The Benefit Audit

Surprise!  I'm not going to rant about the election today.  Every a**h*** on the planet is already doing so.  I don't want to choke up the universe's cosmic energy with more.  I'm going off on a totally different tangent today.  The benefit audit.

We all know the IRS performs their audits.  Nobody likes them, but unfortunately it's the only mechanism that prevents all of us from cheating more on our tax returns than we already do.  The IRS no longer has a monopoly on audits.  Guess what.  Now it's the benefit audit.  Yes, you will need to prove your marriage and dependents that are coat-tailing on your health insurance.

Coming from the employer-sponsored health care perspective, it costs us (depending on the specific plan and number of dependents) about $2,700 per month to insure you.  Some employers pass some of that cost off to you, the employee, but some employers pay the whole thing.  So don't bitch when we have to up your doctor's office visit from $20 to $25.  That's not my point.  I have not even touched on the cost of prescription drugs, as that is another rant. 

Yeah, it's a lot of money we're shelling out.  People are figuring out how expensive health care really is - even if you're insured through your employer.  Because the cost is so prohibitive it's a natural breeding ground for misrepresentation (notice I did not use the word FRAUD, but that's what it really is).  Divorced people do not report the divorce to their insurance and carry ex-spouses on the plan.  People remarry and put step kids on the plan without legally adopting them.  In a divorce these days forget about who gets the house and kids.  The house is leveraged to pay for credit card debt if it's not teetering on foreclosure, anyway, and the kids are spoiled brats neither parent really wants.  It's who's going to carry and pay for health insurance.

Yes, even Quiet Rage is being audited for health benefits.  I think we all will be audited soon.  I'll walk you through the process so at least you have a heads-up.  Here's the general process many of you will experience when the benefit audit comes to you.  Ready?  Here goes.

You take your kid to the doctor, dentist, whatever.  Everything is seemingly normal.  About 30 days later you will get a call or a letter from said doctor, dentist, whatever saying that your claim has not been paid by your insurance and you owe them $160 for the office visit.

You:  WTF!!!!!!!!!!  I have insurance!!!  This should not BE!!!  There is something WRONG!!!!

At first you will try to blame the doctor's office thinking they are effed up.  You take your frustration out at the poor person at the front desk.  Save your anger.  Wrong target.

You call the insurance company to see what's going on.  After being on hold for 30 minutes you finally get a live person.  They tell you that because they have not received the completed benefit audit they mailed to you 3 months ago, all claims incurred would not be paid until the audit has been completed.  One of two scenarios are at play here:
(a) You threw the benefit audit forms away when it came in the mail thinking it was junk;
(b) You kind of remember seeing something like that but did not read the part where you needed to submit proof of your marriage and dependents within a specified time window  -- and especially the part where claims would not be paid if you failed to do so.  It's in the bottom of your paper pile somewhere in your kitchen or car.

No matter, now your peeved.  You now have to submit proof of your marriage and continued co-habitation via your last year's federal tax filings and/or a monthy, recurring bill that has both of your names on it to the same address no more than 60 days old.

For your dependents you will need to provide birth certificates naming the primary insured as a parent, or legal adoption papers.

Sorry it has come to this.  We simply cannot keep your ex-spouses on the plan nor your new wife's kids her from another father.  We are tired of being the main bargaining chip in your marriages and divorces.  We really do want to provide you and your legitimate dependents health care.  Stop fucking it up for those who are doing it legitimately.