January 19, 2005 - Tuesday | 8:03 AM, CST Something fishy is going on here. I just got off the phone with my health insurance company. A few days ago, I received a letter from them stating they were going to deny my claim for the heart monitor I received from the doctor. Their reasoning: because it was considered an "exploratory" procedure, and not an actual treatment, it wasn't covered under my medical insurance policy. Excuse me? Exploratory procedures are not covered? Why the hell not? Do they not cover X-rays, because its only an exploratory procedure? (Hey, you didn't know if your arm was broken, did you?) When I called the insurance company on the first day I got my heart monitor, I asked them if it was approved. They told me, "Yes, if its a medical necessity." Ok, lets see here...
Is this a medical necessity? You're damn right it is! How was I supposed to know that what was happening were just harmless PVC's? I thought I was having a heart attack or something and wondered if my heart would stop the palpitations one night and quit beating altogether. Anyway, back to the phone call. I asked them why my claim had been denied. "We only received the claim from the heart monitor company yesterday. It hasn't even been processed." "Then why the letter?" "We have not yet sent you a letter. The claim has not been processed." I don't know what to say... "So you might not yet deny my claim?" "No, it will have to be processed first. Whatever letter you got was not from us." "Ok then..." Now this is the fishy part. I remember quite clearly opening and reading the denial of claims letter. It stated very clearly the reason it was denied (lack of medical necessity), gave me a phone number to call, a nurse to talk to as a case manager, etc. So where is this letter now? I don't know, thats the fishy part. I lost it. I know good and well I wasn't imagining it. It wasn't a dream. So whats going on? I know this must simply be a computer glitch on their end and they don't know I've been denied yet. That just means more time before I can tell them I'm going to contest their decision. I think I read somewhere that the vast majority of all health insurance denials that are appealed are won in favor of the patient. So keep your fingers crossed for me.
Nothing much else of interest is going on. Suzanne hasn't updated her website in a month to the day. Hint hint. One thing that has interested me of late is the prospect of cooking. Yes, I know, its a woman's chore, but bear with me. I think it would be really neat to whip up some spicy tacos or fajitas one night that could rival any of the three Mexican restaurants I frequent. I'm sure a Mexican cookbook could easily be obtained, or recipes found on the internet. And I'm talking authentic too. I mean making everything homemade with fresh ingredients. But why stop with just Mexican? Why not have fish fries, Chinese food, Italian food? The possibilities are endless. I was walking through my kitchen the other day, and I took a look at my stove. Its a nice stove, and whats better, it didn't cost me a dime. But do you know how often I use this stove? Maybe once every month or two, and only to cook a pot of ramen noodles. Every once in awhile I'll let Kelly fix me supper, but I usually end up with a sink full of dishes that I'm expected to clean. And as you all know, the act of me doing dishes can be a very rare occurance indeed. So why not make it fun? Most small restaurants don't last long in this area. Look at Kenny's. For awhile, their gyros were on my top most favorites list. Besides, if I was the little old lady who owned this house before, and knew that the punk kid who bought it from me was only using my stove as a very expensive clock, I'd be pretty pissed. Time for a shower. |
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