Monday, April 07, 2008

Code word: persistence

How often do you win a round against 'the man'? Well, I don't win them very often, but it is soooo satisfying when I do so I decided to share this with you.

This battle started well over a year ago. My opponent? My health insurance company.

Let me give you some background on the battle...I'm not a person that goes to the doctor very often. Like many women, I go once a year for my annual 'poke and prod.' Okay, that's not the technical term, but I think most women will understand and the guys can just guess.

As a result of an abnormal routine check-up, I had to get another test. The bill for the second test came to over $600 and my insurance declined payment (the rat bastards). Why? I was told by the insurance company that I was 'too old' for this procedure to be covered by insurance. WTF?!?!

Turns out, the procedure was coded as a routine check-up and my shitty insurance (which, as an independent consultant I pay a TON for!) would not cover the charges if I'm older than 16.

Um, excuse me, but how many girls UNDER 16 are getting this done??!! I'm thinking not too many. It was the word 'routine' and the code number that rubbed my insurance company the wrong way.

I called the doctor's office and discussed the coding with the office manager. Turns out, the procedure isn't routine (no shit Sherlock, since I've never had it done and I'm into my 40s now!)and should've been coded differently.

I suspected that my insurance would put up a fuss about this because for the first time in, I don't know, FOREVER! I have almost reached my yearly deductible. That means they would have to pay up -- finally!

Another code, another filing with the insurance company. Second round of coding is wrong, too, because the doctor's office used a code that is no longer valid. Claim is once again declined!
ARRGGHH!!!

Another call to the doctor's office. Another code. I'm now on a first-name basis with the office manager.

The procedure originally was performed on February 1, 2007. And today, April 7, 2008, I received a letter from my insurance company stating that after the PPO reduction, I may owe my doctor a grand total of $51.20.

Yay me!!