that it is a law that insurance companies cover the post-mastectomy option of your choice – prosthetics, delayed reconstruction or immediate reconstruction whether it be a tissue flap procedure or implants.  I also read that many insurance companies will cover one of those options, but no more.  So, if you choose to get prosthetics and have them covered, and later on you choose to have reconstruction, the reconstruction will not be paid.  Or, if you choose to have reconstruction and it fails for some reason, then prosthetics will not be paid.  You get one choice.

Not my insurance!  I now have it in writing that they will cover prosthetics if I have can’t have immediate reconstruction.  Down the line, if I decide to have reconstruction, I can have it fully covered also – and I can have it whenever I want (next year or ten years from now).  This is a huge relief.

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