After heart surgery, hand surgery and what my brother calls a "serious need for brain surgery," I consider myself something of an expert on the folly and futility associated with insurance companies. Over the years, I thought I'd seen it all.
I took over the paperwork on my father's medical bills this past year, and got exposed to a different type of insurance bureaucratic insurance. Medicare.Two months ago, Medicare sent Dad a check, with a message that said it had been incorrectly billed, and the health care provider hadn't given his authorization code, so they'd have to pay us instead of making direct payment. I deposited the money, wrote a check to the doctor, and forgot about it.
This week, we received another message. Medicare said it made a mistake. It was required, the notice said, to send the money directly to the doctor. So, within the next 30 days I have to do the following or face the consequences:
1) Call the doctor and ask him to refund the money I sent him. 2) Deposit the check the doctor gives me. 3) Write a check to Medicare, so Medicare can send the doctor the money I sent him then got back from him to send to Medicare so Medicare could send it directly to him . . .
The woman at the Medicare office sounded shocked when I suggested it would be simpler to send Medicare the receipt showing that I had, indeed, used the original check to pay the doctor. "That's not how we do things," she said. "Our procedures must be followed. And there are good reasons for them . . ."
Now this, I gotta hear.
* When it comes to capricious behavior and paperwork, Medicare has nothing on private insurance companies. My favorite catch-all problem is The Pre-existing Condition.
Recently, a close friend gave me the most comprehensive and coherent explanation of The Pre-existing Condition I've ever heard:
"Anything that happens to your body is a pre-existing condition. That includes both injury and illness. You've had your body since birth," he said, "and if you didn't have a body, nothing could happen to it. Right?"
Right. That man has a bright future writing exemption clauses for insurance companies.
I first met The Pre-existing Condition clause when I was involved in an accident that knocked loose the wires that were used to hold my sternum together after my open-heart surgery. Doctors had to go in and remove wire and staples so that they wouldn't use my body for a field trip "Look, a lung. Let's check it out!"
The procedure took about 45 minutes, including X-rays. The doctor told me that the wires actually saved me from serious injury, because they prevented my chest from being crushed or cracked.
The insurance company didn't see it that way. I had heart surgery, so anything that happened to my chest was a pre-existing condition and uninsured.
I know they were right. But I saw some irony in a policy that would have paid for the more serious reconstruction needed if the chest had collapsed, and refused to pay for this one.
* Sometimes an insurance company works just a little too hard at using The Pre-existing Condition. I dated a fellow who nearly amputated four fingers trying to trim a candle wick (He was using a small knife, but from the damage it did, you'd swear he used a power saw.).
After microscopic surgery to reattach things, his insurance company asked a lot of really strange questions. He'd been in a serious motorcycle accident several years before, and they wanted to know if "residual damage" could have "impeded his reaction time, creating a contributory factor to the ensuing injury." (I think that means: Did the old accident slow him down so he couldn't outrun the knife?)
Eventually they agreed that a five-years-past motorcycle accident had nothing to do with his freak household accident. They paid for his surgery.
But the Pre-existing Condition clause got a little exercise along the way.