Things I'm Thinking of Rather Than Working

Because I'm writing this on a sunny Friday afternoon when I should be working...

It is my general philosophy to not attribute to malice what can be explained by stupidity, but I suspect Robert Hanlon never had to deal with health insurance company.

Conversations with all involved parties have allowed me to piece together the factors that precipitated Coventry's determination that the Midwife Center is an out-of-network provider. A brief time line:

1. The Midwife Center faxes a standard letter to Coventry notifying the insurance company that the center will be providing my prenatal and birth care. The letter contains my name, group number and insurance number. The letter does not contain the Midwife Center's provider number, as the center is not billing Coventry for any services at this time.
2. Coventry sends me a letter stating that the Midwife Center is an out-of-network provider.
3. I call the Midwife Center and inform them of the letter. They call Coventry, verify that they are in-network and tell me that I need to call the insurance company and try to determine where the mistake happened.
4. I call Coventry and speak with a very nice CSR. She explains to me that the Midwife Center has two provider numbers, probably due to a change in the name of the center sometime in the past. One number is out-of-network and essentially defunct. The second is in-network. It appears that an employee assigned the fax to the out-of-network number. In order to change it, I need to get the Midwife Center to refax the information to Coventry, with the correct provider number. Once they receive the corrected information, they will send me confirmation.
5. I call the center back and explain the situation. The woman who handles the billing is completely bewildered as the center has never put the provider number on this type of notification. She also does not seem to understand why it is necessary to refax the information with the provider number included. She says the situation will resolve itself when the Midwife Center bills Coventry at the end of the pregnancy. She seems to have missed the simple fact that this company has pre-emptively refused to pay in-network for a service and will stick to that decision until told otherwise.
6. After hanging up, I remind myself that I paid a considerable sum of money for my older, but still highly functional CDMA/GSM hybrid phone, and breaking the phone by throwing it across the conference room is a bad idea.
7. I decide, instead, to spend my Sunday composing and filing an appeal with Coventry, using the information that the very nice CSR gave to me. Copies of this appeal will be sent to Coventry, the Midwife Center, the PA Department of Insurance and the PA Attorney General. Coventry will also be receiving a copy of the formal complaints I will be filing with the PA Department of Insurance and the PA Attorney General.

My week was rounded out, on Thursday, by my first official "pregancy scold" lecture from a co-worker who felt that I should not have indulged in a sushi dinner earlier in the week. She felt it was "too risky" as "you never know, with all the physical changes to your body, what might make you sick".* While I have experienced a significant aversions to some foods, such as the smell of peanut better and well done (overcooked) meat, I have not become suddenly and mysteriously allergic to raw fish.

The sushi was magnificent.

* The dinner consisted of spider rolls (cooked, soft-shell crab), sweet shrimp sushi (also cooked) and crazy tuna rolls (raw, ahi tuna mixed with wasabi served on warm, lightly fried rice rolls). The combined amount of seafood in the meal maybe reached 8oz total, most of the food was cooked and wasabi is used with sushi because of its anti-microbial qualities.