Kids at school blame peers and teachers for their misbehavior. Their parents blame kids, teachers and administrators for their child's problem. Grandparents, raising grandchildren, partially or fully, blame their own children for their child's misbehavior. Last week, a parent blamed her own mother for spoiling her child, even thought the child lived with the mother.
I believe we all know some aspect of society that excuses their own misbehavior by laying blame on someone else. Until recently, school was my closest experience with the blame game. Now, health insurance and all of it's affiliates has gracefully taken over.
Actually, not too gracefully.
I don't want to regurgitate everything we have gone through in the past few months in detail, but a summary, before talking about our latest fiasco, seems appropriate right now.
- Last fall Dennis was rejected for speech therapy payments that had taken place in the winter of 2008. We simply wrote appeal, as we have become accustomed to doing these days, and waited for the next letter. The next letter arrived in 10 to12 weeks, and said nay, and as usual, we went through the second appeal step.
- Other denials began to come in saying that this, that or the other visit was out of network. We did the appeal process with these, as we were told to do. These included necessary cath changes, physical therapy appointments, regular doctor visits, a flu shot, and the Courage Center, which has been a godsend for Dennis.
- In January, for one reason or another I decided to start calling. I figured a call or two and we would have this all straightened out. Instead, his insurance company told me to call his Cobra money collecting agency, ADP, because they had made a mistake.
- Cobra/ADP told me Cigna, his insurance company, had made a mistake, but they would take and and all action to see that everything would be taken care of.
- A bit later, after 3 or 4 calls to Cobra/ADP (laugh loudly whenever a company that deals with money or insurance tells you they will call you back) they then told me IKEA, his former employer was to blame.
Today, after yet another call to Cigna, the gal that answered the phone told me that the whole problem was that Dennis had never appointed a primary doctor (he had). If only we would do this, all would be well. I gave her the doctors name, phone number and address. I was put on hold.
It seems, his general practitioner is labeled, in their system, as an ENT (ear, nose and throat specialist) and does not qualify as a general practitioner. Therefore, nothing could be done to help us. Dennis must have a primary doctor who practices internal or general medicine.
Now Dennis has been seeing Dr. Kiefer for many, many years. He is a family doctor and not a specialist. But no, Cigna says, this is not possible, because their records state differently. It was not Cigna's fault, but Dennis fault, for seeing a specialist in ENT for his primary doctor. Therefore, Dennis was to blame.
More later, so much more.
Ann and Dennis
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