Category Archives: pen and ink paffoonies

It is now official.  I hate health insurance companies more than I hate the high cost of health care.  I appreciate the emergency room that saved my son’s life a year ago in February.  But I am still trying to pay for it.  I am practically bankrupted by five ER visits in the last four years.  Only one of those was mine.  Health insurance does not approve ER costs for a whole list of health problems.  And that was a better insurance than we have this school year.

In order to get my son out of the Health Facility that the ER sent him to, I had to arrange a doctor and a therapist before they would even discuss releasing him.  I did that.  My son reached a level of recovery that they could have authorized his release after one three-day weekend, but of course, the kept him for ten days… all of which I had to pay for out of pocket at hospital rates.  The doctor I arranged for saw my son every three months after that to maintain his recovery and prescribe the best possible medicine.  He was one of the best doctors in his field and he helped immensely.  The therapist was even more helpful, being able to teach my son how to handle the symptoms and complications of his condition.  He was also worth his weight in gold.

But then the State of Texas decided the health insurance that teachers got through their school districts on State funding’s dime was much too good.  The wise and noble Emperor Perry of Texas decided to hand State employee health care over to Faetna ( a fake name that rhymes precisely with the corporation’s real name if you just drop the letter F).  Wonderful doctor does not even deal with the pirates of Faetna.  They swing into any and all health care situations on boarding ropes and slash at anything that moves with their cutlasses of problem-making.  So I had to get a new doctor.  The doctors in this particular field of medicine are not abundant to begin with.  Aetna… er, I mean Faetna, decided that we could only use doctors that were associated with the same hospital where we visited the ER.  Well, I asked them to give me names of the doctors who qualified.  I got three names.  I made an appointment.  We were filling out the paperwork in the doctor’s office twenty minutes before seeing the doctor.  The receptionist interrupted after I had half-way finished the mountainous paperwork to tell me the insurance had rejected payment.  This doctor that THEY had recommended to me was not a part of the approved network.  They took Faetna insurance, but Faetna refused to pay.  The same day I called the other doctors on the list.  No doctor recommended to me by the insurance company was part of the required plan.  There were no doctors in the city who did qualify.

Okay.  It can’t get worse.  We still had the therapist who was working miracles for my son.  He took Faetna insurance.  There was no problem there, right?  But wait.  The pirate captains of Faetna took another look.  They started rejecting his claims too.  Soon there was a huge yellow envelope full of demands for clinical records to justify the need for the therapist.  I went to the ER, to the wonderful doctor, to the hospital in Denton where they were still taking my money away from me, and to the therapist himself.  We gathered documents.  The lovely hospital charged me $50 for paperwork and made me drive all the way there to Denton twice to accomplish it.  I got all the materials compiled, overnighted them to the insurance company’s disapproval department, and everything should’ve been fine.  But. of course, it wasn’t.   The claims for services were denied.  I am expected to pay out of pocket.  They found no clinical evidence that the services were essential and they insisted I pay the bills without help from them.

So, I am left marveling at the ingenuity of the insurance-pirate racket.  Every month we pay for all five us, hefty premiums because we have health issues that need to be prepared for, and when the problems arise, and we ask them to pay their promised share…  we have issues, and we get denied.  I have been shanghaied by the pirates of Aetna… er, I mean Faetna.