Can You Top This One?

All of us, I suppose, have stories about our medical system. But this one from our son is better than anything we’ve ever had. Lukas and Annika recently gave birth to a son — Aksel — and this is the medical bill’s explanation of benefits that Luke and Annika received after they submitted the hospital receipts:

“We have reviewed your claim and have deemed the birth of Aksel a necessary medical procedure.”

Mighty kind of them, don’t you think?

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  • I have plenty of horror stories that have to do with hospitals killing relatives, but they’d be too long to mention here.
    I do want to mention, however, that “Aksel” is a supremely sweet name.

  • James Petticrew

    Another reason for me to say God Bless the National Health Service, we enjoyed our year in the States but your health service sucks!

  • My health insurance won’t cover anything dealing with my spine since I had prior spinal surgery. A few years ago I had to get my foot x-rayed and they denied coverage since my foot was connected to my spine.

  • When we first moved up to Canada three years ago, I was kind of leery of what universal health care would be like. Can I just say that I hope I don’t ever have to deal with private insurance again!

  • My friends are pregnant and can’t get insurance for their baby until he is actually born. At which point there’s a waiting period before he can be covered.

  • Henry Zonio

    When we first moved up to Canada three years ago, I was kind of leery of what universal health care would be like. Can I just say that I hope I don’t ever have to deal with private insurance again!

  • ChrisB

    Don’t you just love insurance — not just health but the whole concept. They’ll gladly let you send them hundreds or thousands of dollars but when you actually ask them to pay for something …
    Why do we put up with this?

  • CJ

    I recently had surgery to have my thyroid removed (I have thyroid cancer). A month after surgery I received a letter from the insurance company asking me to contact them about the procedure. They wanted to know if the medical services were “the result of an accident or injury”. Apparently, the vast number of referrals I had to get in order to comply with their insurance didn’t clue them in on what was going on 🙂
    So I called the customer service # they gave me, and told the person what the reason for the surgery was (cancer). An no lie, his response was, “But was it the result of an accident or injury?”

  • Well, I have a slightly more disgruntled comment. I had a good Aetna insurance plan when we lived in Chicago. My husband’s foot was badly burned in a kitchen fire and he ended up needing surgery and burn specialists. When I called Aetna to find a burn specialist, they told me that there were no burn specialists covered in all of Chicago. WHAT??? Yep. No burn specialists in all of Chicago. And yes, this is Aetna, one of the largest and best insurance companies, and Chicago, one of the largest cities in the US. Ridiculous. Our only option was to go to the emergency room at Cook county – they would cover us for CC only if we went through the emergency room.
    And by the way, the Cook County emergency room is a taste of Hell, I think. Police walking by with criminals in handcuffs, people screaming and moaning, homeless people, high people, and general weeping and gnashing of teeth all around.
    However, they had excellent service once you were past the emergency room, and I’m thankful it’s available.

  • Your Name

    Hey CJ I went through the same thing 3 yrs ago – thyroid and all. I’m coming up on my 3rd yr follow up scan. I expect the – is it from accident or injury. We have Blue Cross.
    I had a car accident this spring that messed up my shoulder so car insurance was billed for the expense. Months later I went to an orthopedist for my knees, after yrs of going to orthopedists for my knees. Blue Cross sent me a form to explain the accident or injury. Not asking if it was from those. I just wrote across the top of the form – not from accident or injury. I had to end up calling customer service and explaining it.
    On a positive note about insurance companies, I recently had a 6 figure hospital stay and Bloe Cross covered all of it, we pay zero, because I’d met the deductible.

  • BeckyR

    Your name is me BeckyR, sorry.

  • Attorney to witness– a wife:
    Attorney: The insurance will only cover the death of a husband or a wife. Which of you died?
    Wife: Guess.

  • Our son was born prematurely four years ago. He did well, but ten days after birth he had a severe allergic reaction to breast milk (I know, weird). He nearly died, dropped down to 3 lbs, and needed a blood transfusion after bleeding out his GI track. He spent 7 weeks in the ICU recovering.
    The doctors determined the only food he could safely eat was a special formula costing about $500 per month. Our insurance refused to cover it because they said it was a “dietary supplement.” I wrote back, “It’s not a supplement when it’s your entire diet!”
    At his first birthday, we decorated the tables with empty cans of the costly formula.

