Goodnight, Sweetheart...

It's almost 4-o'clock in the morning. What. The. Heck? I've been waking up like this for the last few weeks, at roughly this same time (that's 3:00 am, plus-or-minus an hour of tossing, turning, praying, finding the "rain" music on my iPod, and wishing I could take large amounts of sleeping pills). Tonight, I wound up on the couch (David has a cold/allergy thing, and bless his heart, I can't handle it), and after a particularly vivid dream about my step-mom, here I am yet again. Wide. A. Wake.
I could write about philosophical meanderings, but I really don't have much on my mind (or is it so much, that I can't make it all make sense?). I could make something up that might make me look deep or super-spiritual (I'm not). I could contemplate the frustrations of the sudden appearance of cellulite where I never had it before (WTH? Really?!?!? NOW, of all times in my life?!?) or the fact that I can most likely cross that concept of a bikini off of my bucket list...I could go back to that ever-underlying sense of something missing in the Cooley household, but that's pretty obvious, and I don't feel like indulging in a pity party today. I could mention that I can think of at least 3 instances of unwelcome advice/recommendations from people regarding my reproductive status in the past week alone, and how trying that is, but when I put it in that perspective, I'm pretty sure you get my point...besides, getting THAT riled up when all I want to do is go back to sleep is probably counterproductive.
There's a lot that I could say.
There's far too much that I do say.
The things I should say, I usually bury under fear and self-loathing...
And the things I should leave alone, I usually blurt out in a montage of oblivity and/or what boils down to pride.
Ever wonder what your life would be like, if you'd have just moved your chess piece one square over in a different direction? How much impact would that one square make?
That's one for 4:00 am.
Ever wonder if any of it will make sense? Or if you'll ever live long enough to see if He truly makes everything work out for His good? If He really does have those "plans to give us a hope and a future?" Or how our various messes eventually come together and make the amazing tapestry He's set into order (don't get that last phrase twisted--I'm not a Calvinist)?
No one has it easy. Nobody's life is perfect, no matter what beautiful pictures we make on Sunday morning. We all have what we want people to see, and what really is (and I don't care who you are--we're all in the same boat). As honest as I've always said I wanted to keep my blog, I've been avoiding it for the last few months because I don't want to face the backlash of what people would think if I really let 'er rip (and that includes my husband, whom I will respectfully defer to, as he is the head of this household, and I'm not going to post anything that would elicit the "CASS!" response that I know when to expect :) on certain issues, be they theological, political, or otherwise. I also have been just too plain lazy to do the research on a few things that I will eventually get to (adoption, surrogacy, US infant mortality rates, creation, evolution, abortion, and the fact that Charles Darwin was one of the biggest racists EVER, yet we allow his sick, twisted beliefs on the "origin" of our "species" to dominate our "educational" system)...
Hey, that might just be why I'm awake at 4:00 am...that's a lot on my to-do list.
None of those are peaceful issues to discuss, and a few of them could totally offend people if they let it (regardless of the fact that it's my stinkin' blog). I've been afraid to tackle any of those subjects, because I didn't want it to affect my job or offend anyone who didn't want to hear my conclusions...but I really need to get back to writing stuff that matters, so I'm thinking I need to get over my "fear of offending" and (post-spousal review) intelligently present my simple opinion of complicated issues....The last 2 times I said I was going to do this, I wound up hitting the "snooze" button...darn it!
And no, I don't really think anyone cares. Since this blog has nowhere NEAR the hits as my original MS blog, I think at this point in my writing "career," I'm safe to postulate.
With that off of my chest...and a to-do list that I'd better get cracking on, just in case that New Madrid-or-whatever fault-line-earthquake-apocalypse-thing hits St. Louis, and I lose my internet connection...I'm going back to sleep.

...And...

