Tuesday, October 31, 2006

Insurance lunacy

Ok .. The scoop on the roto-rooter procedure ...

I called the office that is handling the procedure. They got my information and informed me that my insurance was only covering 80%, so I had to have 20%, plus the deductible up front. They prefer to collect that at the time of the procedure. The deductible and the 20% comes to around $140.

I called my insurance company to find out why the 80/20 split and the deductible were being charged. It seems that if the DR orders the procedure as the result of some underlying medical cause, it is considered a medical procedure and is subject to the 80/20 split plus the regular deductible. If the procedure is because I am of the age to have it done and it is part of a routine visit, then I only have to pay the $10 deductible. This puts me in a odd position.

My DR's exact wording was: "We are not sure what is causing the pain, and because you are nearly 50 and due for a colonoscopy at that time, we are going to schedule one." My 'procedure' fits both categories. It is not because of the abdominal pain (which has practically disappeared) alone. If I were 10 years younger, there would be no colonoscopy.

Technically, it is because I am 49 that I am getting it done.

I called the DR office doing the work and explained it to them. They refused to change the way they bill it. They did say that once they billed it, if the insurance company paid it all, they would reimburse me. Yeah, like that will happen. Once they mention the abdominal pain, related or unrelated, an insurance adjuster, who is looking for any way possible to write a smaller check, will latch on to that like a bulldog to a bone.

My insurance company further told me, that even if it were a routine procedure, if the DR found anything, it would then be considered a medical procedure and I would again be liable for 20%.Is it just me, or is anyone else tired of insurance companies telling DR's what medical procedures they should do, and what medicines they should prescribe?

How many times has a DR prescribed a medication, only to have the patient told by the insurance company that they will not cover that, but will cover this ?

Does something seem askew here ?
Oh yeah, I told the DR office doing the procedure that we were cancelling this procedure and we would reschedule at a later date when it is going to be a routine thing. So, my blind date with the roto-rooter man is postponed. So, Wednesday is still hump day, but now is not anal probe hump day. Gotta go change the calendar ... see y'all later ...

1 comment:

Dark said...

Hey there Ron. Hope everything goes well with your date with the roto-rooter man.

I feel your pain dealing with the insurance company. Everytime I have to deal with one, I get pissed off... Luckily, I have retro-girl to do it for me.

Look forward to seeing you later this month