Monogamy at Last

It might sound counter-intuitive to celebrate the lapse of my primary insurance policy, which happened at midnight last night. You'd think that having coverage through not one but two providers would give me extra assurance, financial security, and peace of mind.

You'd be wrong.

I never once dated more than one person at a time, but I imagine that juggling romantic attachments would present the same challenges and frustrations as managing the referrals, pre-certifications, claims, and reimbursements of two different insurance companies.  It's very hard to keep things straight and make everyone happy.

Having two insurance policies means two sets of cards in my wallet, two prescription-drug plans to keep track of, two sets of files at home, and endless conversations with providers, especially when I'm trying to avail myself of the oxymoronically named "coordination of benefits" provisions of the two plans.

The usual sequence of events goes something like this:

1. I need to see a doctor.
   
2. I make an appointment with the doctor.
   
3. Someone from the doctor's office calls and tells me I need a referral.
   
4. I try to explain that no, actually, I don't need a referral because my primary insurance plan has a nifty practice whereby I need just one referral that says, "This chick has breast cancer."  Anything related to evaluation or treatment falls under that single referral.  And, well, I got that über-referral more than a year and a half ago, when I was first re-diagnosed.  
   
5. The person at the doctor's office stands firm and tells me that the doctor cannot see me without a referral that my own insurance company says I don't need.
   
6. I call a really, really nice nurse I know at Columbia's Health Services, and she faxes me the referral within the hour.  (I'd hate to think what the rest of this list would look like without her.)
   
7. I go to the doctor with the referral in hand.
   
8. If I'm lucky, the doctor just collects a co-pay and bills my insurance company for the balance.  I'm not usually lucky, so I typically have to pay the bill up front.  This can range from about $150 to $500, depending on the doctor.
   
9. I come home and submit a claim for the bill I have just paid.  (There is usually a lag between coming home and submitting the claim.  Sometimes it is a matter of days, but more often it is weeks or months.  If I don't get the claim filed within 15 months, we have to eat the cost.  I try hard not to let this happen, but occasionally I fail.)
   
10. I wait for the claim to be processed.  If all the planets align, this still takes a minimum of two to three weeks.  (The planets never align.)
    
11. If the doctor bills my insurance company, I get a bill from the doctor anyway.  I call the doctor's office and am told to ignore the bill.  For now.
    
12. I get the often inexplicable Explanation of Benefits (EOB) in the mail.  A good percentage of the time a mistake has been made in processing the claim:  it's denied because I didn't have a referral (even though I did, even though I didn't need it); it's denied because I have other coverage (even though the other coverage is secondary); it's denied because the diagnosis codes are a) wrong or b) missing or c) for a test or service that is excluded from coverage (but shouldn't be); it's denied because the planets didn't align.
    
13. I call the insurance company.  They promise to "reprocess" the claim.  This takes another 10-15 business days at best.
    
14. I call the doctor's office to explain why I am not paying the second bill I've received.  They make a note in my file.  I make notes in my own file.
    
15. I get a third bill from the doctor's office.
    
16. I get a revised EOB from my primary insurance.  More often than not, the EOB shows that the insurance company has paid less than 100% of the claim.
    
17. I make a copy of the corrected EOB, plus a copy of the doctor's bill, plus a copy of the receipt showing whatever amount I've paid, and send them all to my secondary insurance.  I make a note in my file.
    
18. I get a fourth bill from the doctor's office.  (Or maybe a tenth, depending upon how long it takes to get the initial EOB, or to get it corrected.)  By now, the bill is printed on pink paper with words like "delinquent" or "overdue" or "your responsibility" or "to avoid referral to a collection agency" in BOLD TEXT AND CAPITAL LETTERS.
    
19. I call the doctor's office and explain that I am not a deadbeat, that my secondary insurance company is on the case, that they will get paid (eventually).
    
20. I get an EOB from my secondary insurer.  It shows the amount they paid, either to me or to the doctor, and tells me how much (if any) of the balance (if any) I actually owe (let's call that "X").  I make a note in my file.
21. I get a fifth (or eleventh) bill from the doctor showing the amounts that the two insurance companies paid and asking me to pay the remainder (let's call that "Y"), which is often more than the secondary insurer's EOB says I owe.  (Doctors who have contracts with the insurance companies agree in advance to discount their rates but often then try to recoup the discount directly from the patient.)
22. I fax the secondary insurer's EOB to the doctor's office, circling the part that says "[Provider's Name] may bill you $X."  If only I had BOLD CAPS at my disposal.
23. Someone from the doctor's office calls and concedes that I owe only X and not Y.
24. I pump my fist several times in the air, resplendent in my success, triumphant in my victory over the minions of Satan's health-care bureaucracy.  
25. I make a final, self-congratulatory note in my file. 
26. I pay Y.