If you're looking for Susie-so-Happy, that is not me, right now. I told a friend tonight that one thing I hated about books on the grieving "process" is how they candy-coat things into making it all sound so holy and perfect.
I am not "holy and perfect" right now.
My life is not all about my loss. There is much, much more to me, and losing my daughter is only a percentage. I'm a fairly "normal" person, and that is only part of my "story." It doesn't "define" me. I am comfortable around pregnant people, I can go to baby showers, I can cuddle most infants, I can walk through the baby department, and I will not go postal, so please don't judge me and say that you think I have a problem around someone because they're in the maternal way. Yippee for them. No, really--I have a deep love for pregnancy. It's the most beautiful time in a woman's life, and babies are AWESOME. That being said...
There are certain parts of losing a family member (no matter how small they were) that one must go through. You eventually have to go through their things; eventually, no matter the age, you have to decide on things to get rid of.
First, we got rid of the diapers...the formula...anything new went back to the store, or to the unending number of people that were pregnant at the same time I was.
Certain things were initially held back...a Blues hockey onesie, a particular dress...then, slowly, even those things began to find homes. Some things are still in storage (I haven't given up hope-hope is restored, I am hanging on, etc)=, but some things must be passed along for the sake of space.
This is a small house.
We bought the crib, secondhand. It came with a changing table...the mattress, we purchased brand-new.
"New crib mattress for sale...never used."
They've sat there, in our "nursery," for 4 1/2 years.
The time has come.
They have been passed along.
My nursery is empty.
As practical as I know this is (I have nephews that would like to have a bed to sleep on; we're now looking for bunk beds or a trundle bed to put in there, so if you know anyone, please let us know), words can't describe how much this sucks.
Please don't say, "I'm so sorry." I'm not trying to elicit a compassionate response. This will be fine--I will be okay.
David told me not to go in there, after they came to take the crib away...he said to wait.
I couldn't.
I walked in
This pain is palpable.
I feel like I've been disemboweled.
There is no holiness to this feeling.
There is only leaning.
I can't stand up.
I wasn't even going to write about this, because I feel so much of this very painful journey has been so public...recent doctor's visits have cut my feet out from underneath of me, and I find myself struggling to breathe.
I've actually been sick with some kind of throat infection for almost a month, and I can't help but think the "funk" from the December cardiologist's visit upset me so much that my immune system shut down. I'm on my second round of antibiotics, and I'm exhausted...
I'm back to working out 2x/week, and I'm hoping to consistently get to 3x/week, in spite of being sick. That's got to help, right?
I have an amazing network of friends....I'm sure they're sick of me by now. I have an amazing husband...my family is fractured right now, so I'm trying not to talk to them about this.
This is not about giving up hope...
This is not about not trusting Him.
This is about today.
Today hurts.
Today, I'm not angry...
Today, the fact that we bought furniture we planned to use...and never got to use...hurts my heart.
The fact that the furniture went to someone who will grow up in love, lessens that pain, and helps me to pray for that family...that there would be miraculous provision...strength...phenomenal peace...and nothing but the greatest of blessings.
Today I prayed over that furniture, before I said goodbye (in tears).
And I thanked God for the day that will come,
When I will have the need to ask for it back.

