OK…..I need to rant. Feel free to read or not to read. I need an outlet!!!!
My darling daughter Peekaboo is double insured on all fronts, physical, dental, mental health. We have our primary insurance through my hubby’s work(who is hiking up our deductibles on everything!!) and our secondary insurance, which is my daughter’s insurance through the state of Oregon since she is adopted through the state of Oregon. This secondary insurance is very important when it comes to dental care and mental health since most children who have been in Foster Care(like 99%) have long term mental health struggles and almost universally bad teeth. Our Primary insurance picks up a majority of the costs and the secondary picks up mostly co-pays and extra issues. It’s been a very helpful set up.
if you have OHP as a primary it’s difficult to find providers because they pay slo-o-o-ow and l-o-o-w….not very fair the doctors and dentists who try to provide services and keep their business in the black. By having our insurance as the Primary insurance it’s given us more flexibility in who we see and where we see them. Before doing this we had OHP as our primary and we lost doctors left and right, sometimes before we ever saw them. We’d simply get a little notice in the mail that this doctor’s office was changing it’s insurance policy and was no longer ‘accepting’ our form of insurance. No Joke! this happened A LOT!! But, insurance is expensive so we left it OHP until Peekaboo was about 6 and it just wasn’t worth it anymore!!!
When we switched to having our Primary and OHP as secondary, life became smooth and manageable. We finally found a dentist and a Primary Care Pediatrician and of course have been receiving mental health services for quite a while. All was stable. Then, last month we went to Sarah’s therapist office. When we arrived I was asked if we had changed our insurance. I said “NO!”. Well, they told me that according to the state of Oregon we now had a different insurance and it was Salem based which does not allow us access to anything in “B” (where our doctor’s offices are!!) Because of this snaffoo the doctors office cannot complete their billing cycle. They actually can’t bill us because we claim to have insurance to cover it but State of Oregon won’t pay….etc. basically I was told, Come Back when you straighten out your insurance.
Now, my daughter is wonderful. Do not want to grip. But, she does have issues that become rather prevalent when stress is ……well……PREVALENT! For instance, her BFF is moving, she has 6 weeks to complete 15 units to graduate 8th grade, her grandfather just died & oh, yeah….SHE’S 14! Everything is stressful to a 14 year old!!! LIFE HAS BEEN ROUGH FOR 3 WEEKS NOW!
So, here’s the timeline I gripe about.
- The therapist tells me there’s an issue with our insurance. I promise to check it out.
- The next day I call the # on her insurance card. They direct me to our ‘case worker’ over our post adoption plans. The message on her phone basically says, “Sorry, I’m out of the office today- oh, and at a conference next week and then I have a mandatory furlow day.” So, I leave a message complete with Peekaboo’s insurance info and the issue @ hand.
- One week passes…… OK she’s out of the office.
- Next week, I call on Monday.
- Nothing…. OK I’ll give it time…
- Wednesday I call……
- Thursday I ask hubby to call.
- He calls and leaves message….evidently quite stern
- Friday- she finally calls back:( Says she left me a message last week. basically chastises me for hubby’s grumpy message….. SHE LIES!!!……a representative of my state lied to me!!! Then, as we chat she explains she has nothing to do with this issue and diverts me to another person.
- Call and get a hold of a very friendly person. Chat for 20 minutes. She understands my issues. Says she’ll send it on to be fixed. I should get a call in the next 7 days saying it’s been changed. WHEW!!!!
- But wait…there’s more.
- Yesterday @ 4:50 pm I get a call confirming that my insurance is the way I asked. But, why did I call and ask for it to remain the same? Upon further inquiry it turns out……she can’t adjust our Mental Health Benefits…. I HAVE TO CALL SOMEONE ELSE!! AND GUESS WHAT? THEY’RE OUT OF THE OFFICE FOR THE REST OF THE WEEK!!!!!!!!!!!!!!!!!!!!!!!!
AND, do you want to know what happened? A pre-scheduled computer maintenance went through and assigned dentistry plans and mental health plans for everyone ‘unaffiliated‘…regardless of whether they had reasons why they weren’t affiliated with a program and without the permission of the familie’s who were being ‘assigned. Does that sound right to you?
This is our government not @ work!!