Reading my friend Ernie's account of her health insurance woes reminded me so much of my own battles. Some have had to do with keeping Middle Child on my husband's employer plan, but mostly what I've dealt with in the last few years involves being the medical power-of-attorney for my mother and the trustee of her estate.
When I first took over all her financial and medical accounts, I immediately tried to switch everything to online access. It worked for some things, but not for others. I was dealing with Medicare advantage, dental coverage, a care plus plan, and a health savings account. It was a LOT! The banking issues would be a whole other post of ridiculousness.
When I was unable to make changes, I attempted to call providers from my mom's assisted living space using my cell phone. I explained the situation and would put my mother on the line. Unfortunately, they would ask her any number of questions, which she could never answer due to dementia. I was writing down her birthdate, social security number, my phone number, her and my address, etc. so that she could read it. It was absurd. And then they wanted me to fax (who faxes??) the legal documents showing that I had medical POA. After that, they told me that I had to prove that she was incompetent with a written doctor's order. Good luck with that because she never had the same doctor twice at the assisted living facility.
It got to the point where I would just call and pretend to be her. After several months, I managed to get most of it taken care of, except I was never able to view her explanation of benefits online because no matter what I did, they would not change the phone number so that I could get an access code to log on. Online chats and phone calls did nothing. Apparently, it takes an act of congress to get a phone number changed, 'for security reasons.'
Fast forward to her death in July 2025. She was hospitalized for 9.5 hours until she passed. Half was in the emergency room, and the other half was in a regular room, where she was given pain meds by IV, but nothing else was done for her. And here begins my saga:
Mid November - Thinking that 4 months should be long enough, I phoned the hospital billing dept and asked for a balance. I was told it was $140. I thought that seemed very low and questioned the person if that included doctors, etc. I was told that insurance had covered the rest and that I should receive the bill in 10 business days. Bill was never received.
Mid December - A collection agency called and said that the estate owed $5283 for the hospital charges. Um, what? I told the person about the previous month's phone call, but was told that they are just a third party and couldn't help me.
Mid December - I then called the insurance company and was told that the estate owed $140 for-the hospital and $275 for the ambulance service (not affiliated with the hospital, and no, I haven't received that bill either. I contacted them by email with my address and have heard nothing). When I told the agent about the collection agency call, I will say that he seemed outraged on my behalf, which I appreciated. He suggested a 3-way call to the hospital billing dept. Unfortunately, after hospital picked up, the insurance guy's call was dropped. I proceeded to tell the whole story and they claimed I should not have been contacted yet by the collection agency because the claim was still 'in process' with insurance. (Why did insurance company not know this?) Told me that by next week, they should have an update. As that would have been the week of Christmas, I held off on calling.
Early January - Relayed the whole story once again to a person with hospital billing. He told me that the claim was still in an appeals process and 'on queue.' Told me to call back in two weeks.
I decided to do a deep dive using AI concerning hospital deaths and why insurance would deny claims. It seems that they will cover emergency room visits, but once a person is labeled 'end of life,' they are no longer covered for a hospital stay and must be sent to hospice. We were in the process of doing that, but who in their right mind thinks that's going to happen within a few hours?
At this point, they can hunt me down. I'm working on gathering all the materials for her taxes and once that is settled in April, I will see what's what. It would be nice to be able to close the estate and be done with it all, but I'm not holding my breath.
Wow, what a saga indeed! And it's ironic because I am currently going through something with my own health insurance because they suddenly are no longer being accepted by my dentist. So now I'm in the process of switching to someone else. Which I hate, because I loved going to my dentist. But with the rising cost of insurance, I have to choose a different dentist who is in my plan.
ReplyDeleteAnd it's also ironic that you mentioned being charged $275 for the ambulance service because do you know when I had to go into the hospital in 2015 to have my lung drained? Well, I had to take an ambulance only TWO blocks from urgent care to the hospital and do you know what they charged me? $985.00!!
I sure hope all this works out in your behalf. What is it about you and I and how we ALWAYS seem to get the BEST customer service? LOL!