Abortion, Adoption, and Government Redefinition

I'm not the most politically minded girl. I rarely comment on political things, since I don't really pay a whole lot of attention to that section of the news (it usually frustrates me into a coma, when I do), but every now and then, the perfect storm of a particular issue will get under my skin. And, every now and then, I dig a little deeper to find out what all of the ruckus is about...
First of all, let me preface this:
I'm a registered Republican. Does that mean I always agree with my party? Heck, no. But if you must know, in order to validate my political tantrum, then yes, I'm a Republican.
Most importantly, I'm a Christian. No, I'm not going to hit you over the head with a Bible and tell you you're doomed....but I am going to tell you that I believe God loves you, and that this cosmic killjoy with a beard that we're taught to envision, is not the God Who loves us so amazingly.
Thirdly, I am 100% pro-life. I didn't believe in abortion before I got pregnant, due to my own research on fetal development and my values of life....and I sure as heck don't believe in it now that I've felt that life grow within me. I was born at a completely inopportune time for my mother; she considered aborting me. Since she changed her mind, I can't help but be grateful that my mom honored life...and so do I.
That being said, I have several friends who are pro-choice, hate Christians, and are Democrats. I'm okay with that--I love them for who they are, not for their political/religious beliefs.
New legislation is pending with "health care reform." For the record, since I'm establishing myself before I make my point, I am AGAINST GOVERNMENT-SPONSORED HEALTH CARE REFORM. Anyone who has worked with the current government-sponsored health care reform (Medicare/Medicaid) will tell you it is SEVERELY FLAWED, and the idiots who came up with it, have no business in the health care industry. Health care reform should be privatized by an institution blending physicians in several specialties, and patients/staff who have seen both sides of the issues. Doctors, with no ties to any pharmaceutical company whatsoever, are the only people I'd trust to dictate standards of "necessary" care--not politicians, not drug companies, and definitely not the government. But, that's my perfect world...I digress.
I am against the federal funding of abortion. I believe we as taxpayers should have the option to deny our personal monies being delegated to support the abortion industry. I would love to see the word "abortion" replaced by "adoption" in our vocabularies, and I would love even more, to see the women in these situations, given counseling options that are truly considerate of where they are in life.
That being said, abortions performed in the case of rape or incest have always warranted a turned head from most people. Most of us would say, "Absolutely-who would want to carry the product of rape or incest to term?" I don't know the answer to that. In a perfect world, a woman would be given the degree of counseling that she needs to make that decision with peace...but if someone hasn't been in that situation, you can't expect them to understand the decision she makes.
Can you imagine? Having someone invade you so horribly, that all you want to do is wash it away--all you want to do is forget the trauma you went through...and then you find out that you can't.
I am adamantly pro-life; I'd like to think I would not abort that child, that I have enough of a support group to carry me and my husband through that situation. But I think of a time in my life where "no means no" didn't apply, and the years of pain that followed...had I become pregnant from that encounter, I don't know what I would have done.
And now, with the government stepping in with a "redefinition of rape," I don't know if there would have been anyone to help me, regardless:

'"The House Republicans' second major legislative masterwork since coming into power — the first being a symbolic go-nowhere bill to repeal the Democrats' health care reform law — is called the "No Taxpayer Funding for Abortion Act." Direct taxpayer funding for abortion has been outlawed since 1976. But the new health care law brought back this debate about what counts as "taxpayer funding for abortion." What about government tax breaks or subsidies for plans that include abortion coverage? The GOP's new bill, among other things, would eliminate the health insurance tax-deduction for any plans that offer abortion coverage, meaning those plans would cease to exist.

But for years, there have been exceptions for abortions that are eligible for federal funding: In case of rape, incest, and when the pregnancy endangers the mother's life. The "No Taxpayer Funding for Abortion Act" would make some changes to trifecta! Mother Jones' Nick Baumann reports:

With this legislation, which was introduced last week by Rep. Chris Smith (R-N.J.), Republicans propose that the rape exemption be limited to "forcible rape." This would rule out federal assistance for abortions in many rape cases, including instances of statutory rape, many of which are non-forcible. For example: If a 13-year-old girl is impregnated by a 24-year-old adult, she would no longer qualify to have Medicaid pay for an abortion. (Smith's spokesman did not respond to a call and an email requesting comment.)

Other types of rapes that would no longer be covered by the exemption include rapes in which the woman was drugged or given excessive amounts of alcohol, rapes of women with limited mental capacity, and many date rapes.

The fact that "forcible rape" has no real meaning as a federal legal term makes this all the more obnoxious.

Oh, and what about the incest exception? "As for the incest exception, the bill would only allow federally funded abortions if the woman is under 18." You figure out the rationale on that one."

I don't know what the House intends to do, with this kind of "legislation." How dare they? Not only is it ludicrous--it's damaging for women like me, who wait years before finally getting the counseling and the help they need for that situation.

