I had to write a check for $166.34 for Lain’s latest visit to the hospital for her hip dysplasia treatment. The $166.34 itself doesn’t bother me as much as the fact that our insurance provider apparently does not believe that hip dysplasia should be covered and has rejected almost every claim that has been filed.

I told my wife that we have paid $2,164 for her hip treatments this year and insurance has paid “thirty-seven fifty-seven.”

She said the latter was small comfort, until I specified that what I meant was not $3,757, but rather $37.57.

Whatever, though. Lain shouldn’t need hip surgery when she’s 35. That’s what’s important. To us, anyway, if not to the insurance company.

Will Truman

Will Truman is the Editor-in-Chief of Ordinary Times. He is also on Twitter.


  1. Did you return the $37.57 to the insurance company and tell them to stick it where the sun don’t shine?

  2. Hey, that’s money the insurance company can spend paying for viagra for some old dude or ritalin for a school aged boy so he’s more compliant in publik skool. The insurance company’s got PRIORITIES man.

    Bread and circuses.

  3. If we had universal healthcare and better regulation of the insurance industry.

    In other news, I buy my own policy from Aetna. They are pulling out of California in the individual market rather than comply with Obamacare it seems.

    • So does that mean Obamacare has a bad affect on the insurance market and the insurance business, or does it mean Aetna is a terrible company that will spite its own capitalist motivation just to be vindictive?

      • Individual policies are the most profitable, soon to be were the most profitable. BCBS of North Carolina wanted to go for-profit instead of not-for-profit (which isn’t non-profit!) so they could break their contracts with the public workers’ unions, turn around and charge each individual three times more than they were paying as a pool. Legislators got wind of it and put the kibosh on that.

        See, it’s all a numbers game. The more people in the life pool, the more computable the odds of any one of those lives becomes. That’s why a firm can get a better per-life rate for ten thousand people than one thousand. The optimal rates would come from including absolutely everyone in the life pool.

          • Pynchon: “All the animals, the plants, the minerals, even other kinds of men, are being broken and reassembled every day, to preserve an elite few, who are the loudest to theorize on freedom, but the least free of all.”

          • No, and it’s obviously stupid for you to pretend you can know whether I did. I did read this comment, though, because it was short and sweet enough that it showed up in its entirety in the sidebar. Please don’t respond to my comments, and I won’t respond to yours. I think any interaction between us is inevitably cancerous–if our past interactions have been unpleasant for you, then be smart enough to not seek out future unpleasantness.

          • Oh hush, James. I’ll respond to whom I like, when I like, and within the rules, as I like.

    • If we had universal health care, the bean counters in Washington would look at it, the money it will save the system down the line, and think a couple thousand dollars now is an absolute steal.

      If we had a market system, Clancy and I could have monitored expenses more closely and been mo9re judicious with our usage.

      Instead, we have neither, so this is what we get.

      • Universal health care is kinda amorphous. For all the problems it solves, it only creates other problems. What’s needed is probably more akin to how the auto insurance industry works, where you do have to maintain a certain amount of coverage but you could purchase more. How many children suffer from hip dysplasia and how much have their parents (and their insurers) spent on such coverage? We have no way of knowing at present. Market forces aren’t at work, where you and Clancy could compare the costs and benefits. The cost of a procedure varies wildly from place to place, provider to provider.

      • From what I know of universal healthcare systems, the civil servants that run them tend towards tend to approve everything but fight really hard with the doctors and hospitals about what the procedures are actually worth.

  4. I’d challenge the company on it.

    You’d be surprised at how often they give in and pay up. It’s cheaper.

    • I’d like our chances better had we not already paid the bills. “Here’s a kid with a bum hip and the insurance company won’t chip in” would have made for a good story. At least, until it became known that we had the means to pay for it ourselves.

      • You have the right to be reimbursed.

        Below, Shaz states the standard rule: ask four times. The first three will be denied. Always go higher up the chain of command with each new asking. Eventually, you start getting to a layer where it costs more to deny the claim then to pay for it.

        These things are a pain in the ass, I realize. But they don’t take much time. If they do pay, you’ll have earned money that’s rightfully yours. Make sure you take down each name of the people you speak with, starting with the claims processor; ask for their contact information, and if and when they say no, ask to speak to their supervisor.

        And after you’ve gone up through four levels of management, if they still say no, file a complaint with the Attorney General in the state where the claim was denied; provide the names and reason for each of the denials, and your daughter’s doctor’s recommendation.

        Then go up one level more, this time, with the AG complaint.

        Squeaky wheels get oiled.

      • I’m not too well-versed in bill dispute resolution, but I have heard what Will T. is saying, namely, that one has less of a case once one pays the bill.

        I really don’t like that state of affairs, if it’s true. If someone can pay, then I can imagine they’d want to pay before the dispute is resolved so that if it’s not resolved in their favor, then they won’t get whatever financing charges or late charges might be tacked on (as I’ve heard is the case with credit card dispute resolution), or they might just not want to worry about having to pay something later.

        Obviously, one has to be in a position of privilege to have precisely that problem, but it still bugs me.

        • Not paying the bill only hurts the provider and the insured’s credit record. The dispute is not between the provider and the insurer, it’s between the insurer and insured. The only loss of incentive here would be to the provider to not follow through with whatever paperwork is required; but presumably that was done when the claim was originally filed.

  5. The $37.57 is more insulting than if they just gave you nothing.

    Doesn’t Clancy get some sort of employees’ discount?

  6. Remember the old rule, Will: if a condition is not explicitly covered by the policy, insurance companies will deny a claim three times. That’s SOP. Most people give up after the first refusal.

    • The rule of three denials is written in stone.

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