Insurance

We ran into a case of “read the contract or get taken for a ride” with our medical insurance company. Kylie has some sort of skin problem that we wanted looked at (as well as having a general checkup). The insurance company decided that they would not honor the contract, so we ended up in what I think is like small-claims court. The following is from a journal entry I created Monday. I will tell you what happened today after the entry:

We took Kylie to go see the doctor today because of a rash she has had for a while. We ended up going to a very different type of doctor after that.

Mediplan is the name of our insurance company. They have a pretty decent reputation, and have been pretty good to us so far. Nádya has worked in a couple of insurance billing departments for several years, and is really good at what she does. Not only does she know how to get the stuff done, she somehow remembers the details of lengthy insurance contracts. Our contract basically says that we can include Kylie after she is born if we sign her up within 30 days (I am not quoting because it is in Portuguese, and I don't feel like translating it.). The “inclusion” means that Kylie has the same access to the doctors as we do; which means no waiting period for insurance part of the insurance to kick in.

We have tried two separate times to sign her up, but on both occasions (the latter being today) they said that we could not because we have to sign her up under her own contract—which is no good because she would have to wait before seeing the doctor. [Actually the first time the person who came to our home said that we would have to go to the office to sign up, as he could not do “inclusions.” But this was only after he saw that we were going to find the contract and show him what it said.]

So, contract in hand, we went to the other doctors: The justice department. Sort of a small claims court, I think. The earliest spots available for a hearing were in October, but after reading the contract, and seeing that our case is pretty open and shut they made a spot for us on Wednesday at 9:30 AM. Everybody that looked at our case was certain we had a claim.

I guess that it may have helped that we had our eight-day old baby in arms (which may create a sort of cuteness-induced reality distortion field), and that my wife was complaining of her surgery hurting (it really was—we had waited a long time and somehow the heat makes it hurt more).

That is kind of where we are right now. Nádya expects the insurance company to call asking us to accept a settlement. I am not sure I want to do that because then how many other people will be snookered by these people? I kind of want this on official record, more for the sake of others than for our sake.

We got there early enough that we had to wait around for the representatives of Mediplan to get there. We knew who they were when they walked in, and I wasn't sure whether to laugh or run: There were two attorneys and someone from the company.

There seemed to be a lot of tension in the room, and not just on our part. I was more nervous about being asked questions and stuff than anything. How would I respond? Would my Portuguese be good enough and/or understood?

After waiting around about half an hour for the arbiter/judge to get there we began. We had our files in order in a little folder, but I decided not to even open it until we were asked for a document. By contrast, the lead attorney (the other attorney was his brother, by the look of it) fidgeted with the copy of the contract. I wasn't sure if he was nervous for himself, or for us.

Once the “promotor” got there he shook hands with everyone, and the attorney started in. At first I was kind of put off that he just took off like that, but then I listened and he seemed to be conceding our point!

It actually took longer to document the case in written form, than to get it sorted in court.

We have to have Kylie registered with the government (of Brazil) before we can get an appointment, though. So we still have to wait a few more days, but it will be soon.

I am very grateful that we won, but it would not have happened if my wife did not read the contract. She has to do this stuff for work, so she knows how important it is to read the contracts.

[composed and posted with ecto]

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