I believe that with Godly counsel, love, and a tremendous amount of support, Grace can overcome any situation--I really do. This government "redefinition," however, will cause women to hide in shame, and I do not believe it will do ANYTHING to curb the abortion industry. Women will simply say what they need to say to get the services covered, if that is the decision they want to make. Congress is only making it more difficult to get to the truth of the matter.

Abortion should be a decision that is made state-by-state, and that the degree of its availability, as well as it's funding, should be an issue that is strictly voted on by the people. Do I believe Roe vs. Wade should be overturned? Absolutely. Do I believe that we, as a society, are ready to handle the influx of babies who will need loving adoptive homes, or the influx of mothers-to-be that will need adequate health care? No, I don't. I don't think we're there yet (though I know of many churches who are trying to lead the way). Until we get there, and even when we get there, the way that rape/incest cases are handled will require love, compassion, support, and grace, that we as a society (and primarily as a church) need to offer--we don't need the government (or anyone else) passing judgment on a woman and what defines her condition.

Love the woman. Love the child. Anything less than that should be silenced.

Mad hilarity and total irreverence...

Didn't know Billy Corgan would be leading worship at church today...Just kidding. But the guy who came with Radiant Worship from KC, MO today DID have quite the physical/vocal resemblance. Church today was fantastic, and even though I totally can't sing right now (I've been sick for a week), I tried. There's something SO beautiful about singing at the top of your lungs, "I am my Beloved's and He is MINE!!!" that shakes the inner rafters!
I honestly don't know what kind of bug I got a hold of this week (probably the gift of a patient :), but I was SICK with a capital "ICK!" Coughing, sore throat, the whole 9 yards of crapola, and it all hit on Saturday night. Saturday, 1/22, was the first in a series of monthly events at the church that are designed to focus on just worshiping God for Who He is--not asking anything of Him, just honoring Him, and I was privileged to be on the music team that night. It was the first night of feeling truly awful, but I know I was supposed to be there. Someone from the church said they had something for "those who have lost hope." Well, that's me...I'm someone who has lost hope. Doesn't mean I've lost faith...it's two different things, and yes, they can be completely separate.
So there, in the midst of feeling awful, this woman says a bit about not losing hope, about holding on, yada-yada-yada, and all I could do was engage in the lovely mental picture of stage-diving on top of her and tackling her to the ground. "SHUT!! UP!!" is all I could think--I don't want to hear "don't lose hope! What do YOU know about not losing hope?!?!?" My mental reaction kind of stunned me, but it was honest. Holding on to hope is all I've got, and I've been there for 4 long years.
What would happen if I just let go?
What would happen if I just let it all go--hope, heart's desire, all of it?
Where would I be?
I don't think I'd be any where.
They opened the front of the church up for prayer for those who needed hope, and after I got over myself (I'm on stage! I can't leave the platform!! Whatever, dude--the coolest thing about our team is that our worship director knows that our relationship with God is more important than anything. If we need prayer, we go--no pretenses, no worries--just go), I went over for prayer and (again) laid it all down.
I still have hope.
God is still God.
He knows what He's doing.
Who am I, to think any of it has to make "sense?"
It was actually kind of a deliverance for me, in a sense...it was a restoration, and I truly feel like hope is on it's way to being restored...there is so much I can celebrate right now, and so much to celebrate in it's own time.
My goal for this year is to be thankful for where I'm at...to celebrate where I am.
I like to laugh, darn it, and I like it even more when I MEAN it.
It's the only part of Proverbs 31 that I'm any good at--"she can laugh at the days to come."
I think they should amend that a bit--"She can laugh at today." Sometimes that's the hardest thing to do.
Certain things have happened this week that are troubling me, and challenging my hope. They're definitely nothing to laugh at; in fact, though I should be sad, I'm mostly angry, but none of it is anything I can "fix," so I have to learn to celebrate letting it be...to celebrate letting God do His job. This will be, ahem, hard. Prayers would be appreciated...for clarity, for peace, for my mother, for wisdom, and for (did I say) clarity.
On that note...
I love how glass is clear. (There's my segue. It's all I've got). I was at a health fair in Plaza Frontenac yesterday, that I was worried about. I feared that I'd be surrounded by a bunch of botoxed size-2 white chicks in Versace, feeling underclassed, fat, and out of my element. I put on my black outfit, grabbed some "fling" (it's only "bling" if it's real, folks), and did my best at what I do (remember that I'm still "under the weather"). My boss was there, and she was speaking to a prospective patient; I was turned in the other direction, when I see a man walking with his daughter, and WHAM-O! He walked SMACK into a huge glass wall! (Funny thing--he looked a lot like Scott Joggerst, so use Scott as you're picturing this. It makes it SO much funnier!). He quickly shook it off, glanced around to see if anyone saw, and kept walking like nothing happened...meanwhile, his wife starts CRACKING up, and I, who was aware of my employer off to my side, just about bit my tongue in half to keep from falling to the ground in hysterics. Moral of the story: Just because God makes things clear, doesn't mean we are aware enough to SEE them! (And, watching someone walk into glass is frickin' hilarious. It is. I'd post the video on YouTube, if I had one!).