What annoys me the most is how these companies DO NOT communicate with each other properly. Therefore, they place us in a position of having to constantly call/email back; relaying what they other person DID NOT relay to the other person.
Hope you're having a FAB week, my friend! I thought of you yesterday when I saw that warmer weather is coming this week. I mean today it's going to be 35 degrees and you would have sworn they said 85 degrees because the people here are so excited to receive ANY degree of warmth.
X
I hate when I hear about people having to switch any sort of doctor. You develop trust with a medical professional and you shouldn't have to start all over again! Aren't ambulance bills insane?? Fortunately, my mother's insurance puts a cap on the cost to $275 because I know that the original bill is four times that amount. Insane for you with the TWO block trip!!!
DeleteYes, I don't know how we always end up on the short end of the stick with customer service. Though i suppose it's everyone! We just notice it more after working in retail. And you're right, they never communicate with each other and then it turns into your responsibility to make it right. Terrible!
We have had record breaking lengths of days below freezing. Last Friday, my husband said it was -13 on his drive to work. It is hard for me to even get out of the car to go into the store. The wind chill takes your breath away. I suppose 35 degrees will feel like a heat wave. Ugh! Hope you are well, Ron! XO
Insurance companies are the WORST!! Especially health insurance. I have had so many issues to deal with the last two years and now I'm noticing they are not sending EOBs.
ReplyDeleteI'm so sorry you've had to deal with this. As if losing your mom wasn't difficult enough you have to hunt down someone to tell you what is owed. And I can only imagine the issues with carrying insurance for Middle Child because these companies continue to try to find loopholes not to pay for anything.
I hope you have a good week my friend.
Yup, they try to get out of mailing EOBs now. I just had an email this morning from my own health insurance saying they are going paperless, but at least there was an option to opt out, which I did. If they made it less cumbersome to log on and check, I'd be happy to do it. But you have to jump through so many hoops with the verifications that I'd rather just pull out my file and look at the EOB. So much quicker!
DeleteThis was a sad read, Bijoux, because it seems that you should not have had to jump through such hoops when your mother was alive and certainly not afterwards.
ReplyDeleteYour deep dive about hospital deaths and why insurance would deny claims was quite timely. You said you learned that insurance would cover emergency room visits, but when someone is labeled 'end of life,' they are no longer covered for a hospital stay and must be sent to hospice. At breakfast this morning, we started talking to a gentleman who told us his wife had died on Christmas 2025. He explained that she had cancer and was hospitalized for a heart issue and during surgery developed a blood clot. She survivved and was put in hospice care where she died soon afterwards. He is dealing with insurance now and is being shuffled around because she didn’t die in the hospital. There is a medical consensus that she would have died because of the cancer, but he contends she died because of the surgery.
We had never met him before, but could sense his anguish and sadness. The medical system is helpful until it’s not.
It's really sad what the descendants and widows/widowers have to go through after someone dies. It just adds to the grief. I'm so sorry to hear about the man who lost his wife on Christmas. He should not have to be dealing with the insurance company giving him the runaround. Terrible!
DeleteOh, Good God, Bijoux, I am so sorry you are going through this misery! Losing your mother was bad enough, now you've got struggle with all this nonsense?! Ridiculous.
ReplyDeleteOur family was fortunate with our parents because my sister is an attorney and could handle all the legal stuff.
And by all means, let these nincompoops hunt you down!
It was particularly upsetting to get a collections call right before the holidays. I was pretty distraught about the whole thing. It is nice to have legal counsel when a family member dies. I just need to pay out everything and close the estate for my own peace of mind.
DeleteSheesh, why do they make it so darn hard? That's crazy. I'm so sorry. I had to go through a lot of paperwork when Ken got sick and I was handling all the paperwork for all the doctors and insurance so I understand a little bit. They just make it so hard to get anything done.
ReplyDeleteAnyone who is the responsible party for a sick family member has my sympathy. It’s a lot to handle on top of the grief.
