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But We Did Everything Right! Doesn’t That Count?

October 7, 2015

It was not my fault. I did everything right. And now, because I followed the right steps I was out $8,000. And worse, it was my church that was taking my money. Not my fault!

In 2003 I left Microsoft and tried to decide what was next. Did I want to stay in the software field? Did I want to try something new? Did I want to stay in Washington? Move back to Utah? Somewhere else? 

My uncle lives in Northern Idaho. I remember sitting on his deck watching the sun come up over Lake Coeur d’Alene. I was on a “brothers trip.” My two brothers and I had loaded up my minivan, hooked up my tent trailer and I drove us from Olympia, WA through eastern Washington and Northern Idaho; places we had known growing up. (Yeah, I’m not sure why it was all my gear either.) 

We’d come to visit my uncle and his house on the lake. It was peaceful here. He is a very easy guy to be around. We fished. We water skied. And we sat around talking. But, this morning I was up before anyone else. Just watching the sun chase the shadows off the lake. 

Teach.

I love to teach. Maybe I could teach at college? I’d need more education. Okay. That’s the plan. I’ll go back to BYU and try to get enough education to become a college professor. (I never made it to the tweed jacket, but that’s another story.) 

I had some money from Microsoft and selling our house. My wife and I figured it was enough to get me through a couple years of school. Enough to get started down the road. There was just one problem: health coverage. 

How many decisions do we make based on our health care options? Too many. Anyway, one of my kids had a surgery scheduled. It was one of those schedule months in advance. We were able to find a surgeon  in Utah that wouldn’t affect our schedule too much. But, how to pay for it. The surgery was covered by our current insurance. We were paying COBRA. We had to decide if we wanted to stay on COBRA until the surgery was done, or switch to BYU student health insurance immediately. 

What would YOU do? Well, we called the BYU healthcare provider and asked them about the surgery. 

Yeah, my child has this surgery scheduled and we don’t want to mess that up. We can wait to switch insurance until after it’s done if we need to.

Is it covered by your current insurance?

Yes, it’s covered 100%.

Then, there is no problem. If it’s covered by your current insurance, we will also cover it. 

I’m not sure how else we could have asked that question. It was absolutely clear. Well, we moved, we switched insurance and soon the day of the surgery arrived. I got a very scary phone call right before the surgery was scheduled to start.

Mr. Bliss, this is the surgery office. We generally make a final check of the insurance right before the surgery. And your provider tells us that this surgery is deemed elective and therefore not covered.

Ah. . .

If you will pay for the surgery up front we can proceed.

Ah. . .

Eight thousand dollars later my child was on their way into surgery and I was starting on a quest through the amazing world of insurance. 

Did I mention that we called and checked if the surgery was covered before switching insurance companies? I’m pretty sure I mentioned that. 

Nope. Didn’t make a bit of difference. The company even acknowledged that MAYBE their representative MIGHT have said it was approved. Unfortunately that employee was no longer with the company. We appealed to the higest levels of the insurance company. And here’s where the curch tie-in happened. BYU, of course is owned by the Mormon church. Well their health insurance is also owned by the church. 

So, the final appeal was a quasi-religious group of senior managers. Our advocate went in and made our pitch:

  • Students
  • Adoptive family
  • Made switch in good faith
  • Other insurance didn’t think surgery was elective
  • THEY CALLED FIRST!

The advocate said that she thought she had convinced the board to grant us an exception.  . .until. . .the attorney started talking about precedents, contracts, liability, etc.

Short story version? We were out $8K that we could have saved if we had simly waited to switch insurance until after the surgery. 

The lesson from this? Don’t let the attorney talk. 

Rodney M Bliss is an author, columnist and IT Consultant. His blog updates every weekday at 7:00 AM Mountain Time. He lives in Pleasant Grove, UT with his lovely wife, thirteen children and grandchildren. 

Follow him on
Twitter (@rodneymbliss
Facebook (www.facebook.com/rbliss
LinkedIn (www.LinkedIn.com/in/rbliss)
or email him at rbliss at msn dot com

(c) 2015 Rodney M Bliss, all rights reserved 

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