Like an idiot, I decided a few weeks ago to have an annual physical. I figured that before moving to Panama, my numbers should be checked, so if need be, I can make sure they are in tip top shape before acquiring medical insurance in Panama. My history with physicals is depressingly bad. Not because I am in bad shape. Nope, not that at all. It's because of those two scary words: MEDICAL INSURANCE. I try to do everything right by them, and I am always screwed. Here is to let's hoping that the medical office simply erred in the medical coding this past visit.
Here is what I have gone through in the past ten plus years of trying to get a physical done and paid for correctly, and why I will enjoy just going to Panama and paying out of pocket for any "office visits". For sure, Ray and I are getting major medical insurance coverage when we retire to Panama, and from what I have read, when it comes to getting a sore throat checked, or perhaps an antibiotic prescribed for a sinus or ear infection, I will pay the doctor at the time of visit and not cringe when I see that dreaded EOB (Explanation of Benefits) show up in the mail.
Quite a few years ago (perhaps ten plus), I went to see a Physician's Assistant for a physical that my insurance allowed every five years. The PA did the usual blood cholesterol testing and made a comment that my thyroid looked enlarged. (I have a long, skinny turkey neck so I would think it would always look a bit enlarged.) She ran blood work to check my thyroid. $250 out of my pocket later, my insurance came back basically saying, "Hell to the no, we won't pay that! She went for a physical and nothing more". I appealed and lost. If I go to the office for a physical, I am not to complain about anything or have anything else looked at--I would have to leave the office, pay another co-pay, and return with another appointment (even if it is five minutes later) to have that matter evaluated.
Years go by and I am now in my forties and know that my cholesterol tends to run close to that border of "watch out". My mom and her dad were on meds for high cholesterol, since diet didn't seem to keep the numbers low, so off I went to another office that had better hours, was brand new and a few minutes down the road. The office and staff were super friendly. Blood was drawn (they had to switch arms but the phlebotomist knew what she was doing), and off it went to the lab. Nope. The first time it was something about the blood not making it in time to the lab, so they couldn't get good readings. I went back for more blood to be drawn (I was only off on a few Friday afternoons in the week so scheduling appointments was difficult). This time the driver of my blood was sick and never quite made it with the blood to the lab, so it just sat and nothing was accomplished. Meanwhile, I am getting those EOB's telling me my insurance company is really and honestly paying for this physical (WOW!), but hey, I have no results and they (meaning the doctor's office have now gotten payment and will be confused quite possibly, and I was right about this, when I go back again to have more blood drawn). Three months go by with me calling the main billing specialist and playing phone tag trying to explain why they can't be accepting of this insurance payment when the procedure wasn't performed. FINALLY, the Vice President of the lab calls me, has it all straightened out and simply says "Allison, we have to correct this mistake. You have to go back and have more blood drawn when convenient so we can do right by you and the insurance company". Whatever. So I go back and try to explain to the new "nurse" (I am not giving her the title phlebotomist, because she was more like an angry needle sticker and didn't know what she was doing--was she a nurse? lol It didn't feel like it!) that she cannot put the codes in the computer for this visit, I am not paying a co-pay, and she cannot bill this procedure out to my insurance company. She has no idea what has gone on with the past blood, the past two visits, etc (Do they not write things in the chart? The original nurse had her baby and is on maternity leave.) Perhaps this is why she was so curt. She tried taking blood from the first arm (inside of the elbow) without luck. Instead of going to the other side, like all nurses have in the past (!), she tries to take it from the top of my hand! (I HAVE NEVER HAD THIS DONE BEFORE, AND I DIDN'T LIKE IT). It didn't work. Not enough blood came out. Then she goes to the other hand! How about trying the arm!? She comments I may have to go to lab for blood work! WTH! Nothing! FINALLY, she tries the other arm, and lo and behold, the blood flows perfectly. Duh. I just didn't like her now. And guess what. Yes, the blood did make it to the lab, but I bet she tainted it because my cholesterol came in at 210, and the doctor recommended fish oil two times a day and for me return in six months! Like that ever happened!
