I make no claims to understand medical billing or health insurance. I just know I pay for insurance, then I pay my part at the doctor’s office, then the doctor and my insurance company hash it out from there and I get billed for anything that’s not covered. It’s been a pretty good system for me because over the last 3 1/2 years I’ve had my current health insurance I think I’ve had to pay $12 aside from my co-pays. And that’s with the cheapest health insurance policy I can buy because my and my kids’ doctors participate in the HMO and my family is in extremely good health (knock on wood). If I needed more serious medical care on a more consistent basis I’d pay for health insurance that provided a little more flexibility and independence.
Anyway, last spring I had a colonoscopy. After the procedure there was a flurry of notices from my insurance company stating everything that was submitted by the doctors involved, everything that was paid and what wasn’t covered that I’d have to pay (nothing). I thought it was all over.
Yesterday I got another notice. The doctor submitted a charge for a little over $1200 for something regarding his sticking up a lighted camera tube up my ass. It was denied, and the explanation from the insurance company was that he didn’t follow some insurance company procedure BEFORE he performed the colonoscopy, therefore he was unable to claim reimbursement for it. I wasn’t being held responsible for it either, but the end result is that the doctor isn’t getting paid because he didn’t file paperwork in the proper order. And if I remember correctly, that $1200 is a pretty sizable chunk of the bill for my doctor’s part, if not the entire chunk (there were also hospital, anesthesiologist and whomever else parts).
The doctor was a specialist who I never needed before and don’t need now, but he did a decent job and I guess I’d let him stick a tube up my ass again. But would be want to? I mean, it seems that he basically gave me a colonscopy for free. I wouldn’t do it for free, so why should he? Would he deny me again because of my insurance company being too anal (no pun intended)? Will he even continue to accept my insurance? In the end, won’t it be me getting it up the ass (no pun intended) because of issues that don’t really even involve me?
Oh, well. I guess if it comes down to it I’ll find someone else to look at the inside of my colon, but I have a feeling that stuff like this is what’s going to ruin health care for ordinary generally healthy people, and even more so if/when we get universal health care imposed by the government.
The insurance companies have endless reindeer games. I think something has to be done, because patients and doctors are doing everything on their end (ha) that they’re supposed to do. Yet the insurance folk get to stick it where the sun don’t shine.
Doctors and hospitals know there are some people they make money off of and some people they don’t. They’re disgusted too, but I think they fear something new because maybe it would be worse. I’m not sure we can do much worse than what we have now.
My story is that I checked in to have surgery and was told my share I would have to cover; I paid my deposit on that and off I went to go under. The insurance denied the hospital their fee ($11,500) in full. I wasn’t liable but I felt just awful about it, like I had stolen something. I did EVERYTHING I was supposed to do for pre-certification. The hospital is still open for business 4 years later so I take it they collect enough of the time to make it work. I’m still offended and probably always will be about my former insurance company. I also know they are all alike. Filthy greedy bastids.
No worries. If worst comes to worst, I’ll give you my snake-light and you can duct tape your camera phone to it.