Pills for Breakfast: Stuck in Insurance Hell

Pills for Breakfast: Stuck in Insurance Hell

Insurance companies really are as frustrating, maddening and annoying as everyone says they are.

And it’s not just that they constantly miss-bill things, make claims as complicated as possible, or make fighting a claim as impossible as losing those last 10 pounds.

It’s also all the little things they do that get under your skin and make you want to kill them.

bigstock-Caduceus-Medical-Symbol-Chrome-77624321-300x256Recently I got an incorrect bill for a doctor’s visit. My co-pays for doctor’s visits are supposed to be $30.

For the purpose of this story, we will set aside the fact that $30 co-pays for a doctor’s visit are way too high and add up way too quickly when you have a chronic condition.

This bill was for $56.70. I didn’t have any blood work done, random vaccine injections or even a random breast exam, so the extra $26.70 made no sense.

The office visit was to a new doctor at a new office though, so I started getting worried that he was out of network, even though I had called to check that before I started seeing him.

Then I started panicking that I was going to get a bill for $56.70 every single time I went to the new doctor. Suddenly a typical week for me, which usually means about three appointments, would jump from $90 to $170.10.

Seeing as how I’m sick and I’m trying to hold down a fulltime job, I did what anyone in this situation would do — I tossed the bill on the kitchen counter and hoped it would fix itself.

It didn’t.

Then, a few days later, I got the related paperwork from my insurance company. It’s not quite a bill, but looks just enough like one to be super confusing. And it too said I was being charged $56.70 for the recent office visit.

So, I decided to be an adult and call the stupid insurance company.

The man on the phone started out as a reasonable person. I explained the situation, and before I could even finish my tale of woe, he agreed that I should have been charged $30. He immediately put me hold so that he could talk to someone in another department and have the claim reprocessed.

Then I waited. And waited. And waited a bit more. And then I played on Facebook, checked some emails and waited a little more, and then he came back on the phone to ask if I could wait just a few more minutes.

So, I waited some more.

And then, finally, he came back on the phone. And there I was on the other end of the line, naïvely expecting him to tell me that everything was fixed.

Alas, that was not the case.

Instead, he informed me that the billing department at my doctor’s office had coded the visit as being in a hospital rather than a doctor’s office. That’s why I was being charged $56.70 instead of $30 for an office visit.

Obviously, that made no sense to me.

So I explained to the man — who was starting to sound less and less reasonable —  that I understood my new doctor was connected to a hospital, but my old doctor also was connected to a hospital and I never had this problem there. Plus, my doctor’s office was in an entirely separate building from the hospital. In fact, it wasn’t even on the same campus.

The insurance guy would not budge though. He just stuck to his story.

So I was like, “But sir, it clearly says on the billing paperwork that YOU sent me that my ‘procedure’ was an outpatient office visit. I don’t understand why I’m not being billed for an office visit.”

And he was all, “Well, your doctor’s office listed location code 2, which is for hospitals, and they should have listed a location code 3, which is for doctor’s offices.”

Then he explained that I should call the doctor and have them re-file the claim with the proper location code and that they should file all future claims with the proper location codes.

I tried to tell him that this should be a problem that the insurance company should be able to fix, but he just kept rambling about the location codes and hospitals.

At this point, I quit arguing with the unreasonable man and hung up the phone.

Then, I did what anybody would do if they were sick and trying to hold down a fulltime job — I threw the paperwork on the coffee table and hoped the problem would fix itself.

Crystal Lindell

Crystal Lindell

Crystal Lindell is journalist who lives in Byron, Illinois. She loves Taco Bell, Burn Notice reruns on Netflix and Snicker’s Bites. She also has been diagnosed with intercostal neuralgia, a painful disorder of the nerves running between her ribs.

Crystal writes about it on her blog, The Only Certainty is Bad Grammar.

The information in this column is not intended to be considered as professional medical advice, diagnosis or treatment. Only your doctor can do that!  It is for informational purposes only and represent the author’s personal experiences and opinions alone. It does not inherently or expressly reflect the views, opinions and/or positions of National Pain Report or Microcast Media.

