Wednesday, February 11, 2009

The squeaky wheel gets the oil

As I think I've mentioned before, when we checked my son into Brighton Hospital for a two-week rehab stay in September, my insurance company told me that his care wouldn't be covered. The bottom line was that the treatment was going to cost me $12,155.00 out of pocket. That was a very bitter pill to swallow.

But on the day my son was discharged, the woman at Brighton who took my final credit card payment told me that I should submit the claim to my insurance company anyway. And that if the claim was denied, that I should appeal it. "The squeaky wheel gets the oil," she said to me.

It was a hassle, but I did proceed to submit the claim. And my insurance company denied it because it wasn't "pre-certified." In other words, I didn't get approval from my insurance company prior to my son's admission. That is true, but the only reason I didn't was because they told me that they weren't going to cover it. I didn't think I needed insurance company approval for something they weren't going to pay for.

In any case, I worked with someone from the insurance company to retroactively pre-certify my son's care. Lots of phone calls and e-mails and contact between me and the insurance company; and me and the hospital; and the insurance company and the hospital. It was one of those things where you just wanted to say, "Fuck it," but you knew that you couldn't give up.

Well, the other day I got a notice in the mail saying that the first two days of my son's rehab stay--the detox days--would be covered, but that the remaining 12 days were still under review. I had pretty much resigned myself to the fact that the insurance company was going to cover the detox treatment and deny coverage for the rest of the stay. Until I got this e-mail this morning from my insurance company rep:

"The review was completed on 02/09/09 and letters mailed. The entire stay was approved. The service was considered acute care and therefore payable. I reprocessed the claim on 02/11/09 and you should receive an updated explanation of benefits in about 7-10 business days. If you have any additional question please let me know."

Well, whaddya know. I actually cried when I read that e-mail. Shortly after I got it, the billing person from Brighton Hospital called me to tell me she had gotten word that my son's stay was going to be covered, and that she would call me next week to let me know exactly how much money they would be refunding me. I'm not exactly sure what percentage of the costs will be covered; it could be 60% or it could be 80%. And there are co-pays and deductibles involved, too. But suffice it to say that I will be getting a significant amount of money back, and that I will not be out the complete $12,155.00.

"The squeaky wheel gets the oil." You're damn straight it does. I owe that wonderful woman at Brighton Hospital some flowers or something.