FUNNY WOMEN #96: Explanation of Benefits


Dear Sir/Madam/Dependent/Spouse/Dependent#2,

This notice is to inform you that the procedure/treatment performed on January 2, 2013 is not covered under your health plan by reason code L0L.

Receiving an Explanation of Benefits showing that a service was not covered can be confusing and frustrating. You may have figured out that your coverage contains a wide range of benefits and resources unavailable to you. You might wonder if, deep down, we care about your health or mock you in times of illness or injury. You might feel that we are dashing your 2013 New Year’s Health Resolution to smithereens. You might be wrong (which is a medical condition we do not cover).

We are here to help. To assist you in understanding how your health plan works, please refer to the following reason codes explaining why your problem cannot be covered.

PRE&PRE: This service requires preauthorization of the preauthorization.

PENPAL78: The Plan will not pay for this service until you mail forms back and forth with us seven or eight times.

MATH4U: The Participating Provider/Network Not Available benefit after copay is equal to, less than, or greater than the fee allowance/coinsurance/out-of-pocket limit/plan number/Tier 53 Preferred Prescription Drug Mail Order Service, or ab2x4+bx3+cx2+dx+ad2=0.

V0Cab: Because we’re not sure what the word “maxillofacial” means.

0ldF9RT: If you are Medicare-eligible, this plan pays only the portion of covered charges not paid by Medicare Parts A and B if Medicare Parts C, D, G, H, and P are not in existence, regardless if you are eligible to be enrolled in Medicare or if the above-mentioned Medicare Parts exist.

TOS5UP: If there is a conflict between what is written in the Benefit Handbook and your Health Contract, we will flip a coin. If we don’t like the outcome, we will flip again.

N1C3TRY: Procedures that involve the eyes, legs, nose, or throat are deemed to be investigational according to our criteria. What a mystery the human body can be!

N0D1CE: Even though you received services from a Participating Provider, he hasn’t been joining in of late. Also, we don’t like his new mustache.

WhatTH3: Why, oh why did you go to the doctor for this? Couldn’t you have had spouse/dependent/dependent#2 just get you an ice pack?

DuMBA55: The plan does not cover foreign objects in ears if the patient is an adult and the object is something stupid. Examples include a Cheerio, Lego, crayon, hors d’oeuvre, chess piece, or gummy bear.

5ONG: Because the song “Party in the USA” is stuck in our heads and it’s driving us crazy.


OOPSx2: Not again! Really? Didn’t you learn your lesson the first time around?

If you have questions about how we have not paid your claims, our staff is available to converse with you Monday through Tuesday, 8 a.m.-8:30 a.m., in Code, pig Latin, or emojis. If you need assistance filing an appeal, we would be happy to send you a next-step guide in randomized algorithms.

We look forward to serving you by avoiding your healthcare needs! Isthay is otnay an illingbay!

Please retain for your records.


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Serena Crawford's fiction has appeared in Epoch, Nimrod, Other Voices, Another Chicago Magazine, The Florida Review, and elsewhere. The recipient of an NEA grant and an Oregon Literary Fellowship, she is at work on a novel and a collection of stories. More from this author →