Last week we had the joy of a visit from the stomach flu. Yikes, my normal bouncing, loud, energetic, hyper, busy (you get it yet?) five year-old turned into barf-a-saurus Rex. To my delight he is the least dramatic barfer I have ever met, merely turning his head to the side, doing his business and the continuing on. The downfall to this is that he doesn’t happen to care where “the side” is, and will throw up on/in anything.
After 12 hours of nothing staying down I realized that dehydration was quickly becoming a threat. Being an emergency medical professional, I know how hard it can be to access care after hours without a visit to the emergency department, so I gave the doc a call and asked for some anti-nausea medication before things got out of hand.
Blessedly, we were quickly ushered into the clinic, where my son informed the doctor he was “fine, just throwing up a lot”. (His definition of “fine” is different than mine.) Doc declared what I suspected: a touch of the stomach flu and ordered the meds to be picked up at the town pharmacy.
Once in the pharmacy I filled out all of our new-patient paperwork and plopped down in the chair with my now-crabby 7 year old and my sickly boy in my lap. The pharmacist said it would be a bit because we were new, he had to call the insurance company to verify coverage. He suggested some ginger loli-pops to settle tummies while we waited, and of course Sickly was thrilled with having “candy” to eat while we waited.
Twenty-minutes later the pharmacist was starting to (loudly) argue with someone on the phone, and then turned to me and asked if I was “certain he didn’t have other health insurance?”
I asked to speak with the insurance company, and before I could even say hello, the woman on the other end of the line informed me that she “didn’t know what kind of game (I) was trying to play, but federal fraud was going to land (me) in prison!” Ummm, yeah. I am not real fond of the idea of rooming with our favorite DIY/homemaker/chef Martha What’s-Her-Name, but I am also pretty sure I haven’t committed any federal crimes lately.
I politely asked this woman what she was talking about, and she informed me that she had “proof” that my son has other health insurance, and that I am running a scam. She continued a lengthy diatribe about “people like you” and my “free” health insurance.
So now I am standing in the pharmacy talking on a phone from 1983 with its twisted-up cord stretched over the counter while this woman accuses me of random federal crimes and my 5 year old sits on my hip and rests his head on my shoulder. Finally I get out her what this “proof” that she has consists of.
Wait for it…
She tells me she has a copy of the statement showing that he used his state medical coupon to pay for his birth control pills, in July.
(About this time he throws up ginger-lollipop down my back.)
I asked her why she thought my 5 year old boy would be on birth control? …She not-so-politely explained that is how she knew I was a fraudster.
I hung up on her, apologized to the pharmacist who was now mopping up the ginger-scented puddle off the floor, and proceeded to pay cash. (Good reason to have an emergency fund, because you never know when your son’s birth control pills will cause a financial crisis.)
While the problem was very quickly resolved the next day, with the assistance of the Federal Recovery Coordinator, I was still rather upset that my family had to experience it. (and there was no “proof” of anything, but rather a rogue employee)
The moral of this story is: Have a back-up plan in place! I will get the money refunded to me by the insurance company, but it was the emergency fund that saved our hide in this case. Even federal health insurance is not bomb-proof, and while CHAMPVA and TriCare are good, they tend to have more problems than the private sector, so be prepared for an uphill battle.