The health insurance plan I have through my work processed the claim for my emergency room visit and gall bladder removal surgery. They approved everything, with one exception: a $780 charge for general anesthesia.
Ouch!
According to the first footnote on the Explanation of Benefits:
Your plan benefits do not cover all services. The service noted above is not covered. Please read your plan booklet for details.
Naturally, this made me want to read my plan booklet, because it seemed to me that not covering anesthesia during surgery was a rather large thing to leave out of a medical plan. But I don’t have a copy of my plan booklet. So I asked the local HR person at my office. No plan booklet. I called the corporate HR office. They don’t have a copy of the plan booklet, either.
Apparently, no one at my company knows exactly what is covered by our medical plan.
But it gets better. There was a second footnote regarding the denial of the claim:
Your plan excludes coverage for services related to weight control, including surgical procedures primarily intended to control weight or treat obesity, including morbid obesity.
Riiiiiight. That’s the primary reason why I wanted the anesthesia — to lose weight. The whole being-unconscious-during-painful-surgery thing was merely secondary.
I called the insurance company about the denial of the claim, and the customer service representative burst into laughter. Fortunately, it was the good kind of laughter, rather than the evil, maniacal laughter one generally expects from an insurance company. She said it was clearly a mistake and that they would reprocess the claim.