I quit what I thought would be a dream job last fall. I had been hired to reboot the oral history program at the Washington State Jewish Historical Society, but about six weeks in, it was clear that the organization had, uh, let\u2019s call it a leadership issue. I chose to leave rather than accept the solution proposed by the board. And I wanted out before my benefits kicked in to avoid insurance shenanigans. I was emphatic in my resignation that they ensure my benefits were not activated. <\/p>\n\n\n\n
About a month later, I got Covid. I\u2019d been able to avoid it for almost three years. I acknowledged that pile of positive tests wasn\u2019t getting any more negative, called the doc, and got a prescription for Paxlovid. Then I called the pharmacy to confirm it was ready for pickup. <\/p>\n\n\n\n
\u201cYeah, we have it, that will be $1600,\u201d the pharmacist said.<\/p>\n\n\n\n
\u201cExcuse me, WHAT? No. NO.\u201d<\/p>\n\n\n\n
\u201cOh, no, wait, never mind. You have a $25 copay.\u201d<\/p>\n\n\n\n
I picked up my meds, went through the trauma of trashmouth you get from Paxlovid (it is awful), and went about my existence. <\/p>\n\n\n\n
In January — conveniently after the low\/no cost Paxlovid program expired — I got a bill from Regence for nearly $800. The letter claimed that I had used cancelled benefits and as such, I was required to pay up. I called the pharmacy. <\/p>\n\n\n\n
\u201cNotes on your account say secondary insurance,\u201d said the pharmacist. <\/p>\n\n\n\n
\u201cWhat secondary insurance? I don\u2019t have secondary insurance.\u201d<\/p>\n\n\n\n
\u201cYou need to call Regence and ask them why they told us you have a $25 copay, then. We can reverse the claim, but you will need to come pay us $1600.\u201d <\/p>\n\n\n\n
\u201cNo. And Regence? What? I don\u2019t have a Regence plan.\u201d<\/p>\n\n\n\n
\u201cYou need to call them. We submit against what we see in our system.” <\/p>\n\n\n\n
I sent the bill to my former employer. It was a direct result of my relationship with their organization and given the terms of my departure, I had hoped they\u2019d pay it as an act of goodwill. They declined. I escalated to the board, and they again declined, saying my policy had never been activated, something I later had them confirm with their insurance broker. <\/p>\n\n\n\n
I called Regence. They couldn\u2019t find me in their system. So began my journey into the process of health insurance appeals. I started calling this whole situation \u201cSchrodinger’s Health Insurance.\u201d If I was covered, why did I have to pay? If I was not covered, where did the pharmacy get the account information, since it didn\u2019t come from me?
I learned some things as a result of this process.<\/p>\n\n\n\n
The Attorney General\u2019s office will take your complaint, but they won’t resolve it.<\/strong> \u201cThey might already be under investigation,\u201d said the helpful AG\u2019s office contact I spoke with. \u201cYou wouldn\u2019t know.\u201d They aggregate complaints into broader suits against perpetrators, but they don\u2019t handle individual complaints.<\/p>\n\n\n\n The Insurance Commissioner’s office \u201chas little oversight when pharmacies are involved<\/strong>,\u201d the office told me. They encouraged me to file a complaint, but their backlog was tremendous and they could not confirm they would act on my case. <\/p>\n\n\n\n The appeals policy is bullshit, but you should do it anyway, repeatedly.<\/strong> With each step, Regence introduced an additional inaccuracy into their account of why I was being billed. There were two lines in particular that I found amusing. They said I should not have presented a Regence insurance card at the pharmacy (I did not) and they wanted to know why I did not question the additional $800 copay (I was never told this would be the case). I requested an external appeal, the final option in their process, which they would not provide because I did not have a Regence plan. \u201cIf I don\u2019t have a Regence plan, why was the pharmacy able to bill that plan? Where did they get that information, since it didn\u2019t come from me?\u201d I asked them, in response to their final communication with me. They sent me to collections.<\/p>\n\n\n\n The organizations that might help you with this nonsense are woefully overburdened<\/strong>. It took me months to get a consulting call with legal aid, but it was worth the wait. \u201cWhy did Regence pay the claim if you weren\u2019t a customer,\u201d the lawyer asked. \u201cThey should have rejected it outright. If the pharmacy screwed up, they need to work it out with them, this isn\u2019t on you.