DeleteOh my gosh, that is so frustrating. I feel for you! I haven't had any experience like that, yet, though I had some car insurance issues when I got into a car accident shortly after moving here from OH. The place that had my car kept denying they had it b/c they couldn't locate the license plate number in their system. It was still an Ohio-type number, which is different. Even though I'd called and eventually determined that that place did indeed have my car and explained this to whomever answered on a later call, that woman wasn't convinced. That was frustrating. I hope your whole situation resolves soon, and without having to pay $5K!
ReplyDeleteI totally believe you on the car insurance fiasco. It’s always like it’s everybody’s first day on the job and nobody knows what anyone else is doing. Very frustrating!
DeleteGoodness. Why does it have to be so hard? I'm guessing because there is SO much fraud happening in our world, that nothing is done easily when it comes to insurance, bills, etc...
ReplyDeleteI recall getting some bills after my Mom passed away, but she didn't really have an 'estate' to speak of, so we just paid what we thought and left the rest go. They never bothered me about anything.
Knock on wood---I've not had any horror stories like you or Ernie! Sorry you've had to deal with that on top of losing your mom. XOXO ~Suz
As I always say, once again the criminals win and the rest of us suffer! Think TSA! I’m glad you had an easier time, but that was probably prior to all the fraud out there. Thanks for the empathy, my friend.❤️
DeleteI'm so sorry you have to go through this! Insurance overall in the U.S sounds like the most scammy thing I've ever heard about. I've never had any experiences like that yet, and I only use my plan provided by my university for my glasses and perscriptions, but my boyfriend (who does live in the US) got hit by another car and he's been stuck in a bureaucratic process for the past 2 weeks and a half. He had insurance but the other guy didn't (although he said he did), so my boyfriend has to pay his own repair. This is how I learned how car insurance works. "Then what's the point?? You pay for insurance so you can cover the other person just in case you hit 'em? what?!" I asked him, lol. Naive little me.
ReplyDeleteAnyways, I'm really sorry about the loss of your mom. I can't imagine how frustrating the whole process must have been on top of losing her to dementia. I hope everything finally gets resolved soon! ♡
The crazy thing is that our personal health insurance coverage is great. We've been fortunate to have employer sponsored insurance for over 30 years and have to pay very little out-of-pocket expense. As someone else mentioned in the comments, the increase in fraud has been so great that now companies make you jump through a million hoops to get anything done. And yes, the car insurance thing is wack!!! In our state, you supposedly have to prove that you have car insurance to renew your license, but I still hear stories like your boyfriend's. I'm so sorry that he is dealing with that!!! What a nightmare!
DeleteThank you for your kind words!
Well, I think you know my story. What a waste of time and energy it is to have to navigate situations like this. What a joke that we have to literally fake our identity to get answers. Annoying and frustrating. I ended up emailing the benefits dept as if I was Coach. Then he sent it in through his email and we got a fast response and someone responded already to say that they think it was coded wrong and it should all be sorted out. What? I'm so grateful someone on my blog suggested doing the email route. I had to ask Coach to find an email for me of course. Fingers crossed it gets sorted.
ReplyDeleteIsn't it interesting that they ALWAYS say things were coded wrong??!!! We've gotten that excuse plenty of times. It's hard to believe that a doctor's office billing doesn't know what they're doing, but who knows?? I'm glad you're making progress with your situation!
DeleteSeveral years ago my former employer who I retired from and gives me my medical insurance decided that I was on Medicare 6 months before I turned 65 and was actually eligible. They promptly notified my insurance company that they were now the supplemental insurance! Of course, at that time I had an ongoing medical issue which involved many visits to doctors' offices and labs taken. It took 3 months for me to start getting bills telling me that my claim was denied because they had to bill Medicare first. I can't remember how many phone calls I had to make between my former employer, the insurance company and the many labs and doctors offices. It was a daily thing for weeks! It was so frustrating! I still have a stack of notes and bills an inch high! So I sympathize with what you are dealing with and I hope it all gets resolved quickly!
ReplyDeleteOk, that sounds like a complete nightmare, Jeanette. And yes, of course it was while you were dealing with medical issues. You would think with computers, errors would not happen like that, but we all know that's not the case!