And, just because I wanted something else to laugh at, I purchased a book at B&N today, called "B is For Bad Poetry." It's cheesy enough, and corny enough, that I think I'll periodically be quoting it for my Facebook status updates (just to make Pastor Joe go "WHAT?"). It has absolutely nothing spiritual to do with this blog, and there is no point whatsoever in my tacking this onto the end of my ramblings, so here's a quote for now, just to make you wonder:

"Zebra"
It's too bad you think
life is so black and white.
If you had four legs and a tail
we could at least talk.

(Oh, that's mental!)

Sometimes, He gets you with a song...

I haven't been posting much; honestly, I've been totally sick for the past few days, and wouldn't even be writing this if this song hadn't gotten my attention so violently...
My friend gave me the Steven Curtis Chapman CD, "Beauty Will Rise," which he wrote after his little girl passed away. The entire CD grabs my heart, as it's written from someone who's faith has been shaken the same way mine has, and who has lived to tell the tale...This particular song moved me, as these are words that I find myself saying so often--"This is not how it should be; this is not how it could be; this is how it is, and our God is in control." It's the blind acceptance that we don't get it, but He gets us, and we STILL trust Him. This is not an easy thing to do, and it's a daily journey for me on so many levels. God is, and always will be (no matter if I agree or understand), GOOD. This song is called "Our God is in Control" (and side note--extra-special meaning, as this was partially recorded at Rupp Arena in Lexington, KY, in the UK Wildcat locker room. Love it!)

"This is not how it should be
This is not how it could be
This is how it is
And our God is in control

This is not how it will be
When we finally will see
We'll see with our own eyes
He was always in control

And we'll sing holy, holy, holy is our God
And we will finally really understand what it means
So we'll sing holy, holy, holy is our God
While we're waiting for that day

This is not where we planned to be
When we started this journey
But this is where we are
And our God is in control

Though this first taste is bitter
There will be sweetness forever
When we finally taste and see
That our God is in control

And we'll sing holy, holy, holy is our God
And we will finally really understand what it means
So we'll sing holy, holy, holy is our God
While we're waiting for that day

We're waiting for that day
We'll keep on waiting for that day
And we will rise
Our God is in control

(Holy, holy, holy)

Our God is in control

**I could sit here and post the lyrics of the entire album. If you, or anyone you know, have been through a major loss in your life, get the CD. It's worth it...there is hope out there, and things like this remind us all of it.

Sometimes, you HAVE to tell on yourself!