\u201d He suggested that collections might take me to court and I should go if that was the case, but given my efforts (and extensive documentation) he seriously doubted the courts would rule in Regence\u2019s favor. He also suggested I tell collections about my efforts to appeal. <\/p>\n\n\n\n Collections agencies are total bottom feeders but they will cut their losses.<\/strong> First things first, you should immediately send in the collections dispute form asking for more information about the claim. They must send you information validating the claim and their qualifications to collect said claim. They sent me the original letter from Regence. I responded with a list of actions I\u2019d taken to appeal with Regence, including that Regence had failed to respond to my line-by-line refutation of their assumptions. As a result, collections said they would close my account. <\/p>\n\n\n\n Medical debt isn\u2019t supposed to hurt your credit rating, but that\u2019s at risk<\/strong>. The Biden administration passed an exclusion; the current anti-human administration objects. This is unresolved right now (May 2025). <\/p>\n\n\n\n Fraud complaints go into the void<\/strong>. I filed complaints against Regence and RiteAid with fraud investigation organizations. I have yet to receive a response. <\/p>\n\n\n\n The customer is always wrong, especially when it comes to health insurance. <\/strong>Imagine any other scenario where you make a purchase. You pay the cashier and leave the store with your item. Months later, you get a bill stating that in fact you owe several hundred dollars more for that item. You are retroactively liable for their error. In my case, the insurance company made up details about my case that were simply untrue. They lied about my actions and when I disagreed, they sent me to collections rather than respond to my corrections. <\/p>\n\n\n\n This shit takes ages to sort out. <\/strong>I\u2019m keenly aware that not everyone has the time, energy, resources, or skills to tackle a matter like this. It\u2019s literally my job to document things so I made sure to get everything in writing, to start a running file the moment this problem reared its ugly head. Collections is scary, too, there\u2019s a whole emotional impact when these third party bullies come after you. It\u2019s fucking exhausting. I wonder how many people write checks to collections because they simply don’t have what it takes to fight. Too many, I’m sure.<\/p>\n\n\n\n I\u2019d like to say this whole thing is resolved given that collections has declined to proceed, but the collections agent said they could not guarantee I would not hear from Regence again. <\/p>\n\n\n\n Employment based health insurance is complete and utter trash — as is health insurance. <\/strong>I would never have been in this mess if my ACA plan insurance covered Paxlovid. I would never have been in this mess if I hadn\u2019t applied for employee benefits.<\/p>\n\n\n\n A friend recently told me she\u2019d been billed for her mammogram. She had called in advance to make sure it was covered and later, got a bill saying it was not.<\/p>\n\n\n\n What the fuck are we doing here, people? <\/p>\n","protected":false},"excerpt":{"rendered":" What did the pharmacy know and when did they know it? They didn’t get it from me, after all. <\/p>\n","protected":false},"author":74,"featured_media":14519,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[],"class_list":["post-14518","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-seattle","masonry-post","generate-columns","tablet-grid-50","mobile-grid-100","grid-parent","grid-50"],"_links":{"self":[{"href":"https:\/\/www.nerdseyeview.com\/blog\/wp-json\/wp\/v2\/posts\/14518","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.nerdseyeview.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.nerdseyeview.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.nerdseyeview.com\/blog\/wp-json\/wp\/v2\/users\/74"}],"replies":[{"embeddable":true,"href":"https:\/\/www.nerdseyeview.com\/blog\/wp-json\/wp\/v2\/comments?post=14518"}],"version-history":[{"count":13,"href":"https:\/\/www.nerdseyeview.com\/blog\/wp-json\/wp\/v2\/posts\/14518\/revisions"}],"predecessor-version":[{"id":14535,"href":"https:\/\/www.nerdseyeview.com\/blog\/wp-json\/wp\/v2\/posts\/14518\/revisions\/14535"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.nerdseyeview.com\/blog\/wp-json\/wp\/v2\/media\/14519"}],"wp:attachment":[{"href":"https:\/\/www.nerdseyeview.com\/blog\/wp-json\/wp\/v2\/media?parent=14518"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.nerdseyeview.com\/blog\/wp-json\/wp\/v2\/categories?post=14518"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.nerdseyeview.com\/blog\/wp-json\/wp\/v2\/tags?post=14518"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}