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1/14/08
Insurance Fraud

It's a new year, and that means new calendars, new resolutions, and most notably, a new insurance plan. Sigh. I HATE getting new insurance. (Every year Ye Ol' Company contracts our insurance with the cheapest most value-added plan provider, and every year, due to complex insurance rates and contract plans and random darts thrown on a random dartboard on a random day, that company changes). This does not really bother me since all the plans basically provide the same pay-out scale for doctor visits (roughly 0.00007% of the total bill) and cost basically the same (roughly 99.999997% of my paycheck). What does bother me about insurance companies is all the time I have to spend trying to convince them that I really am who I say I am.

Here's the thing. I do not go by my first name. I go by my middle name. (And sometimes, I go by a nickname of my middle name, just to trip people up. I have three aliases). Insurance companies, however, only know you by your first name. Sure, they make you put all the names on the forms, but they do not really care about your middle name and your nickname. This causes confusion for them because my doctor sometimes turns in my claim form with my middle name. And as insurance companies do, they studied the claim thoroughly, and sent me a letter:
"DENIED!" screamed the smug little letter. "On this date, (middle name)(last name) filed a claim, when the policy holder is actually (first name)(last name)! DENIED! DENIED! Nanny-nanny-boo-boo!" And I sighed, and called them up.

Me: Hi. My name is (first name)(middle name)(last name). You have denied my claim.
Insurance company: Yes, that claim was for a (middle name)(last name), and she is not covered under your policy.
Me: Yes, but that is me. I am both names. The policy covers me- (first name)(middle name)(last name).
Insurance company: Yes, but (first name)(last name) does not cover dependents on this policy.
Me, now with eye twitch: I'm not a dependent! I'm the policy holder! Check the social security number. Same person.
Insurance company: Hmmm. Yes, the social security number is the same for both. Do you want to change it for your dependent?
Me, ripping out chunks of hair: No! It's just me! There's no dependent! NO! DEPENDENT! How can I be a dependent of myself? I AM (first name)(middle name)(last name)!

You get the idea. This conversation went on and on for about 45 minutes until I managed to get it through that I did not spontaneously clone myself, go to the doctor, and then try to scam the insurance company by trying to get them to pay for the "other" me. I've started going by my first name at the doctor's office to avoid confusion, but the dilemma still pops up randomly from time to time...almost like the insurance company is testing me to make sure it really is me and not the "other" me.

Another problem with my first name is that it's one of those ambiguous names that can be either male or female. (The army hounded me for years because they thought I was a guy that they wanted to enroll. Oddly enough though, as soon as they found out I wasn't a guy, they quit calling. Hmmmm). Apparently, the army forgot to pass that information along to the insurance company though, because when I stopped by the pharmacy to pick up some certain lady pills necessary for hormonal sanity, the insurance company once again denied my claim.

Pharmacist: I'm sorry, these pills are not covered by your insurance.
Me: What? Sure they are.
Pharmacist: I have your insurance company on the phone if you'd like to talk to them.
Me, on the phone: Hi. My name is (first name)(middle name)(last name). You have denied my claim....again.
Insurance company: Yes, those are lady pills, therefore (first name)(middle name)(last name) is not eligible for those pills.
Me: What? Why not?
Insurance company, smugly: Why, because he is a man of course!
Me, ripping out chunks of hair: THAT'S ME! DO I SOUND LIKE A MAN TO YOU?!? GIVE ME MY PILLS! I'M VERY HORMONALLY UNSTABLE WITHOUT THEM! DO YOU WANT TO SEE ME HORMONALLY UNSTABLE?!! DO YOU? DO YOU?!

At this point, the pharmacist wrestled the phone away from my death grip and testified that from what he could see I was not, in fact, a man. Then he filled my prescription and ushered me out of the store before I could unleash hormonal wrath on unsuspecting customers.

Last year, the insurance company attempted the insurance trifecta by confusing me with someone else entirely. They sent me a card for a guy (again) who works with me, but has a completely different name. The only thing that was similar is that we had the same initials. INITIALS people? What are you smoking in your little insurance break room? My only guess is that the insurance people do this on purpose to amuse themselves, and then have a pool to see how long it takes me to call them up and tell them that they've confused me with a 65 year old man who works on the floor above me and apparently has just been diagnosed with an enlarged prostate (and by the way, they're only paying for 97 cents of it).

Now once again, we have a new year with a new insurance company and new forms. I'm waiting for my new card to arrive in the mail. This time I'm hoping they'll make me Elvis. Our names contain some of the same letters, so the chances are good.

It's too bad Elvis's insurance-caused eye twitch is considered a preexisting condition.

2 comments:

smc said...

so you're saying that according to your insurance company, you could be my... brother?

Noooooo!

Quirky said...

according to my insurance company, I could be the Queen of Sheba