Bundle Up Folks, There's an Artic Chill in the Air or I am a Demi-God

For months now, I have been working to get some kind of clarification from the insurance company and the Kennedy Krieger Institute regarding Jackson's upcoming appointment. He is scheduled to see the world reknowned Developmental Pediatrician, Dr. Paul Lipkin. This appointment was made in NOVEMBER. Yes, nine long months we've been waiting. During the period we were on the waiting list, I was advised by KKI that they do not have a contract with our insurance company, United Healthcare, and that we would be responsible for the entire bill. WHOA.

How much are we talking here? Well, that's the problem now isn't it? Does anyone ever know how much a visit will be or the cost of additional testing? Nope. The best they could do was guesstimate.

"Around $800 for the first visit", I was told. HMMMPHM. Better get on this.

So I called our friends at UHC. Their story was that Dr. Lipkin was indeed an approved in network physician. As long as the visit was billed through the provider (Dr. Lipkin) not the facility (KKI) it would be covered. So all I had to do was make sure it was billed that way. Right.


So then I called KKI.
"How does Dr. Lipkin bill?" I ask.
"All of Dr. Lipkin's billing goes through KKI." she responds.
"He can't bill it out to UHC himself?" I ask.
"No." she responds.

Oh boy. Another phone call to UHC.

"So if Dr. Lipkin is in network, and only practices at one location, why isn't that location also in network?" I inquire.
"The location does not have a contract with UHC." she responds.
"Then what's the point of the physician having a contract with UHC?" I retort.
"This physician has been contracted with UHC for quite some time," she informs me. "He may have changed locations after the contract was initiated."
"Great. So there's nothing I can do?" I ask.
"Well, the name on the bill doesn't matter so much as the tax ID number. As long as the doctor is on the tax ID number used for the billing, it will be covered in network."

WHOA.

Several emails later I have the tax ID numbers. I call UHC to compare notes.
"Nope, he's not listed under any of these tax ID numbers, so we won't cover it" I am told.

Another email to KKI to find out if there are any additional tax ID numbers produces this reponse..... "We are calling UHC and will inform you of the outcome."


Wait a minute. UHC and KKI are actually going to talk to each other?!?! WHOA. BIG WHOA.

Twentyfour hours later I get a phone call:
"Hello, Mrs. Bender?"
"Yes."
"This is Latanya with KKI calling. I just wanted to let you know that we've worked out an arrangement with UHC and we'll be billing them directly for your visit. There will be no payment neccessary at the time of service."

I swear my ears are deceiving me.

"Really?!?!" I respond.
"Yes" she says. "In fact we've spent all morning in meetings and conference calls getting the agreement set up."

"THANK YOU!" I'm practically screaming in the phone.

"No, we thank you Mrs. Bender. This is just the push we needed to initiate this contract and get the procedures in place for billing UHC."

Now I am sure my ears have deceived me. Playing in my head is the Rocky theme song and I'm mentally dancing around the room.

Yep, I am pretty sure now I am a Demi-God. Sent to earth to make the insurance company and medical facility actually work together to resolve a problem. And if you listen carefully, you can actually hear the sound of the eighth circle of hell freezing over.