Insurance Nightmares Know No Borders

The American healthcare system is broken. This isn't news to anyone that has paid into a health insurance system for years to only be declined for a legitimate claim. Maybe it was a bureaucratic "check the box" rejection. Maybe you didn't have the right rider. Maybe your doctor put a code in that was off by one digit. Maybe the insurance adjuster had deemed your medically advised procedure as "unnecessary." 

I had my fair share of medical frustration state side. There was the neurologist who told me that "your headaches are in your head because you're too overweight and curling doesn't count as an exercise." (Brilliant diagnostic work there: my headaches are in my head🙄). My school district medical insurance stopped covering chiropractic care "because clearly it isn't helping and is wasting yours and our money because you keep getting migraines and going back." There's the classic, "IUD insertion doesn't hurt you'll be fine" followed by a pain I can not describe, tears, and having to wait before being able to stand let alone drive myself home. The "do I really need X because I know what it will cost" negotiations that go on in your head at medical advice. The still yet undiagnosed random bouts of nausea that I was told repeatedly was pregnancy despite 17 negative tests in three months. My list isn't unique. Every American - to be fair probably every human in the world - has a list of WTF moments with the medical world. In the States we just have the "privilege" of paying up the wazoo out of pocket for these experiences. 

Cheers. It's taken a few beverages to get through the insurance processes. Pardon, to get to where we are now because I'm definitely not done! 

BUT, and this is not the direction you thought this was going, there is an aspect of the American healthcare system that I miss while living out this Italian dream. It's medical paperwork. Or the lack there of. Kind of.

One thing I was not mentally prepped for, or verbally prepped, was dealing with medical claims. For most of my medical needs (as "only" a dependent of "only" a civilian GS employee) I have to go "onto the economy" to find care. This means I have to find Italian services. This alone is a feet. I need a provider who can communicate at least the basics in English. Sure, I can ask where the bathroom is in decent Italian at this point but I can't comprehend medical procedures. Sometimes I need them to dumb it down in English even at home! Italy doesn't do medical insurance like we do which means medical providers also don't file your medical claims like you'd expect from an office in the States. (I also have no hands on experience with local socialized medicine but I know if I go to to the ER it won't bankrupt us.) I spent so much time lamenting about the issues of American style healthcare, that I didn't realize it was a privilege to leave an office with them saying "we will file the claim and if you owe more than the copay you just paid, we will send you a bill." Now, keeping track of which medical bills went with which explanation of benefits that went with which doctor's office's invoice that went with which rejection yada yada yada was a headache, but the actual filing a claim chore had never been mine. 

An exact representation of my face with each passing phone call and email! (but actually this is at Bosco Sacro di Bomarzo north of Rome)

Until Italy.

We see a provider and then I have to go online to fill out claim forms. So far this has only been for dental and vision. Easy enough. Here are some of the issues we've run into: 

• timezone differences
• Italian provider's invoices and receipts have very different info on them than US providers, so lots of going back to offices to get additional info (fun when one office is three trains and over two hours away)
• Of course, everything is in Italian. Insurance adjusters think my Italian is better than Google Translate 🙄
• Programs designed for DoD employees not accepting DoD addresses overseas
• Being told that the world wide web can't accept receipts uploaded from Italy and we have to snail mail them
• Communications expected to be sent to our "US address" (which is Brian's parents) and then Jackie and Ed pay to mail it to us
• Being told that the state of "AE" doesn't exist to the USPS (not sure who we pick up mail from regularly then)
• Having to snail mail claims and then having that claim "return to sender, address unknown."
• Verifying it is the correct address with insurance and the conclusion is 🤷‍♀️ weird, I guess you can't file 
• Dental claims for Brian being processed but the exact same procedure for me being rejected and when confronted being told "ooops, oversight"

My general feeling after these loops of insurance hell

Toss up: did I want to barf more dealing with insurance issues or sticking my hand up a squids butt (do squids have butts?) to turn him inside out to clean him?

It's turned into a part time job to file, track, follow up, and contest basic insurance issues. These are processes that I took for granted at home. Some of them seem like blatant "mistakes" in hopes that the policy holder just gives up and eats the cost of the service. It does make we wonder how many times these issues happen when medical offices file for us but we never know the issues. How many dollars are sitting out there in the insurance world that are rightfully ours?

I won't lie. I have enjoyed making colour coded spreadsheets and having some iota of functional purpose as I take train rides, make phone calls, and fire off emails. Teaching requires a level of organization that "dolce vita" does not and dealing with insurance has brought some of that back to me. 

This art installation in Brussels fits my state of mind when the response is "oh, your address DOES exist! Look at that! But, yah, we can't process your claim with it."

When you agree to a DoD sponsored adventure of a lifetime there are many pieces of advice people will share. You'll ask a lot of questions. You'll get there and realize there's so much more to learn despite endless research, note taking, and listening. Dealing with medical insurance, senza the provider's office, is one I would definitely add to the list of wisdoms to pass on. 

So wish us "in bocca al lupo" or "in cuolo alla balena" that we don't need any serious medical services while here. I can not imagine that mess. I'm also giving myself kudos for restraining the 40 year old Karen inside of me when on the phone with VSP Vision the other day. I had to remember it was 6a there and I was here first interaction of the day! I'm not sure what is better: offices filing for us and never knowing what "mistakes" are made and payments left unclaimed or the endless loop of trying to file yourself. Much like the American healthcare system, both seem broken. 

So true!

FPO/APO Military Shipping FYI

• We do have an Italian address but getting packages here is an unclear process and one thing shipped to it didn't show up

• The US Post Office offers specific addresses for military affiliated people

• Sending us, or other military affiliated friends, a box costs the same as sending something within the US but it does need a customs form

• Our "state" is AE or "American Armed Forces Europe"

• Our "city" is FPO or "Fleet Post Office"

• I had to ask the post office lady in Norfolk how to address boxes to ourselves before we moved because of the alphabet soup! 

• As far as the Post Office is concerned we live in the US....but explaining this feels like trying to explain to companies that Alaska IS in the US and it shouldn't cost more to ship there. If you know you know 🤣