Sometimes, we do things that are so embarrassing...The lady who was texting and walking, and fell into the fountain? Oh, I can so relate to that! What I can't relate to, is her whining about how she was going to sue the mall because "no one came to [her] aid." Not funny--pathetic, really. I could go on all day about that one, but it's not my point.
I have to tell on myself--I did a stupid, and I will happily sacrifice my reputation on the altar of hilarity! (I totally shouldn't tell this on myself, but who cares? It's funny! I WISH I had it on video, I'd be a jillionaire!)
I woke up this morning feeling terrible--I have a wicked-bad sore throat. Throat lozenges aren't helping me.
I laid down to take a nap.
I took my glasses off--did you know I'm totally blind without my glasses?
I reached for my throat spray...
IT WASN'T THROAT SPRAY!!!
IT WAS BIOFREEZE!!!!! (That's a mentholated muscle rub in a spray bottle)
DO YOU HAVE ANY IDEA HOW MUCH THAT BURNS?!?!?!?!?
I jumped out of bed, ran to the bathroom, couldn't breathe, jumped around in a circle, spit in the sink, rinsed my mouth out, did an oh-my-mouth-is-on-fire dance, and kept spitting.
Guess you had to be there.
It was hilarious.
I felt stupid.
It hurt.
And I'm still laughing about it. But, it makes sense, when you see what I saw when I reached for the bottle:

Really, could you have told the difference, if that's what you saw?!?!? Please note that I didn't even know the Biofreeze was on my night stand. I have no idea how that got there--it's supposed to be in the drawer. I couldn't see, I noticed a white spray bottle, and WHAM-O!
Now I'm going on national television to cry about the bottle's similarities...I may sue my husband for not helping me...I'M A VICTIM, HERE, PEOPLE!!!!
Oh, the sad state of our society...
Since I've been fired up about the fountain lady all week, I thought I'd share my own most recent embarrassing story to even the playing field. Hang around me for more than 5 minutes, and there will probably be more, to add to my lengthy list of falling over trash cans, falling into trash cans, tripping down stairs, attempting to poison myself, and setting the kitchen on fire.
When society can no longer laugh at itself, it's time to start over.
I'm going to call Poison Control now.

