June 16, 2009

An Expensive Lesson

Posted in Uncategorized tagged , , , at 12:47 pm by sillydreamer

I am 40 years old so you would think I know not to assume things, right?  Wrong!  The only defense I have is that thankfully we have been very blessed to be healthy and therefore I am not insurance savvy.

One of my daughter’s has been having some tummy issues for awhile so we took her in to see our family physician.  He in turn refers her to another Dr. who orders a colonoscopy.  The first thing they always do is check your insurance.  Yes, we take it and this is what your copay is.  We schedule the procedure and again we are told it’s accepted and here is what your copay is.

I need to stop and commend my daughter on what a little trooper she was for the whole thing.  The procedure itself wasn’t bad at all, it’s the prep for it.  First of all she could only have liquids the day before.  That was terrible but she never once complained she was hungry.  I would have complained so much I probably would have been sick of the sound of my own voice but she was awesome.  Then she had to down all that nasty medicine.  Again, not a word of complaint.

So the insurance bills have been trickeling  in with no problems until yesterday.  There was a pending status on a pretty steep one so hubby got on the phone to ask some questions.   Turns out that yes, the Dr accepted our insurance but he wasn’t an in network provider, nor was the facility that the procedure was perfored in.  We blindly assumed that he was because our Dr had referred us to him.  Of course  in hindsight it makes perfect sense to question that but at the time we never gave it a thought.  The difference for us could mean a few thousand dollars instead of less than $200 as we were led to believe.  Pretty expensive lesson, huh.

My daughter is doing better.  The Dr believes she has irritable bowel syndrome with constipation so he put her on a medicine that seems to be helping so this is a good thing.  You can’t put a price on your health, period.  It doesn’t matter what it costs us, we will pay it and be thankful that is all that is wrong with her but it would have been nice to do this over and ask a simple question first and not just assume that a copay is all that is owed.  I hope my mistake saves someone some pennies 🙂

September 10, 2008

It’s a love/hate thing

Posted in Uncategorized tagged , , , at 1:00 pm by sillydreamer

I want to start by saying that I am extremely thankful that I have health insurance.  I remember the early days when the girls were little and we didn’t have it for a time so I know how that feels and I don’t take having it for granted.  So while I am thankful to have it, I get very frustrated at the system and it’s not easy to place blame.  Do I blame the Dr.’s for the outrageous price of health care, do I blame the insurance companies for the run around they give trying to get out of paying, do I blame the lawyers who file the friviolous lawsuits that drive those costs up or do I blame office workers who have defrauded the insurance companies out of millions?  Are we all sharing this blame?  In one way or another, we are all paying for it.

Here’s my rant this morning.  My oldest daughter is required to have a physical to participate in drill team.  The school offers this one day a year for free but rather than stand in the hot gym for a few hours, I decide that it’s worth my copay of $15 to just go in to the Dr’s office.   Thankfully since I have insurance, that’s all I have to pay and that’s worth it to me.

I got the statement from my insurance company yesterday and couldn’t believe my eyes.  I assume a physical for school would be billed the same as a regular office visit.  I think that runs about $65 in my Dr’s office.  They don’t do any blood work or any other type of lab screening.  Basically, he asks her some questions about rapid breathing or heart beat, makes her bend down and touch her toes a couple of times and feels around on her abdomen.  Pretty basic stuff, right?  It’s actually less time with her than if she were sick.  Don’t get me wrong, I like our doctor so this rant isn’t about him personally.  Just imagine my surprise when I see that this visit is actually $170!!!!  After the “discount” given because he is a participating provider, his office billed my insurance $95 and then I made the $15 copay.  Isn’t that insane?????? 

Like most issues, I know what the problem is, I’m just clueless as to how to go about fixing it.  Apparently so do those in charge because the problem isn’t getting better, it’s getting worse.   We’ve been very blessed to not have had anything very serious come up health related but the few trips we’ve made to the emergency room have usually resulted in lots of correspondence with the insurance company, convincing them to pay what they owe.   Several years ago my oldest daughter was turning cartwheels on the front lawn and landed on her elbow which resulted in an ER trip.  I had to write in detail what exactly happened and where before they would pay.  Of course they were hoping that this happened on someone else’s property so they could sue the homeowner’s insurance for payment but in the end, they had to pay.  It’s all about passing the buck with insurance companies these days.  I think most people don’t want to sue others but sometimes our own insurance companies give us no choice. 

And that’s my rant for the day, done without a Diet Coke no less!  Off to the kitchen to crack one open and get this day started right!  🙂