  • I had major open heart surgery 3 years ago due to an aortic aneuyism. Our insurance covered all $250,000, never had a hitch in coverage, preapprovals flew through with no problem. I am very very grateful!

  • SRH

    One year ago, I began having an irregular heartbeat and definitely needed to see a a doctor-pronto. When I called to schedule an appointment with my insurance approved GP, the doc wasn’t accepting new patients. I called my insurance company to ask for a new GP, but they told me I would have to wait a month before I would be covered to see this new doctor. When I told them I needed to see a doctor immediately, they explained that I would not be covered for any expenses related to my heart problem if I went to a doctor before the 30 days was up. I politely explained that they would approve a new GP, or they would pay my bills in the emergency room. That worked, and I got a new GP.

  • Michael King

    My wife gave birth to identical twin girls last year via c-section.
    At first the insurance was only going to pay for the delivery of the first girl.
    Strange, but eventually we were able to prove to them that both girls existed and that the surgery was actually used to get both of them out.

  • Karen in AZ

    The hospital: “You have to request any refund for less than $10. Since your refund is for less than $10, you will have to request it. Plus, remember, we don’t bill for anything less than $10 either. It all evens out.”
    My answer: “I can’t walk into your emergency room and be charged for anything less than $150. I would like to request my refund, please.”
    (I couldn’t quite believe she really thought there was anything at the hospital for them to bill me for that they “wouldn’t” bill, even if it was for less than $10! I’d been billed for medications I hadn’t even taken!)

  • H.S.

    As someone who is somewhat familiar with medical billing, the term ‘necessary medical procedure’ is insurance company jargon. Yes, yes, I know it looks like English, but it means that they agree to make payment under the terms of the contract.
    Just now on the way home I was listening to a church scholar explain that repentance doesn’t mean what I thought it meant, even though that too looks like English. Theologically, though, it appears to mean something other than what I thought it was. We’ve all got our jargon, I guess.

  • H.S.

    Oh, and I have a relative who is a primary care doctor who is strongly considering shutting down his medical practice because of the hassles in dealing with insurance companies.

  • Eileen

    I deal with insurance companies in my counseling practice every day. They seem to always second guess the clinician as to what really constitutes “medical necessity.” Insurance companies often deny claims willy-nilly thinking if you give up it they are that much more ahead. It is a tiring and labor intensive process to get them to cough up what is due you. if you call an insurance company you get an automated phone option list that often seems to direct you to the wrong option. After about 30 minutes of figuring out which option to select you get a customer service person that has no clue what you are asking or how to direct you to get the answer you are seeking but tells you he will connect you with a supervisor and then you are disconnected. Phone calls to insurance companies often take over an hour to get simple answers like quotes of benefits. We wonder why health care is so expensive – chasing down claims is part of the cost of doing business.
    Some things they do seem funny but in my opinion insurance companies are no laughing matter!

  • Bill

    In 1985, we had our second child in the car. When the hospital bill arrived, they charged us a $500 fee for the delivery room. When I called them on it, the lady patronizingly said, “oh, young man, you don’t know the costs of having a child today.” To which I responded, “no, you are unaware that we had our child in the car and therefore we never used the delivery room.” Her response, “oh, I heard about you.” They eventually removed the charge from our bill. Interestingly that the ob/gyn also gave us a discount since his work load was less than expected. And if you really want a laugh, ask me what his name was!!!

  • eleanor

    We had been caring for my father-in-law at home for eight years. A week before he died, his needs became greater than what we felt capable of administering to, so we enlisted hospice. Their evaluator came to our home and said they couldn’t take him just yet because he was not “actively dying.”
    A few days later they determined he was, so he spent 1.5 days at hospice before he passed away.

  • Friends of ours recently had a baby, during delivery at a local hospital there were some complications, so they had to transfer her to a larger hospital north of where they were. They sent the husband and mother of our friend giving birth ahead in the car whilst our friend having the baby was transported by ambulance. The Ambulance driver got mixed up and drove to a city south of where they were and she had her baby upon arrival, then had to call her husband and tell him they were in a different hospital and she had already had the baby! Only in UK…in the US people would sue, in the UK people just shrug.