I pay $786 a month for health insurance for my son and me. In no way does this premium cover the cost of receiving healthcare. Basically, a healthcare premium is what you pay so the insurance company takes your calls. You could call it your healthcare retainer fee. And 99.9 percent of the time these calls to the insurance company are due to the mistakes they made while processing your claims. In 2023 my premium will face a 12 percent increase. But the absurd cost of health insurance is another issue for another time. Today’s issue is copay maximums.

I had my son earlier this year. Giving birth is one of the rare instances when an overall healthy person maxes out their benefits. You hit what’s called your “copay maximum,” meeting your “maximum out-of-pocket” costs for the year. This means once you’ve paid $8200, you will not be required to pay any more for healthcare, except your monthly premium (which is almost $1000 – what a bargain?!).  When you reach your out-of-pocket max, health insurance starts to function the way it should in the first place, because again, why are you paying 786 dollars a month? Just so they take your calls. Also, the new person you just gave birth to comes into this world with his very own “max out-of-pocket limit.” A gift bestowed to him (you) upon delivery. This means your max out-of-pocket is actually $16,400. Unless of course, your newborn plans on getting a part-time job to help out.

Luckily I had a pretty standard cesarian delivery, but I still easily reached my copay maximum. However, my insurance company keeps charging me for copayments and they refuse to make a note on my account that I’ve reached my max benefits. The first time this happened I was informed that for them to confirm that I reached my max out-of-pocket they would need to perform an audit. Sure, audit away. In approximately 21 days I received a letter that the audit did confirm what I knew to be true. I did indeed reach my max out-of-pocket for the year. They adjusted the claim and that was that.

Then I go to the doctor for my annual physical. I discuss my high blood pressure that seems to have developed during my pregnancy, which is most likely white coat induced (I’m neurotic). Now this visit is no longer a preventative care visit (Even though dealing with high blood pressure could prevent something worse from happening. But okay, sure, let’s say it’s not preventative). So, this means they get to charge me a copay. But I don’t have to pay copays anymore this year because I reached my copay maximum. Are you still with me?

I dial customer service. Randy, short for Randall (yes, he told me), picks up and our 67-minute journey begins. After explaining the situation to Randy he quickly realizes this was an error on the part of the insurance company. I have a letter in my inbox clearly stating the results of my audit. I have met my copay maximum. At this point, it seems I have the rare good fortune of getting someone on the phone who is invested in solving my problem. Randy and I have a pleasant conversation. He’s a Scorpio and this means he’s determined to right this wrong. And I’m a Virgo so obviously this disorder must be ordered. Randy gets Virgos because his mom is also a Virgo and it was recently her birthday. Happy Birthday “Randall’s” Mom (because that’s what she would obviously call him). Randy cares. He actively listens and feels for my situation. He talks me off the frustrated ledge. When I’m about to go full Karen, he shuts it down by solving the problem. Randy is good at his job and I appreciate it.

Randy says we have to call the claims department. Randy also has some knowledge about claims since he wants to be a part of the claims department. But because he works part-time they won’t let him join the department. Instead, I have to settle for Sara, from claims. Randy puts me on a brief hold while he gets Sara on the line and explains the situation to her. I wait and listen to stressfully soothing hold music. Randy returns. He explained the situation to Sara and now Sara will simply adjust my claim. All will be ‘right’ in my health insurance hell. Randy and I part ways and I thank him profusely for guiding me to the light at the end of this dark tunnel. CLICK. Bye Randy. Hello Sara.

“Hi there, Erica,” she says. Sara’s chipper – maybe a little too chipper. The type of chipper that only spawns from the heavy, heavy mask one must wear to perform a soul-crushing job that consists of delving out one empty promise after another to innocent consumers. But I digress. Sara is “just gonna pull up my account and take a look at what we’ve got here”

The aggressive typing begins…CLICK CLICK CLICK CLICK. “Hmmm, ” Sara muses. A lump forms in my throat. “Hmmm” isn’t good. It’s never good. Then more typing… CLICK CLACK CLICKITY CLACK. There’s a lot of typing. Too much typing. “Hmm, oh okay, I see what happened here,” Sara says. What happened Sara? She continues, “It looks like we’ll have to do an audit just to confirm that you indeed reached your copay maximum for the year.” I immediately need a paper bag to breathe into.

I inform Sara I already did an audit and the audit letter is in my account inbox if she wants to take a look. Didn’t Randy tell her about the letter? The letter clearly states I have met my copay maximum for the year. My child begins to stir on the baby monitor. The 60-minute nap window I have to deal with this issue is slowly coming to an end. The 60-minute window I would’ve preferred to be doing anything else. I start to lose it now. In the same way, the hulk turns green and starts to explode, I morph into the Kate Gosselin-style Karen meme. My red curly hair falls out and a blonde highlighted reverse spikey mullet grows in its place. Suddenly I have 10 square acrylic tips on my fingers. My cellphone is covered in Swarovski crystals. ME KAREN! GRRRR.

What choice has my health insurance company left me? Am I never allowed to get frustrated with any customer service Kafka trap anymore? We’re just supposed to shut up and take the subpar service we’re being subjected to on a daily basis? I try to control my inner Karen but sometimes Karen needs to speak up. In 2022 if you’re not Karening-out once a month, you don’t have a pulse.

“This is unacceptable! An audit was performed and you have the results of that audit!” I exclaim. CLICK, CLICK, CLACK, CLACK, CLACKITY CLICK. Then the typing. stops. dead. The phone line crackles. “Hmm, we’re going to have to confirm the results of that audit,” says Sara.

I don’t understand. I need clarification: “So, what you’re saying is my audit needs an audit?” “Yes, I’m afraid so,” Sara replies. I know for certain Sara is afraid right now. My “non-preventative care” blood pressure is spiking. I blurt out, “Will that audit also need an audit?” A long silence… Like a really long silence. Sara breaks first: “I understand this is frustrating ma’am.”

It’s a lot of things, but I’m not sure frustrating is how I would describe it. It’s dumb. It doesn’t make sense. It’s convoluted. It’s a waste of time for all parties involved. It’s neverending torture. But it’s not frustrating. Frustrations are temporary. This isn’t. This sick health insurance cycle is forever.

After more nonsense back and forth, Sara finally agrees to adjust the claim due to the letter that was right in front of her face. But this isn’t without a warning. “There’s a good chance the next time the same thing will happen,” she says. She might as well say, “Sleep with one eye open, bitch. We will get you. You might have won this battle, but you will lose this war.”

Two weeks later an unsolicited email arrives in my inbox from my insurance company. For the first time in all my 38 years, I receive an email that just so happens to update me on my copay maximum totals for the year… Just for fun… A fun courtesy. I open the email. Sure enough, they deducted the $70 claim adjustment that Sara made from my copay maximum.

If it was hard to explain the situation last time, this new fuck up within a fuck up will be impossible. Audits of audits, of audits of audits of audits… is how you break a person’s soul. This is definitely how I lose the war. Because the war is impossible to win. I guess that’s why I’m gonna win as many of the battles as I can. Sorry, Sara.