Sunday, February 15, 2015

Just Kidding

I knew from the start that the surgery itself would be a big adventure, and that my rehabilitation would be an even bigger one. And it has been—the day-by-day painful progress, the occasional backslide and its consequent despair, the dance with the narcotic oxycodone. A big adventure to be sure.

Yet I knew there was going to be a third adventure as well--the financial dance between the doctors, providers, and clinic, and BlueCross BlueSheild of Arizona, and little old me. The adventure began on Saturday when I got a note from BlueCross. Mind you, I HAD called them before scheduling surgery to find out if my doctor was covered (he was) and if the procedure wa covered (it was). Even so, I expected some amount of charges that were somehow going to be not covered. I had looked up the true cost to see just how poorly things might go if something wasn't covered: MAKO Robotic Unicompartmental Knee Replacement @ SurgCenter GreaterPHX-implant included: $21,225." I figured $40,000 max, but more likely well under $10,000 with my insurance. So to be honest, I didn't really expect this. The gist of the letter was, "Just kidding, Brad. That wasn't really covered at all. Fooled you, huh?" And the surgical center forgot to check the doctor's website about the pricing.



Hmm. Patient owes $79,286.88 You know, that really kinda changes everything. I mean... I went into this in good faith. I had a newly upgraded insurance policy with a reputable company, had made a pre-check call to okay it, and had far more in the bank than my deductible, just in case. But not $79,286.88 more than my deductible.

And oh yeah: this is just for the first knee. With in-network and out-of-network deductibles I could be looking at maybe $175,000. Gosh darn it.

The bottom line on my IRS 1040 form has averaged $20,000 for the last five years. I run a pretty thin margin. That's why I have insurance. That's why I checked things out. Maybe if I paid them $100 a month until I am 250 years old? Turns out that even though the doctor and the procedure were fine, the surgical center was not "in network." That's handy. Didn't check that one. When I handed the nice receptionist at the surgical center my BlueCross card before surgery, did she say, "We don't work with BlueCross?" No. She smiled, xeroxed it, and handed it back. And turned away so I wouldn't see her blow coffee out her nose.

So I wandered into my insurance agent Carla's office, handed her the statement. She looked it over, let out a few expletives, and asked a few questions. She noted that several of the charges were double-billed, so only $60,000 was valid. Not that much help, really. We quickly agreed that it was flat out negligence for the surgical center not to inform me they weren't covered. And really dumb. I mean... how the hell do you stay in business? Nobody can pay that kind of dough if they are not insured.

Carla crossed her arms, put on a really scary, mean face, and punched up the surgical center on the speaker phone and leaned back.
"Are you covered by Blue Cross?"
"No."
"When a patient hands you a BlueCross card you you ever inform them?"
"Let me transfer you."

Things went better quickly. It turns out that there is some sort of deal between the noncovered surgical center and the covered doctor which does not show up on the BlueCross statement. According to the gal on the phone, I would be liable for just 20% of the "allowed amount" that BlueCross said they would cover ($1100), making my personal liability $220. Just kidding about the $79,286.88. Carla gave me a wonderful What The Fuck look, got the lady to repeat it, and hung up.

I gotta say, maybe that's not a big deal for some folks, but I sure like $220 a lot better than $79,286.88. Or $440 for the pair.

But...

I have a sneaking hunch there may be a few more "Just kiddings" heading my way. Carla assured me we'll go to war if there are. But jeezuzfugginkryst. They didn't offer to cover the staining of my shorts when the first statement came through.

The adventure continues...

1 comment:

  1. Oh the pains of insurance! I love the humorous take on this but the truth is, it happens way to often, with the outcome not as humorous as this situation. I can appreciated the feeling of "soil in thy pants" because I have been there. Looking down at my life summed up in a few itemized details of a $48,127 bill. But hey, I am alive!

    Steven Keltsch @ Allied Insurance Managers, Inc.

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