Health Insurance Ordeal Made Me Sick

In last week’s column, I described the most interesting thing that happened to me during the entire year of 2017. Back in August, I thought I was having a heart attack, and after calling 9-1-1, I took a five-minute ambulance ride to the Emergency Room. It turned out not to be life-threatening, although having your heartbeat go from the normal 75 beats per minute to a jackhammer-like 200 beats per minute was almost as uncomfortable as listening to those panel discussions on the cable news channels (or as I call them, “shout-a-thons”).

A few months after this frantic episode (I mean the ambulance ride, not the TV “shout-a-thon”), we received an invoice from the ambulance company for $1,155.97, and a note explaining that my health insurance provider declined to pay because the ambulance company is “not in the network.”

During my ordeal, I learned a lot about the intricate workings of the human heart. However, I did not realize the human heart is a pile of crude Tinker Toys when compared to the baffling complexity of the health insurance system.

First, I should backtrack for a moment. The health insurance coverage where I work has experienced skyrocketing premiums in recent years. In typical federal government fashion, when they used the word “affordable” to describe the health insurance reform law, we should’ve know it really meant “the exact opposite of affordable.”

Anyway, to make sure our premiums only doubled (they otherwise would have increased four-fold), we selected a plan with a $5000 deductible rather than our old $500 deductible. With the exquisite timing that I’m known for, as soon as this new health plan went into effect, my heart started doing weird things, and I became intimately acquainted with the following procedures: stress test, nuclear stress test, ultrasound, MRI, cat scan, and I forgot the name of the test where they attached electrodes to my chest and wired them to a small monitor in my pocket. The electrodes and wires had to stay attached 24/7 for two full weeks. This made bathing somewhat awkward, but not nearly as awkward as being in a business meeting and having someone say, “Hey Bill, there are wires sticking out of your shirt. Are you a terrorist?”

By the time my ambulance ride in August occurred, I had already met the 5 Grand deductible easy. (Well, easy, except for the part about where the money was going to come from.) So, I knew that no matter what the ambulance ride and ER visit cost, it wouldn’t be coming out of my pocket.

And then we got that invoice for almost 1200 bucks, and the notice that the ambulance company is not in the insurance provider’s network. I only want two simple questions answered: 1) Which ambulance company IS in the network? And 2) am I really expected to search for in-network ambulance services when I think I’m dying?

Ten phone calls and 15 emails later, I was told I needed to file an appeal (three pages, single-spaced, and took me four hours to research and compose). I also was told the appeal would be promptly rejected, but then I could file a second appeal, which had a 50/50 chance of being approved. When I asked, “Why don’t we just skip to the second appeal stage?” I was told, “Oh, we can’t do that. You don’t understand how the system works.”

You have that right. I do not understand how the system works. At all.

I think MSNBC, CNN, or Fox should have a panel discussion about health insurance appeals. I’d like to be on that panel, as I’m in a shouting mood. I just hope my heart can handle it.