More health insurance woes:
Went to the doc, whom I haven't seen since October. Found out my doc sold the practice to a health network and left. Whatever. Nurse went to take my blood, then stopped and said, "Who's your insurance with?"
I told her and she stopped, explaining, "Blood draws by us aren't covered, you'll need to go to the hospital." So they did the rest of the exam, wrote me out a slip for blood work, and off I went to the hospital.
Now, a month later, I got a whopping $500 bill for the lab work (usual bill, with insurance, is about $15). That's the entrance to health insurance phone hell.
First call, to the lab who did the testing: "You need to call your insurance. They denied two of the tests as 'medically unnecessary.'
Second call, to my insurance: "You need to call your doctor, they coded it wrong."
Third call, to my doctor: "You need to call our billing service, they're the ones who coded it."
Fourth call, to the billing service: "Our computers are down, call back Monday."
Fifth call, back to the billing service: "Your doctor hasn't been cleared to order blood draws through your insurance yet, so we coded this as out-of-network. We're just getting that set up. We'll get that done and re-bill it, so wait a month, and see if you get another bill for less."
So, the more I thought about it, the "we coded this as out-of-network" didn't wash, as when I later got the paper bill and could see the itemized charges, some of the bill was covered. So I called the doc's billing department back.
I spoke to a different person, and she concurred that the guy who told me it was coded out-of-network was full of crap. She then said that since the doc's office didn't physically draw the blood and just ordered it, I needed to call the hospital where my blood was actually drawn.
Called the hospital. She told me that they don't determine what the code is, that they get the code from the doc's order and that's what they use, and that I needed to call the doc back, but not the doc's billing department, the actual doc's office, and have them submit a corrected physician's order directly to the lab that sent me the bill.
Called the doc's office back. She said, "I only have five codes I can use, and the one I used is obviously wrong. You need to call the lab that billed you, find out what code works, then call me back and tell me, then I'll resubmit it. Otherwise, I'll just start with the next code, then the next one, and so on, until I get to the right one."
Called the lab, and they said (as I expected), that they don't know what code is the right code, to call the insurance company for that.
Called my insurance company, and
finally I got someone who gave a crap about doing a good job. It took her over an hour of research, but she determined two tests (out of six or seven), were denied, and she found a proper code for one and resubmitted that to the lab while I was on the phone.
The other one, she said that test was only to be used if I was being actively treated for a particular condition, and that the code was such-and-such, but she couldn't resubmit that, that I would have to call my doc, find out why that test was ordered, as I didn't have that condition, and if I did have that condition and didn't know it, then have them note that and resubmit the claim with that code.
Called my doc back, and the nurse said that they always order that test as a monitoring test, blah blah blah, but she took the code and will try resubmitting it.
Now I just have to wait 3-4 weeks for a new bill.
