Had a positive experience yesterday Well, you might not have because yesterday The episode for yesterday of this podcast posted but it also posted the day before him because of some issues with how micro.blog handles Editing posts.

Anyway, it’s fine.

Here’s a new episode.

You haven’t heard this one yet, but a good thing happened yesterday And although the fights not over I’m still in the fight and I’m pleased allow me to explain Your Daily Lex So I currently use horizon Blue Cross Before when I worked at Amazon and for 18 months thereafter, I used Primera Blue Cross After I left Amazon I did Cobra for a year and a half paying something like $2,300 a month I’m like boy, that’s an exorbitant amount of money to pay for insurance or a family of five Then I went on the private market to get insurance from horizon and started paying them like $2,600 a month for much worse insurance But I have a couple positive skewing insurance stories, which is not the norm at least here in the United States of America I don’t know why we call ourselves the United States here in the Full of hate for each other states of America anyway My son as you may know has Crohn’s disease and as part of his Crohn’s disease his pediatric Gastroenterologist sends him for occasional blood work The insurance company likes to deny coverage for that saying that testing his blood to see how much of the medication this Injected medication that I give him once a month To see how many antibodies his body is generating for the medication because apparently it’s a problem with Humira That over time you can develop antibodies to it.

And so we test to make sure the medication can remain effective Insurance says that test is experimental and thus not covered It’s not an exorbitant amount of money But I’m paying insurance an exorbitant amount of money and they should pay for it because the doctor says he needs this test So they denied it.

We didn’t appeal they denied the appeal and said you could do a level 2 appeal So I started work on the level 2 appeal that included getting letters from my kids doctor From my wife’s gastroenterologist and from other folks putting together all this information and essays explaining why this test is in no way experimental Sent that off to the insurance company.

Of course, the insurance company says you have to send that via postal mail Eventually Two months later.

We got a letter saying that appeal was also denied because my letter arrived late and their letter their second letter to me says Our records indicate that on July 15th, you got a level 1 appeal decision letter It states the following You must submit your request for a second review within 60 days from the date of this letter for us to consider this request We must receive it by September 13th, 2024 And they were saying they didn’t receive my little my letter until October.

Here’s the thing The thing that they I just read to you that they say is quoting the initial letter is now what the initial letter says The initial letter says I have to send it By September 13th, not that they have to receive it and those are two different things and they claim they’re quoting the letter.

They’re not They are absolutely in very intentionally misquoting the letter Also, I sent it in plenty of time.

I sent it in August and so I spoke to this guy yesterday and he’s like Well The very first thing he says as I had said in the letter Quoting your first letter it was due by this you we had to receive it by this day I’m so glad you mentioned that because that’s not at all what the first letter says He’s like, what do you mean?

I’m like, well, I have the first letter right here and I read it to him I’m like it says this you have to send it by this day and you say this It’s just like absentee ballots, right if I’m voting The absentee ballot has to be postmarked by the date And I promise you mine was And you misquoted it you lied in your letter.

You said that it said a thing that it didn’t say But clearly this is what the first letter meant like no that’s not clearly with the first letter man It says it has to be I have to submit it by that.

I did submit it by that It specifically says it must be I can request it a level to appeal by September 13th 24 I requested it well before September 13th 24 and it’s like well, we didn’t receive it by then I’m like, well, I don’t know that you didn’t and just like you’re not accusing me of lying about when I sent it I don’t know if your mailroom just decided to take a really long time to deliver it to you And I’m now finding you harder to believe that I would otherwise Because you lied in your letter to me and you led this call with quoting that lie It’s like well, I understand why that would be concerning to you.

Yeah, it is concerning to me And I literally said to him listen, I understand that everybody needs a job.

I don’t regret you your job I feel sorry for you that your job is constantly fighting with people all day and telling the things They don’t want to hear and having to defend an insurance company But like I said, it’s it’s fair and reasonable for you to have this job.

It’s just a crappy one I also said I want you understand I’ll fight this.

I will fight this to the bitter end I will cost both of us more than it’s worth to either one of us because that’s how mad I am at you and this Insurance company for lying to me and I said listen to be frank I have the means to hire a lawyer and to pay Even if I have to pay that lawyer triple what I would get from you because you guys are gonna pay And he said well, I can try he said let me try to see if I can contact the mailroom And get back to you within a week and I was like, I don’t see what that means How you’re gonna try to contact the mailroom?

You said that you already had been in contact with the mailroom So what do you have to try to contact the mailroom now?

well what I mean is I didn’t talk to them and somebody else on my team did so I have to see if I can get Them to him like you have to see if you can get them to talk to the mailroom He’s like, well, I’m sure I can’t but I need I need a week to talk to them because they will have An image of the envelope that we receive so we can see the postmark on it Okay, and then he said so I promise I’m gonna call you within one week from today I’m like, okay putting in my account.

He’s like, oh wait, wait Let me just make sure that next week is in Thanksgiving cuz I don’t want to tell you I can call you on a day I can’t call you and I said, oh, no No Next week is not Thanksgiving because I happen to know Thanksgiving is on my birthday this year and next week is not my birthday So that day works great.

It’s a go.

Okay good Well, then I look forward to talking to you next week and I said, I really appreciate your saying that but I think we both know It’s not true.

There is no chance that you look forward to talking to me again And he said well, you’re actually much nicer than most people But I can’t tell you how proud I was of Catching him in a lie and catching the insurance company in a lie and he fully acknowledged.

Yep.

We lied He didn’t say those words, but he fully knowledge Yeah, what we said the letter says it’s not what the letter says because it’s not Anyway, we’ll see if I win.

I don’t know Also, I’m changing my new insurance where the one I’m paying $2,700 a month for We’re now gonna get that same coverage through Lauren’s work except it has three changes number one We’ll only have to pay $1,700 a month number two That’s the best change by the way our co-pays will decrease by $15 and number three my current coverage that I pay for privately only covers us in the state of New Jersey and once we get it Through Lauren’s work.

It’ll cover us everywhere in the country So for the privilege of paying less we’ll get more Hashtag America Lex