Insurance Insanity

knee xray side view

Last spring my orthopedic surgeon determined that the bones on the outside of my right knee are rubbing against each other.  Trust me, it’s uncomfortable and limiting.  For the last six months I’ve been wearing a brace that cranks my knee around and keeps those troublesome bones from rubbing.

After six months of almost constant use, it was time to order a new skin for the brace. The current skin is stretched out, losing its elasticity, and just looking gross.  It has served its purpose very well, but it’s slipping out of place so often I’m starting to wear it less frequently.  Two weeks ago I decided to see what I needed to do to get my brace reskinned.

Last June the brace company told me I needed to get a prescription from the doctor for the new covering and then send the brace and script.  They would reskin it and send it back; the insurance company would then pay for it.  I called the company to make sure that was still the protocol.  It wasn’t.  Now they want me to pay for it and submit the charges to the insurance company.  I’ve never done that so I had the Human Resources people at the office check on it.

They informed me the brace company was NOT one of their providers, they had no record of paying for the original device ($1200) and I needed to start over again.  So, instead of paying $149 to reskin my device; they’re buying a whole new appliance.  It’s still cheaper than a partial knee replacement, but really?!?!?!  I’m thankful they’re providing what I need, but it seems to me there’s a more economical way to do it.

I think I have a clue why the health insurance industry is having a few problems.

photo courtesy of Adam Ciesielski

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