So, … Funny Math of the Healthcare Variety

Ugh!  I am a broken record.  I know.  But I am pissed and sad.  Truly a crisis.  And I am immune … sort of … and I feel guilty.  I am a HAVE not a have not.

Here is what went down.  Thoughts free-flowing as they come to me.

B has no steady job.  He was “off”  today.  I left for work like usual and barely into my day, he calls me.  He is easily bored or so I assumed that was why he was calling.  Tells me hey we got work again starting next Monday.  Me “oh honey, that’s good” all  while thinking I guess self employment is ebb and flow/feast or famine.  I need to chill.  I vaguely remember those three years.

B –  don’t know what I will do until then but I want you to know so you can stop worrying. Plus V is going to resubmit those two invoices and we’ll get paid. (oh yeah, that too … having to hunt down people to get paid.  I blocked that out completely).

Me – Good.  You should have your colonoscopy.  I am taking off Friday already.  You need to do this now.  You can no longer afford not to take what you get work-wise when you get it.  Your off.  I’m off.  I’ll see if they can get you in.

B – yep I know.  Okay.

And as luck would have it, Thursday is open.  Now I am taking off Thursday and Friday.  But not without going through a whirlwind first.

While filling out paperwork in online portals, I notice the patient responsibility is $2300.  WTF.  Mine from February 2018 was free.  Did the price really shoot up that much?!??  I called our carrier and sure enough no age or time limit.  A perk from my employer in negotiating costs of colonoscopies.  She compared billing codes and said B’s too is covered in full.  Insurance offered 3-way call with provider.  Fun times I tell ya.  Provider says this is medical not preventative.  Medical with a $2700 deductible, the $2300 is our responsibility.

Okay.  What the what?!?!?  this is medical … yes a medical procedure but not required due to a medical reason.  If B had it his way, he’d never go back.  He got the appointment reminder last week … for a routine exam … because it was time.  He was not seeing the doctor for symptoms that needed to be diagnosed.  All that is semantics folks.  Fucking circular illogical.  To-MAY-to. Tu-mah-to.

Anyhow, we are all squared away.  They will bill the insurance first.  On a recorded call, the insurance confirmed they will pay.  Though we are getting annoying texts that we owe provider.  Uh no, talk to Cassie.  She agreed to BILL THE INSURANCE FIRST!!

So why am I sad?  well fuck.  if I (or anyone else) needed this exam because I was sick, I’d pay out the ass – pun intended.  And while maybe preventative should be less expensive than treatment, a diagnostic test is a fucking diagnostic test.  The rate should be the SAME!!  Then if treatment is needed bill for that.  Fucking vultures preying on the weak and infirmed.

As always, more to come.


10 thoughts on “So, … Funny Math of the Healthcare Variety

  1. Yup. I was/am a medical biller, when I’m working. It is one of my many job hats. I don’t specialize in gastrointestinal stuff, but ran across this a few times. There is a difference between a screening colonoscopy and a diagnostic one. Different codes even. A screening colonoscopy is performed on a “healthy” person to look for cancer or polyps. Due to the Affordable Care Act (Obamacare), screening tests are covered at 100% (no patient responsibility). Even if they find something during the screening, the screening test is covered. In a diagnostic test the patient isn’t “healthy” and has some kind of symptom (stomach pain, bleeding, etc.) and are trying to discover what it is. Same test, different intents. Medicare and most other insurances don’t waive the copay or deductibles on the diagnostic. Yup. Stupid. And a frequent mistake in coding, by the way, so that some people who should pay don’t and vice versa. At least the ACA made it so screening tests are covered, which is an improvement over pre-ACA coverage. Even better, if you require anesthesia, even for the “free” one, there’s a good chance you’ll have to pay for that.

    It used to be common-ish that a yearly deductible was in the $500 range. That crept up and is now often between $2000 and $5000, which used to be considered “catastrophic” insurance. Now it is normal. The insurance industry sucks and has for a long, long time. The ACA helped, wasn’t perfect, but was a step forward. We all know how that’s going politically.

    Liked by 1 person

    1. PS. In your talks to the many people, it sounds like B should be getting the screening test? But the doctor says diagnostic? Hate to tell you, but doctors aren’t coders and often get confused as to the difference. Not always though. You need to be clear as to which is going to be billed, because if you bill it first and they determine it IS a diagnostic, you will be on the hook for the $$$, even if they told you something else. Fine print: They will say that estimates are not guarantees of charges, or what you are told over the phone is not a guarantee of payment.

      Liked by 1 person

      1. Thanks for sharing. Yes his is now screening. Took an act if Congress for that to happen. Fingers crossed because I have a feeling this isn’t over yet.

        Liked by 1 person

      1. “Funny” but over the weekend, because of SoCS posts, I had similar comments/discussion with two other bloggers, these about the confusion (and payment or not) about Medicare’s annual wellness exams (covered) and annual physicals (not covered). It is SO confusing, for everyone (again, a lot of doctors don’t know the difference, people doing the scheduling don’t get told), and yes, so many people just see the bill and pay it. Shameful.

        Liked by 1 person

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