Health Insurance Deciphered...Part 1

I've been snowed in today, which means I am home alone without any plans. I remember a time in my life when that was a recipe for destruction, fo' sho. Those days are long gone, though, and I find myself in full-on task-accomplishment mode. The dog is hardly a distraction, minus her snores, and with the dulcet sounds of "Funkytown" playing in the background, I'm going to knock out something that's been on my to-do list for over a year: The Insurance Blog--Part 1
At some point, I'll be editing this and making it uber-professional, to send out to patients on the mailing list for the office. Since this is my personal blog, I'm going to be as honest as I can, without fear of retribution--it's MY BLOG, darn it, and I'll say what I want!!! :) The more I think about insurance companies, the more I realize I couldn't possibly write all of this in one blog, so at least, on this snow day, I will handle the first part.
For a background, (because credentials are always nice), I do not have a degree in health care. I am not a nurse, a licensed medical assistant, or a doctor. I am not a certified biller or coder, and I do not (nor have I ever) worked for an insurance company. I am not issuing legal or technical advice, and I am not guaranteeing benefits. So, on paper, I don't know anything, and I am not responsible for what you do with this information.
Practical experience, however, trumps credentialing. I have worked in health care for 10 years, starting as a chiropractic assistant/communications coordinator for a chiropractor in Franklin County. From there, I worked briefly as an unlicensed Medical Assistant/Federally-Certified Drug Tester, and then to my current position, as an Office Manager for a chiropractor in St. Louis. My specialty is chiropractic billing and coding.
Numerous personal health conditions have taught me extensively about handling insurance companies as a patient; my job has taught me extensively about handling insurance companies as a provider. I've seen both sides of a very ugly industry, and needless to say, I have opinions, tips, and tricks to make dealing with said companies much smoother than most would know.
Here are a few things I've learned along the way, in dealing with insurance companies. Remember that this is Part 1--if you have questions, I can try to address them in the next part.
1. Always review your Explanation of Benefits (EOB).
People get statements from their insurance company all of the time, and usually barely glance at them. In the office, I've heard the following phrase that truly disturbs me: "I barely look at the statements. I trust you guys." REALLY??? That's incredibly brave--you barely know me. Billing and coding is intentionally confusing (and it's about to get a lot worse). Some insurance companies don't even put the procedure codes or explanations on the statement, which I wholeheartedly disagree with. I recently received a statement from United Healthcare (my insurance company) for $1100 worth of lab work, that they said I was responsible for, that the lab would be billing me for. It stated the lab, and the cost, but not the codes or description of what the charges were actually for. Had I not known what the doctor had ordered, or what the lab was called, I'd have no idea what that $1100 charge was for, and would promptly freak out. The EOB is NOT a bill--it merely shows what your insurance company covered, and what your responsibility should be. You don't have to pay anything until the provider (the doctor,lab, or hospital you were seen at) bills you directly. Should you need to negotiate that bill, you'll do it with the provider, NOT with the insurance company.
Reviewing the EOB not only prepares you for the billed amount; it also alerts you, should someone have committed insurance fraud on your account. If you see a provider you've never heard of on your EOB, you need to call your insurance company and find out who it is. Don't forget, though, that labs/radiology usually has a third-party handler that bills for interpreting your tests, and you may not know their name. For example, say I go to St. Luke's for a chest x-ray. I am billed at least 2 different ways--1. The hospital bills me for the x-ray. 2. The radiologist bills me for his interpretation of the x-ray--we've never met, so when I see a charge from a Dr. I-can't-pronounce-this on my EOB, and I call, someone has to tell me that he's the radiologist who read my film. In a private office, they could bill 1. for the x-ray; 2. for an outside consultation of the x-ray; 3. for the doctor/patient follow-up consult on the x-ray. Keep in mind that EOBs do contain the date of service for the charges. If you keep track of when you've had doctor's visits/lab work, and compare it to the charges on the EOB, it really does help clarify.
2. Verify your benefits before you make an appointment. No one likes to do this--if I had a nickle for every time someone asked me if they had coverage, I'd be rich. It is not my job to find out what your benefits are, and even if it was, I can't do it unless I have your card in my hand. And, even if I have your card in my hand, whatever information I get from the insurance company clearly states that it is NOT A GUARANTEE OF BENEFITS. I can only find out so much; usually, it's not until a claim actually goes through, that I see the full insurance coverage for service. BE PROACTIVE. Go online or call the Member Services number on the back of your insurance card before you see a physician to make sure they're in-network. Look at your card to estimate your co-pay. Know what your deductible is. This is all part of being a responsible patient--if you know what your benefits are before you go into a doctor's office, there are fewer surprises when you get that EOB.