A few months after that disastrous visit, I go for my annual "girl" visit to the gynecologist. Here, they don't perform an entire exam. No physical done, just focusing on certain parts. I wrote that for a reason. A few weeks later I get that EOB in the mail (these arrive after five pm usually on a Friday, so I can't make any phone calls for a few days and get to stew about it the entire time), and my yearly gynecological exam has been denied. Seems I already had this procedure done a few months prior. NOT. This resulted in the billing specialist, the representative at the insurance company and me having a three way (LOL) conversation about why the BS at the medical office is NOT going to change her code, she has been doing this for thirty years, and it is fraudulent to change codes, and why the insurance company is being ridiculous, and the computer simply spit my claim out and decided to just deny it rather than research it. I just listened :) Needless to say, after that call, my claim was paid in full by the insurance company.
Here we are three years later, and I think, go have your numbers checked. What could go wrong? Ray calls the insurance company and finds out EXACTLY what can be done at the time of the physical appointment. We can now have an annual exam yearly. I have been pleased with using Patient First (a little better to me than a "doc in the box") in the past (had a lump on my knee checked and toe issues looked at), and Carly has had success, so off I go. Easy breezy. I also know that the doctor there is ONLY ALLOWED TO CHECK my blood pressure, height, weight (wow, thanks BlueCrossBlueShield), bone density (not an exam they perform there though), glucose (haven't had this done since I don't know when) and blood cholesterol levels. When the assistant has me read an eye chart, I have a moment of concern, ask her about it and then feel safe that this won't be an issue. I have my blood drawn (simple as pie), my finger pricked (I HATE THIS, but my sugars are beautiful!), and the next day they call (I wanted a piece of paper in the mail and not a phone call) with the numbers. The total is high (229), and my LDL's stink (136--borderline high), but Triglycerides are ideal. It is recommend I watch my diet (I guess losing 15 pounds didn't help), exercise and having it checked in six months. I continue to take my fish oil, and here comes that EOB. This time I receive it after five pm on a Wednesday. Here is the note:
The patient's coverage does not provide for the Routine Preventative Health Care service when performed with the reported diagnosis code. No payment can be made.
Patient may owe (well, I will owe if we don't fix this!)--
Preventative Medical Care (meaning "office visit" which could be the big error in coding)---------$ 123.00
Glucose Pathology Test--------------------------------------------------------------------------$ 25.00
Special Service (I truly feel special now)----------------------------------------------------------$ 19.00
Venipuncture (this was great so I could pay this since so easy!)----------------------------------- $ 8.00
Cholesterol Pathology Test-----------------------------------------------------------------------$ 93.00
I guess I could have to pay a whopping $268 if it isn't resolved. I pick up the phone, since Patient First has crazy hours. First step is that the billing specialist at Patient First is re-evaluating why the code is the code and why, if my insurance pays for an annual exam, why oh why, can't the coding be different to state ANNUAL PHYSICAL EXAM THAT ALLISON GUINN DOES NOT HAVE TO PAY FOR TODAY? So now I wait. Wait for the error to be corrected.
I decided to rant and rave here, because this is what I would do when I kept a journal for Carly (it was my place to shout and vent). And now that this post is almost complete, I am tucking the EOB's away in a cubbie to not be looked at until I get that new statement, bill, EOB or flowers at my doorstep apologizing for the mistake! My blood pressure was low in the office, but boy, this really throws it off the chart.
Now I will be afraid to go back in six months to have it checked again. Now I am afraid to go ask about having an earlier than recommend and paid for colonoscopy (before heading out to Panama) since many deaths in my family have been due to colon cancer (Patient First physician did say that due to familial history, my insurance company--if I am high risk--should waive the "to be done at 50 and older" regulation hahaha), but I also know that when Ray goes to the doctor the insurance company will most likely owe him money or send him to Bora Bora or give him praise for using his benefits to the fullest!
I work in a dental office, so I know the insurance company games that can be played. I have had to be a part of the games for quite a few years now when I am just simply trying to go and make sure I am healthy (how dare I try for this). Health care and insurance is what is driving us to Panama (oh, and not working is a biggie). I hope I can play other games and not this kind when there.
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