Dear Insurancy Company: Chapter 26

Dear Blue cross/Blue shield, why are you being so mean to me? This is how I wanted to start the appeal letter that I wrote to my insurance company. Up until now they had been pretty good, I mean they didn’t pay for every thing, but they were reasonable. I knew that fighting cancer was not going to be easy or cheap. Staying alive means endless hours waiting to see this doctor or that doctor. It means waiting to have this test or that test done, all the while being subjected to endless hours in waiting rooms listening to soap operas and games shows. I have always liked books on tape for when I drive, but now I depend on them to block out the sounds of bad TV.
Then it’s more hours waiting for test results, and just when it looks like you might have a few days rest THE BILLS ARRIVE, and the experts wonder why so many people being treated for a major illness become so depressed.
The only insurance that we have is through Mark’s job because my part-time job offers no benefits, so what ever his company gives us is it. Anyway back to my appeal letter, I was writing to appeal the cheesy amount of money that Blue Cross had paid for Dr. Asgari to perform the breast reconstruction surgery.
I should not have been surprised that the payment was so low; I had been warned from Lacy( the woman who handles the insurance companies in Dr. Asgari's office) that there might be trouble. You see Dr. Asgari might be happy with his adopted country but he was not happy with American’s HMO system (who is) so he refused to play. He was not a member of any HBO, when a person chooses him as their doctor, he-the doctor not the HMO sets the rate so a bill is submitted to the patient's insurance company and what ever they don’t pay the patient does.
It is the law in New Jersey that insurance companies must pay for reconstructed surgery after a mastectomy, what the law doesn’t say is how much they have to pay. So my insurance company felt that reconstruction should cost $7000 and they will pay 70% of that or about $4,900, not bad huh? Well Dr. Asgari charged $10,000 for his reconstruction surgery, so now I own the doctor over $5000 and I still needed the second part of the surgery done which will cost another $6000. So I was writing an appeal letter, hoping that the insurance company would pay a little more toward the surgery…they didn't.