DeleteWow, am I thankful for the NHS. That's an absolutely nightmarish saga you're going through. My bit of nonsense came yesterday when I was trying to change my mobile number on my Sky account. I was sent a special six figure code - to my out-of-date mobile number! I had to phone Sky to sort it out.
ReplyDeleteIt's been a lot, Nick. I never had too much trouble (besides dealing with an adult child with a disability) with insurance until I had to deal with everything for my mother. It's as though these companies never dealt with a POA before. And yes, the sending of an access code to an out-of-date phone number when that's the purpose of your business is so typical of the stupidity!
DeleteI HATE dealing with insurance companies.
ReplyDeleteTwo circus stories immediately come to mind.
About ten years ago my mom was rear-ended by an idiot who was texting. It was at a redlight, and her car was pushed into the car in front of her. She had a friend in the car with her, and they both ended up going to emergency room. When I got there, my mom started telling me how she had talked to the idiot's insurance company and they told her what she needed to do was a subrogation claim to save her the hassle of dealing with their company and how that would be quicker and easier. They really convinced my mom that going through her insurance, paying her deductible, etc. would be better/easier for her. I was livid! I called them back handled it. Not nicely!
The second was after Helene when our homeowner's insurance immediately said our damage was all flood related, which we didn't have coverage for (it wasn't offered/available for people in our area). That wasn't great (I still maintain that some it was wind damage), but was what it was. It took months of calling, emailing, and finally threatening them with going to the news media and the NC Department of Insurance to get them to put it in writing that they weren't covering our damages so we could move forward with our FEMA appeal. Meanwhile, we had no working furnace. Most people here dealt with similar things from their homeowners insurance.
I hope you're able to get everything handled with your mom's insurance and estate soon. I'm not sure how it is in your state, but at least in NC, threatening the insurance company with taking your complaint to the Department of Insurance tends to get results. From what I gather, they can lose licensing or face other serious consequences. That was I finally got our FEMA letter from them. I was fed up, and I emailed their corporate office and our local agent with a draft of the email I would be sending to the Department of Insurance if I didn't receive the letter within 24 hours. They sent it in less than two hours.
That is FRIGHTENING that a car insurance company would try to trick your mother
DeleteWHILE SHE WAS IN THE ER, no less!!!!! That is unreal! How unethical!!! Was it a fly-by-night sort of company or one of the big ones?? Just awful!
Homeowner's insurance is notorious for not covering damages by using loopholes. We pay extra money for flood insurance, but if you read the fine print, they still do not cover everything. But, you go girl for the lengths you went to in order to get action! I'm quite proud of you :) Honestly, I feel like my current issue is 50/50 the hospital's fault and the health insurance. Because if the hospital contracts with these insurance companies, they have to accept whatever the insurance company is willing to pay. I think when it comes right down to it, the estate is not responsible for the $5000 if the insurance company says we are not. But I'm sure the hospital will try their best to get the money. They don't know who they're dealing with though - LOL!
My bad insurance story is the fact that I had to work for Blue Cross Blue Shield for nine miserable months in 2003-04. It was a desperation job after being unemployed for 10 months and every bit as horrible as you can imagine. The system is screwed up, and the people answering the phones don't know as much as you would hope. Even with five months' of intense training, I was ill-equipped to help a lot of people who called in. Talk about a low point in my life.
ReplyDeleteI'm impressed that you suffered through five months of training. It sounds like the worst job ever, besides cold call sales. I do try to be nice to the agents on the phone, because I know that they are just doing their job, but damn, it's hard!
DeleteWow, this felt like a front‑row seat to the ‘health‑insurance madness’ tour. You’re a warrior, and I’m so sorry the system makes caregivers pay in stress on top of grief. Again, terribly sorry, Bijoux.
ReplyDeleteThanks, Mr. Shife. It’s been rough.
