Three years ago, my husband and I agreed I should seek counseling to help me better deal with some issues that I had related to a lot of bs I went through as a teen/young adult. After a year of successful counseling for myself, hubby joined me for couples counseling, mainly focused on conflict resolution and learning how to communicate effectively. It was extremely helpful on both fronts, and we were making very good progress. Meanwhile I was dissatisfied with the service at my primary doctor's office (Different suck: Sorry, but if you as a doctor can’t tell the difference between me and my mother, then its time for me to find a new doctor.), and decided to switch over to the clinic within walking distance of my house. I thought this would be better all around, because then my pcp and my councilor would be part of the same hospital system, as opposed to being in two completely different ones. How wrong I was.
Apparently, despite covering my counseling sessions for two years with no problems, immediately after switching my pcp to one in the same network as my councilor HIP stopped covering my counseling session for 'lack of authorization'. When asked why they covered the sessions for two years and were only now balking, I could not get a straight answer. I never received any request for new authorizations, nor was I at any time informed that new authorizations were needed, even when I asked if there was anything I should do when changing PCP's. Coverage was simply stopped and I was on the hook for the cost of the three sessions? $450.00. While trying to sort this mess out, I also lost my place in the program since I couldn’t attend until the mess with the insurance company was settled. At least I had dealt with the most pressing issues, and had a good foundation to work on the rest by myself.
In all the time that I have been a HIP member, I have only ever gone to one OB/GYN. He was never 'in network', but that hadn't been an issue for the last fifteen years, so it didn’t bother me now. Once a year I would go, have my yearly exam, and it would be covered without a problem. In early November I went for my annual as planned. The only difference being that this year my doctor sent me for an ultrasound, since there was some concern about my having an extremely delayed/missing cycle the month before. (He was afraid I might have had a miscarriage, and wanted to be on the safe side.) Thankfully all the tests came back clean, and surprisingly we found ourselves back in his office a little over a month later because of a positive home pregnancy test.
Of course we had to do the in office test, which confirmed the HPT, and then I had to have (I swear to heaven) six vials worth of blood work done as part of the initial pre-natal testing that is normally done. (Yes I checked, every pregnancy book I have so much as glanced in warns about the massive amounts of blood work they do in the first visit.) He gave us a small pregnancy book, a small care package, and some prenatal vitamin samples for me to try out. (There are all different kinds). Everything was copacetic until the letter from HIP showed up in my mailbox.
Suddenly after fifteen years of covering visits to this doctor without problems, there is a denial of coverage form for both visits in my hands. Total cost for both visits (both of which fall under basic care for OB/GYN) and related labs? $580. Which means that this insurance company, that is paid to cover my medical expenses, has now cost me a total of $1030, in fees for things that have always been covered? Livid doesn’t begin to describe how I am feeling about this situation.
Of course I am appealing the 2nd one. When I called and asked what was going on, the rep tried to give me the 'I know how you feel" speech because she didn’t have an answer. I kind of lost it a little and (politely) asked her if she expected the company to be around in the next 5-10 years if it kept denying basic medical coverage to people who pay to have that coverage. Surprisingly she didn’t have an answer for that question either.
TL:DR HIP refuses coverage for services that have been covered for years. When questioned, they offer garbage explinations. Not surprisingly they begin losing large contracts because of this new bad behavior.
* edit to fix second cut and spelling