Frustration

***Warning: Long, venting post about insurance and doctors. Read at your own risk.***

Kate was supposed to have ear tubes put in next Monday. Supposed to. But we all know how that word works, right?

This past Monday, her doctor's office called to discuss fees, since we haven't met our insurance deductible yet. There were no surprises there, but the conversation reminded me that I needed to call the Commission to make sure that they were still not contracting with my doctor.

(For those of you who don't know what the Commission is, it is a program in our state that provides care for children with various medical needs. Kate is a patient of one of their cleft teams, and they have provided her with dentistry, audiology services, and plastic surgery services, including her palate repair, free of charge. The providers are wonderful. The red tape? Not so much.)

So, I call my coordinator at the Commission, and she informs that while my doctor is not contracted with them, there are other ENTs who are. WHAT? Before, I had been told that there weren't ENTs, and I had to find my own. Now, 18 months later, the story has changed, and we are faced with a decision. Continue on with our current ENT, or change providers for these ear tubes.

What to do? The doctors are less than a mile from each other, so the distance is negligible. I know nothing about the new doctor, but I honestly don't have strong feelings about Kate's current provider either. He has done a good job, but I get frustrated with him sometimes too. But I prefer him more than I prefer going to a new doctor.

To get the whole picture, here's little background on me for ya. I'm a researcher at heart. If I need to buy something new, I will read all about it, price check at least three different stores, and ponder the decision for a month before I purchase it. Not every time, but the bigger the purchase, the more the research. You also need to know that I used work for an optometrist, and one of my responsibilities was to contact insurance companies to find out patient benefits before the patient came in. Plus, I have had to fight with my insurance companies to provide coverage for me and my children on more than one occasion. I know the lingo. I ask a lot of questions. I threaten to report them to my state's department of insurance. I annoy the crap out of them.

So, I did not just say "whatever" and do what they told me to do. Partly because everyone was telling me different information. One person told me that if I used Commission providers, I would be billed at 65% of the total cost. Then I heard that it was 65% of the allowable cost of my insurance company. Then it was the Medicaid rate.

Lost yet? I sure was.

In addition to my doctor's office and my contact at the Commission, I contacted eight other people (not counting receptionists), trying to figure out what my costs would be if I used a Commission provider versus Kate's regular ENT. Which meant I had to explain the problem to every. single. person. that I spoke with.

So what did I discover? After talking with three different offices at our regular hospital, I put together an estimate of what they would bill us if we used them, along with what our insurance's contracted rate was and what we would be responsible for. It was higher than I expected (choke worthy, in fact), but still do-able. Then I called the other doctor/hospital that is contracted with the Commission and found out what they would charge, approximately, of which, no one seemed to be able to tell me what I would be responsible for. I made phone calls for three days, left more messages than I could count, and cried a lot, and still was no closer to knowing what I needed to do.

This morning (day 4) I woke up to start calling back all the people who still hadn't returned my calls, and with a plan for finding out the Medicaid rate for this procedure. Thankfully the first person I talked to actually seemed to have some answers. She said that if we used the Commission provider, that they would bill our insurance, and then they would bill the Commission, and then we would not be responsible for any of the associated costs. I told her that this contradicted what several other people had told me. She checked her information with the supervisor, and yes, it was correct information. So let's see, do I want to be charged a whole lot of money or $0? Hmmmm.

How does a mom weigh a free doctor that she doesn't know against an expensive doctor that she does? This isn't the first time that I have had to make a decision like this. We had to do this about a year ago when we got new dental insurance. We loved our pediatric dentist. Loved. But our insurance wouldn't pay for her. They would only pay for one specific pediatric dentist. So I cried. And I called our insurance and complained. And then I called the new dentist. And guess what? We love her even more. She is completely amazing.

But I am still frustrated. Frustrated that I didn't know about the ENT contract until this week. Frustrated that now we have to visit another doctor. Frustrated that this will postpone Kate's tubes until... I don't know. Frustrated that even after I made a decision, I still had trouble contacting Kate's coordinator who had to pre-approve the new doctor before I could make the appointment. And then I had to talk to three other people to make it happen.

{sigh}

And some of you people wonder what I do all day...