Answered Prayer

Last week, I was checking the claims for my surgery. Prior to that, I’d found the anesthesia group was out of network. I called and was told the claim would be processed in network because the procedure had been performed in a participating hospital. Here’s what hit me right between the eyes:

Amount billed, $1280, you owe (as in ME), $311.96. Yikes! It showed up as still being in review. I called and talked to a rep who told me the same thing—that it should be paid in network. She didn’t want to do anything at that point because it hadn’t been completed.

Yesterday, I checked again. I didn’t think anything would have changed but that’s where I was wrong.

Out of network processing

It was completed and it still showed I owe over $300.

Being Sunday, the automated system would be the best I could hope for so I accessed the Communication Center. I sent an email with the preceding screenshot attached and explained I’d been told more than once that the claim should be processed in network.

After I sent that one, I did this screenshot showing in network amounts on the left and out of network on the right.

Anesthesia

I’d been praying off and on about it ever since that first little “out of network” icon showed up.

Yesterday convinced me I really needed to be more proactive about getting some B-12. I called Bi-Lo and asked for a refill. Did they have the 30 ml vials in stock? Yes. I asked if the person on the other end of the line was sure and she said yes and to give them an hour before I came in to pick it up.

My sister called and asked if I wanted anything from the university supermarket. I thanked her but said no. They were still planning to meet me at 11 but she would call just before they left.

Time marched on and no phone call. I called and she thought I’d changed my mind about their picking up something for me. No, but were we still going to meet at 11? Well, that was tentative. 11:30? Yes, that would be better. I’d had my OJ and vitamins so I grabbed something to eat before I took my shower. Long story short, I got to the meeting place before they did and heard the courthouse clock chime 12. I was sitting in the sun when they drove up.

We had a pleasant time. My niece was driving and really had no idea where my sisters wanted to go in town. She hit most of the high spots, though, and then headed for the cemetery. We visited Mother’s grave and several others. I’d failed to take a camera but my sister took pictures.

It was lunch time and everyone agreed beforehand that we should go to “my” little cafe. We were warmly greeted and had a delicious meal. There was some good crunchy bread to munch on while the food was being prepared. One of my sisters and I had the wraps—she had broccoli cream soup with hers—and my other sister and her daughter had beautiful big salads. We visited some more while we ate. My sister picked up the tab (including a loaf of rosemary bread for me) and then we went back to where my car was parked and said our goodbyes.

When I got into the car, I looked in the mirror and was horrified. Wrap was stuck to my front teeth. They looked like I hadn’t brushed them for a week. I used my fingernail (I’d discarded that toothpick my sister gave me ‘way too soon) to get what I could off. How embarrassing.

I’d mentioned the library during lunch and when we went our separate ways, I stopped by and got a library card. I have one for the other side of the mountain but I never get there.

It was on to Bi-Lo to pick up my B-12. It rang up as $4.75. I questioned it and when the girl checked, it was a 1 ml vial, not 30. The pharmacist came over and apologized. Did I want it? NO. She went to the computer and found some 25 ml vials but she didn’t know the price. She went ahead and ordered two and told me to check back around noon tomorrow to see if it comes in. ARRRRRGGGGGGGGGHHHHHH!!

Of course, I had to go to Walmart. I’d checked Aldi’s web site this morning and did a print screen on the 4 lub bags of oranges for $1.99. I got three bags priced at $4.88 for $1.99 each. Since it was the cashier who gave me grief once upon a time, I was ready. I took out my printout and handed it to her. She barely glanced at it and rang them up. That was $14.64 Walmart price for $5.97 Aldi price.

I saw a friend/former co-worker plus her daughter and grandson. We visited long enough to convince me she hasn’t read my blog for a long time. She used to be a faithful visitor.

I got home, unloaded, had a cup of Dandy Blend (I’d taken some with all the fixin’s but no one wanted any) (I didn’t even try with the coconut water) and checked my email. Nothing from Humana. I went on about my business and, around 5 p.m., I got this:

Your claim should have been considered as part of your outpatient hospital claim for the same date of service and has been sent for reprocessing. This could take 30-45 days. We apologize for any inconvenience.

In answer to my second email, this came in:

After reviewing the claim in question I have determined that should have been paid at an in network rate.

Based on these findings, your claim has been forwarded to the Claims Research Unit for further review. You will receive a response within 14 business days, which will be a letter or a corrected Explanation of Benefits. If for any reason more time is needed, Humana will contact you by telephone. If you wish to follow up on this, please use reference number xxx.

Praise the Lord! It isn’t over but it looks as though I won’t have to pay such a large chunk of money.

I’m tired. Twinkle has to be fed, still, and then I’ll go to bed.

2 Responses to Answered Prayer

  1. Lila October 13, 2013 at 7:25 pm #

    Tommie, if you had food on your teeth, I didn’t notice it, and doubt that anyone else did.

    • Tommie October 13, 2013 at 8:20 pm #

      That’s a relief!

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