DeleteI absolutely hate living in the US simply because of our healthcare and dealing with insurance. I had to fight tooth and nail to get a very much needed med approved years ago. Since it was considered a specialty med, they kept denying my dr's request. It eventually got to peer to peer review and was finally approved, but I suffered for months without medication. Fast forward to Jason leaving his job and we had to get new insurance, the whole process started again. By the time it got approved, too much time had passed and the biologic had worked its way out of my system, and once that happens, the same biologic will never work with your body again. Being a small business owner, I could only afford subsidized insurance through marketplace, but thanks to politics, my rates quadrupled and I can no longer afford insurance, so I had to let it expire in January. I'm to the point now that I'll just file medical bankruptcy should anything major happen before I'm able to get another affordable plan.
ReplyDeleteIt wasn’t always like this. I cannot imagine the nightmare of being denied a much needed medication. I’m so sorry you’ve been going through all of that. I don’t really understand marketplace insurance as I thought it had become a law that you have to have health insurance now? Maybe that expired. I dread what’s going to happen with our own insurance once my husband retires.
DeleteI believe I'll get fined $600 on my taxes when I file next year. Or maybe it's $1000. I don't remember off the top of my head. But that's what I'd pay for one month of insurance for myself, so it's cheaper for me to get the fine and pay for my dr out of pocket. I was covered all last year, so I won't get hit this filing season, so that buys me a little time that something affordable will pop up.
DeleteOuch. That is truly insane to me!
DeleteI'm so sorry you're going through that. My little sister went through a similar situation with our mom, and it truly was a nightmare, and it seemed like it was never-ending. I have no major insurance issues, but I do take issue with the pharmaceutical companies moving my medications up and down their tier system. Last year I paid $1.85 for one of my medications; this year it's $60 because they bumped it up a tier. Ridiculous.
ReplyDeleteOk, that is an insane price difference. I dealt with that for my mom’s medications and they blamed it on the Medicare donut, which is a whole other rabbit hole! Shouldn’t these drugs being going down in price after a number of years on the market? Research has been paid for by then. Ugh.
DeleteOh my, that really is a circus! I can’t imagine juggling all of that on top of caring for your mother, do you ever take a moment just to breathe amidst it all? Did this saga make you laugh nervously at the absurdity, or was it all just hair-pulling? I hope your weekend is filled with joy and a break from paperwork and insurance calls! I just shared a new travel post too, and you’re warmly invited to peek: www.melodyjacob.com
ReplyDeleteNo, there was no laughter. It's been a non-stop headache, from the time she fell until now (2.5 years later). Hopefully, by next year at this time, the estate will be closed and I can move on with my life.
DeleteSomething very similar happened to my mom after my dad died. Everything was paid in full for the hospital stay until he was sent home for hospice, and we had the paperwork to prove it. A few weeks later, they sent her a bill saying she owed $1,000, and then sent it straight to collections. He had not even been gone a month.
ReplyDeleteI truly believe there is a reason things like this happen. It feels like a system designed to squeeze out extra money at the most vulnerable moments. I do not trust this side of the healthcare system, and it is incredibly frustrating because we still need it.
There is another story I almost do not want to write out. Before my dad died, he was moved from the ICU to a rehab facility across town, even though he was not well enough for the transfer. We only understood later that this happened because Medicare would not pay if he stayed. That move was when my dad really went downhill. Being transferred from one facility to another took more from him than his body could give.
Apparently, hospitals use collection agencies for deceased individuals, even when they have the next-of-kin info, medical POA info, etc. It makes zero sense to me, as it must cost them more?? Again, insanity! Yes, they certainly are trying to get extra money from vulnerable people. It can be very upsetting to get a call and letter from collections. What infuriates me the most is that medical providers have contracts with insurance companies to accept what the insurance company says they will pay. The individual is not supposed to be responsible for anything else (besides a co-pay in applicable and if you have an 80/20 plan). Anything beyond that, the medical provider is supposed to eat. I can guarantee you that I'm not paying anything the insurance company says that we do not owe!
DeleteI'm terribly sorry that the move caused your father's downhill. What a horrible lack of care! Society as a whole has an extreme aversion to caring about humans from conception to end of life. Devo was ahead of its time, predicting the de-evolution of mankind. Sigh.
So sorry you are going through this utter misery, may it be sorted soonest, but I fear it could go on longer?
ReplyDeleteAll the best Jan
Who knows when it will end?!
Delete