There are 5 comments for this article
  1. CP merry-go-round at 11:13 am

    Hi Crystal! I’m in “insurance limbo” as I write! It’s frustrating & often feels like we have to do what “others” should be doing!! I recently had a change in dosage on my monthly medication. These meds cannot be manipulated, so it becomes a new prescription. Low & behold it kicks back at nearly $1,000! I nearly croaked! How could this be I thought. It’s a measly #60 tablets! As it turns out @the new year; it needs prior authorization. Well it’s a legit prescription they’ve filled before & this just seems like red-tape to me!! Doctor prescribed it & now “you” want more clarification! As if things weren’t cumbersome enough! I hope your situation was resolved & best of luck in the New Yr. to everyone; I think we’re all going to need it!!!!

  2. Stephen S. Rodrigues, MD at 7:27 pm

    When you signed the consent forms in the doctors office, you’ve made a contract with him/her that they are responsible for your medical needs, billing and coding. They are responsible for this error. I would suggest that you call the office manager or talk directly to the doctor.

    Who owns the patients? The insurance company which also owns the doctors. The insurance contract you have is with the company and NOT with the provider per se.

    Be nice to your primary care doctors who are actually carrying a lot of the loss revenues due to payment formulas. We are at the end of the line and are truly small businesses. We have to see folks without insurance at steep discounts, and have to hire extra help to fight with the deceptive and confusing insurance industry.

    Single payer, detaching insurance from employment or universal care would eliminate all this chaos.

  3. Trudy McGee at 10:42 am

    Hi Crystal, I totally understand your frustration. When you have a chronic condition, you know too well that it is bad enough dealing with doctors, let alone straightening out insurance screw-ups. My husband could not possibly hold down a full time job, if I didn’t spend hours, (and I do mean hours), on the phone several days a week, just running….life. My suggestion to you is NEVER take no for an answer. The insurance company made a contract with your doctor. YOU did NOT! Speak to a supervisor. If that doesn’t work, then ask to speak to their supervisor, and keep on going up the food chain. It doesn’t matter that your doctor decided to code your insurance wrong or not. You went to that doctor because your insurance company told you that he/she was on your plan. They made the contract NOT YOU, and don’t let them tell you otherwise. You pay plenty of money for your insurance, and your doctor makes enough money, or they wouldn’t contract out with the insurance company. I will not listen to the BS that the poor, poor doctors are losing their lives because of AHA, or Medicare, or any other reasons. If they became doctors to be rich, then they should cater to the rich and famous and leave the regular people alone. I am sick and tired of hearing about how much money the poor poor doctors lose because of us sick patients. I have never met a doctor that didn’t have a very nice lifestyle, so tough.

    Sorry to go on and on. Speak to a supervisor, and make them do the work for the millions of dollars they make off everybody giving up with the system. Best wishes to you!! You CAN make it work, just make sure they know that you won’t take no for an answer again!!

  4. Karlya at 5:33 am

    That’s not something the insurance company can fix. It must be recoded from your doctor’s office. I was a medical receptionist for 10 years of I have some experience in that department. Call your doctor’s office and ask them to code it properly and resubmit the claim. That should fix the problem.

  5. Brad Whittaker at 5:25 am

    Hi Crystal
    This sounds very frustrating, and unfortunately it may get much worse with the impending “Affordable Care Act ”
    I am not familiar with your condition, it sounds painful.

    On a recent trip to my Chiropractor she was very surprised that I was not taking any drugs at my age (60) and said that was very unusual, looking around I have to agree. It seems that the drug companies invent a disease or disorder then create a drug that people need to take to deal with it.However other than anti-bionics when was the last time you heard of a drug curing anything !

    As for me I have subscribed to a wellness program that allows my body to heal itself. With the much higher cost of health care in the very near future, you might want to and recommend friends and family to do the same !

    Hoping you feel better soon

    Brad Whittaker