3. Things aren't always what they seem. I realize that may come as a shock, when dealing with an insurance company. Services can mistakenly be denied; software issues can cause claims to process incorrectly. *()*( happens. If you get a statement or a denial, and you feel that the charges are not correct, call the insurance company. Ask them to reprocess the claim. I once sat in a physical therapist's office where they told me I didn't have the necessary coverage to pay for a $400 custom wrist brace. I asked them to hand me the phone, and I spoke with the insurance representative. Within 2 minutes, I had the brace paid for in full. What made the change? Besides the fact that I'm a self-proclaimed insurance badass, logic was on my side. Deny a $400 brace, or pay $10000 for surgery. EVERYTHING IS NEGOTIABLE (except for deductibles and copays). If a service is denied, talk to the insurance company first, then file an appeal. When you file the appeal, (which usually, your doctor's office knows about before you do), contact your physician to get the necessary documentation to support your claim.
4. Repeat it again: EVERYTHING IS NEGOTIABLE except for deductibles and copays.
Deductible = The amount of money you pay out of pocket, before your insurance pays anything. This amount varies; David and I currently have a $1500 deductible, per person. This does not mean that we pay $1500, dollar-for-dollar, before the insurance company kicks in--the deductible is subject to the contractual agreement your provider has with your insurance company. Deductibles are perhaps the most confusing part of the insurance process, and this is why. Your provider agrees to take a significant reduction in fees, in order to be in-network with (and advertised by) a set insurance company. For example, Dr. R., a chiropractor, would like to have access to the number of patients who have United HealthCare for an insurance company. In order to get into that network of people, she agrees to accept a discounted rate for her chiropractic adjustments--instead of the $45 she normally gets for the adjustment, she agrees to accept a contractual rate of $30 for the adjustment. If I have a deductible of $500, and I want to go see her, I will pay her $30/visit (not $45) until my deductible is met. I get the United HealthCare discount, but United HealthCare doesn't pay anything until I've met that $500 deductible, $30 at a time (even though $45/visit is billed, only the $30 contractually allowed amount applies to the $500). Then, after the $500 deductible is met, United HealthCare will pay Dr. R. the $30 (minus whatever my copay is-if my copay is $15, then United HealthCare will only pay Dr. R. an additional $15) per visit until my visit limit is reached.
YOU AGREE TO THE AMOUNT OF THE DEDUCTIBLE AT THE TIME YOU CHOOSE YOUR HEALTHCARE PLAN (ENROLLMENT). IT IS NOT NEGOTIABLE, AS YOU ARE RESPONSIBLE TO BE INFORMED ABOUT THE DECISION THAT YOU MAKE. I stress this--just last week, I got a phone call from a patient who was totally distraught. During Open Enrollment at her company, she chose the wrong plan and will now have a significant decrease in her coverage. DURING OPEN ENROLLMENT, YOU CHOOSE YOUR PLAN, YOUR HEALTH INSURANCE PROVIDER, YOUR DEDUCTIBLES, etc. MAKE THIS DECISION VERY CAREFULLY, as it will have a huge affect on you in the following year. You might laugh, but I sat on the floor and highlighted key issues in each plan offered. It was a detailed decision, and not easy to make. Consider yourself, your spouse, and your family; don't base the decision strictly on the cost/month.
Copays and coinsurance are generally not negotiable, either, unless you're able to prove financial hardship. Copays are clearly defined on your insurance card, i.e., $20 Office Visit (OV), $35 Specialist, $50 Emergency Room. This amount is generally due at the time of service. Coinsurance, however, is a little different. Most plans with coinsurance have a deductible, and after that deductible is met, you're responsible for a percentage of the contractually allowed fees. For example, after I meet my $1500 deductible, I only pay 20% of any medical charges I might have. Most practices will bill for coinsurance, as it's nearly impossible to know the percentage of the contractually allowed amounts before it's processed through the insurance company.
Deductibles, coinsurances, and copays are not usually negotiable because they're something you agree to when you choose your plan during open enrollment. If you can prove financial hardship, though, most hospitals are willing to work with you (I speak from experience--David was unemployed while I was hospitalized for almost 3 weeks in 2006 and while Hannah was hospitalized for 2 weeks and 5 days--and life-flighted; we were also down to one income while I was hospitalized back in April for surgery, for 3 days). Never be afraid or ashamed to ask a hospital to work with you, financially.
Individual health care providers vary, as far as financial flexibility goes. I've never met one who wouldn't set up a payment plan, and few charge finance charges. People do need to understand that failure to pay health care bills will be reported to the Credit Bureau. You can get thrown into collections, so don't take their willingness to work with you, as a reason to blow off those doctor's bills. If you call the provider, they'll work with you. Don't ruin your credit over something as flexible as a doctor's bill.
I know this is long, and that it's only Part 1...this is a tangled industry, and there's a lot of information out there. I'll periodically add more to this, and if you have questions, I can try to answer them or find out more, to help you. Just know that YOU are not a helpless patient against the GIANT insurance companies. David felled Goliath--you can take these guys on, and come out ahead (or at least, with understanding).