I Don't Think So

To fill you in...I got an Explanation of Benefits letter from my insurance company on Saturday. For those of you who don't know what that is, it is a statement from the insurance company that details how much of a claim they will be paying. If there is a balance, you wait and see if you are going to get a bill from the provider of the service. The letter I received on Saturday said they were denying payment of the lab work on my recent bone marrow biopsy. In addition to the letter from the insurance company, I received a letter from a pathology lab based in California stating that they did do the pathology work on my bone marrow sample and that even though they are not an in network provider, they would work with the insurance company to make sure I wouldn't have to pay any more for the lab work than I would if they were in the insurance company's network.

Here's the issue. I pay zero dollars for that lab work under my policy coverage. The insurance company was advising that my potential payment could be over 5 figures. Doesn't make me happy to consider that.

What do I do? I call the insurance company and ask about it and am advised that since the lab was out of network, I would probably be responsible for that amount. I then asked if it was the same lab that did the lab work on my previous two bone marrow biopsies and if it was, why is there now an issue. I must insert, "Good question, Greg.", here because the representative from the insurance company then said, "Let me call your doctor's office and get back to you."

I'm not telling you this for pity, but rather for informational purposes. I'm not the least bit annoyed if the bone marrow sample went to the wrong lab by mistake. Those things happen. I am a little annoyed at the possibility that the lab knew I was out of network and didn't question it prior to examining my bone marrow. However, there may be some logistical problems to that, i.e. what I would call the "freshness date" of my sample and whether or not it could have been returned to the correct "in network" lab in time.

I am learning that the "fun" doesn't stop after you get the all clear. It's just a different sort of fun. Initially, you are fighting for your physical life and then it evolves into trying to at least maintain your mental life.

Don't know the outcome of the claim yet, waiting to hear back from the insurance company. When I made the comment in an earlier post about health care reform, I will tell you I am as confused as the next person about the details in any of the bills or proposals. My "bill" boils down to this. No one should be denied coverage or treatment, for a serious illness based on their ability to pay or because of a pre-existing condition.

I'm lucky. I've had, and have, great people in my corner pulling for me and helping me when I need it.

"For I was....ill and you cared for me....I say to you, whatever you did for one of these least brothers of mine, you did for me."