Calling Them Out (Part 1)

Won't name names, but.....

This is the first of a 2 part rant. In this post, I rant. In the next post, I share with you how to face the issue head on and how to get you well and keep you well.

On November 4, 2008 I received a bone marrow biopsy. The sample was sent to a lab in California that is out of the network of the insurance company. They paid the claim at an agreed upon amount and I heard nothing more about it. If the lab had felt that the amount was below their minimum acceptable level of payment, I would have received a statement from them requesting additional money. I didn't. I had another bone marrow biopsy last March. Same deal.

The latest biopsy yielded an explanation of benefits letter from the insurance company stating that since the lab used by my doctor's office was out of the network (it was the same lab that they have used for the previous biopsies), I would be responsible for the entire amount the lab charged. The amount the lab charged was 3 times the amount they settled for in November 2008.

I am assembling all of the previous statements and mailing them to the lab and the insurance company to remind them of how they settled in the past. I hate having to do this. I don't feel I should have to. If your response is, "I understand," I thank you for that. If your response is, "Well, that's what you have to do," I really don't want to wish this upon you, but I didn't choose to have cancer, and I hope it never chooses you. If you haven't walked through a major illness, then keep your opinion to yourself. The main responsibility of the patient is to focus on recovering. Premiums are paid not only for payment of claims, but for the service that should accompany the payments.

I do not believe insurance companies or labs are evil. I like what they do. I will name Jim and JoAnn at the insurance company as two people with whom I interacted that were absolutely amazing. I miss talking to them.

Interesting fact: My doctor's office and the folks at MCV are the only caregivers that have sent me completely itemized statements (without request) during the entire process.

As I have said before, I don't know enough about any of the health plans being discussed in Congress. However, the system is broken.

The Founding Fathers agreed and acted upon a broken system.