We interrupt this monthly "Luke's First Year" post series with the following story....
Before Luke was born, I was looking through my insurance pamphlet. A note about breast pumps caught my eye. "Breast pumps will be covered 100% under the new health care reforms," it read. Too good to be true, right? Those things are really expensive, like $300. I called the Aetna customer service number to get the details.
"Oh it's very easy," the associate said. "Just send in your receipt after you buy the pump and it will be reimbursed 100%. Just make sure it isn't electric grade."
"So, I won't have to pay anything out of pocket, right?"
"Nope, just send in the receipt and we will reimburse you."
Reassured by this response, I bought a very nice Medela breast pump (non-electric grade) at my pediatrician's office a couple of days after Luke was born. A few weeks later I submitted the receipt and forgot about it.
About a month later I remembered that I hadn't heard anything from Aetna. I called in and asked about it...
"It looks like we forgot to process this reimbursement (emphasis added)" the agent said. "We'll get it out to you next week."
Two weeks go by. Still nothing. I call back.
"Oh, it looks like we can't process this because the pediatrician's tax information is on one page, but not the other," another agent responded.
Right. I drive to my pediatrician's office and get another copy of all the information with the tax code on all the pages. I try to fax in the corrected claim, but Aetna's fax is broken for several days. In the end, I just snail mail it in.
Another two weeks go by. I call the office.
"The claim went through [yay!]. We are going to cut you a check for $30," the agent said.
"$30? That barely covers the tax on the pump. I thought you said you would cover 100%."
"No. It's 100% of the negotiated charge with the pediatrician's office. You have to get them to reimburse you the rest of the money."
This morning, I go to the pediatrician's office and explain everything up to this point.
"Oh yes. You signed a waiver saying that you were responsible for any difference between the negotiated charge and the cost of the breast pump," the assistant said.
"I don't remember signing anything like that. Can I see the waiver and where I signed?"
.... Twenty minutes go by as I sit in the office...
She returns. "Um, we're going to have to call you back."
Stay tuned for next installment....
The funny thing is that I heard a story recently on NPR about how insurance companies are increasing premiums quite a bit because of the reforms. Breast pumps reimbursements were specifically mentioned in the report and how they are SO EASY to get reimbursed for. Yeah...
[Note: The frustration with this actually makes me incredibly grateful that all three of us are healthy and we only have to deal with insurance on a very limited basis. But still.]
