Jumping Through Hoops Like a Circus Poodle

I think the general public might agree that the last thing anyone needs to have to do when caring for a loved one with cancer (or any life altering situation) is to have to have their insurance company on speed dial to argue with each day about some claim or another.

I just got off of what seemed to be an absolutely endless phone call with our insurance company.  I say, "if our deductible has been met and our maximum out of pocket is $3,000... why am I holding an already processed bill for $4,600?"  ... He says, "You should call the hospital"  the hospital says to call the insurance, the insurance says it's the hospital's fault because they must not be billing correctly, etc.  Then he tells me that they (the insurance company) don't keep track of the bills and amount owed.  I respond with, "then how would you know when to start covering at 100%?"  Is this really happening?  How can this be an actual dialogue of any sort of productivity?  It took absolutely my entire being to remain calm, civil, and collected.

The man kept telling me that he needed specific claim numbers/dates of service... I said, "I have three months worth, do you have all day?"  He told me I should double check them as they don't keep track and I responded, "So you want me to go through myself, add up everything I've been charged until I hit the deductible and total out of pocket and then call you with the other fifty pages worth to discuss why it's not covered?"  In retrospect, that must have been the point where I lost my cool.

In the end, I decided I would go with his suggestion and pulled out the explanations of benefits and when I gave him specific dates and whatnot, his response was "these are all in reprocessing, ma'am."  Are you kidding me?????? Maybe it's just me, but if they did right by the customer and processed everything correctly the first time... they could save a lot of people a lot of unnecessary stress.  In the last minute of our conversation the human emerged and he told me he understands what I'm going through, as his mother also battled cancer and that if I need anything I shouldn't hesitate to call them for another song and dance. Fantastic. 

On a slight side note, within these "reprocessing" claims is one for a drug called Rituxan which costs just over $14,000 each time and Tom has has now had six of these!  We were not informed until he was going in for his fourth one, that our insurance had only just (a month and a half later) got around to denying coverage for the first dose he received of the drug.  Which meant we'd already incurred $56,000 worth of "patient responsibility".  Our oncologist had done some extra screening drugs to make certain that Tom was a patient who would benefit from the use of this drug before giving it to him as he said this often occurs with patients receiving this drug.
Crossing our fingers that the "reprocessing" and the appeal letter sent in from our oncologist's office does the trick and gets them to cover it... otherwise, future bankruptcy here we come!!!!

Fairly certain I will have gray hair by the end of all of this.