Tuesday, June 05, 2007

Oh for Fucks Sake**

A MEDICAL INSURANCE BULLSHIT VENT

This week we got a bill and an insurance statement for IF related blood tests that the useless OB wannabe RE sent me for January 2nd. Insurance was billed May 14th.

Insurance is paying nothing. We are being told to pay $95.02 (full charge $253) after insurance discount, which will be applied to our deductible.

Deductible? For blood tests? (We have copays and coinsurance, neither of which is what they are asking for.)

Here's the gist:

The blood tests were ordered as part of a routine medical exam by an in-network doctor. (Routine = nonemergent, I asked.) Blood tests in this case, these exact tests, are covered 100%, no deductible, no copay, no coinsurance if you go (in-network) to an "independent lab" not located inside the doctor's office. The lab I was sent to was "independent" and "in-network" located in an adjacent building in the same medical complex and is privately owned. We will call them ABC Labs. They also have additional locations all over town.*

But the won't cover it. They say we have a $100 deductible, and once that has been met, they will cover 80%.

Insurance agrees that the tests would have been covered 100% if we had been to an "independent" lab. They agree that ABC Lab is "independent" and "in-network" but a different kind of "independent" yet still in-network. The difference? They can't explain other than to say it would have been covered if I'd been to any other independent lab, which includes *other ABC Labs around town.

J went to an ABC Lab, different location, for his SA because it was closer to work. It was covered at 100%.

"Are ABC Labs a franchise? Is that the problem?"
"What's a franchise?"

"Okay, so I will be having more blood work done this week as part of an IF workup. I want to make sure I go to the place that will cost me the least out-of-pocket in the long run."
"Of course! Will it be part of a routine medical exam?"
"I'm seeing an RE. These tests are being done for IF reasons. It's nonemergent. You tell me."
"I'm afraid I can't answer that."
"May I speak to a supervisor?"
"I am a supervisor."
"Can I speak to your supervisor?"
"I don't have one."

It's not the money, it's the ridiculousness.

But really, why should I be surprised? Last week I was on the phone with our insurance company numerous times trying to find out who is a "preferred vendor" for IF meds down the road. Because while they agree they will cover IF meds if we use the correct vendor until we reach (a very piddly might cover an IUI or two unmedicated) lifetime IF max, they can't tell us who. And just so we're clear, by "preferred vendor" we're talking about a mail order drug supplier, so it doesn't have to be a local pharmacy because local pharmacies don't carry IF meds.

And so I say again, oh for fucks sake.


**After posting this I came across another IF blogger who had used this same title last week. Crap. It wasn't intentional, but probably in my head. Sadly, it's not the first time I've gone to write something and found that some one else in a small circle of bloggers had already covered it. So much for my having original thoughts...

5 comments:

Jen said...

Have you heard of michael moore's new documentary coming out called "Sicko"? It's all about this issue, insurance companies dodging payments and claims to make profits... it's fucked up. Luckily I'm in Canada and we don't have any of these issues to deal with, so I feel for ya! And "oh for fucks sake" definitely goes with your post so I see why it came to mind! Funny enough, that phrase applies a lot in this IF journey...

Alexa said...

Oh, don't get me started on insurance and IF meds...I'm sorry you had to deal with such ridiculousness.

Anonymous said...

Hi,

I can't understand all your acronyms! Do you have a dictionary somewhere on your blog to help this uneducated twit?

Tx

Heidi said...

Uneducated twit? ROFL J has to ask too.

To answer your question: I don't, but I'll add to my to do list. =)

For now, here's one I found that has at least a little more info than most:

http://infertility.suite101.com/article.cfm/infertility_abbreviations_acronyms

Thanks for asking!

Heidi said...

Jen,

"Sicko" is on my list, though I probably won't see it until it's available for rent.

As proud as I am to be who I am and live where I do, I gotta tell you that more than once while traveling overseas I've claimed to be Canadian, and that was during the George Sr. and Clinton administations. (That admission is gonna rub some people the wrong way. Flames, anyone?) My #1 rule for foreign travel, especially in Europe, especially in a bar, is not to discuss US politics. Everyone loves Canadians. =)