Thursday, December 4, 2008

Helpful Insurance Company

It is AMAZING how helpful your insurance company can be when you suggest they may have been overcharged.

I believe I mentioned this before, but when I came back from Mexico, I had an unfortunate little bout with La Tourista. I went to the doctor, he gave me the magic antibiotics, I got well. The End.

Except it wasn't. Today I get the Explanation of Benefits from my office visit, and it indicates a charge of $585 for the appointment, for which I am allegedly responsible for some $300.

Insert skeptical eyebrow raise here.

It was an office visit, I paid my $20 copay -- where'd the extra $300 come from?

Upon closer examination, my EOB indicates two charges: one for "Office visit" and one for "Surgery."

Surgery? I think I would have remembered surgery.

I called Anthem, my insurer, to see what the hell my doctor charged them for. After about four minutes on the damn computerized system, I finally get a live human being.

"I need an explanation of the statement you sent."

"You need us to send you an Explanation of Benefits?"

"No, I have my Explanation of Benefits -- I need you to explain something on it."

Specifically, what's this "surgery" charge for? She couldn't tell me. She could give me the magic code number used for the procedure (which was already on the EOB in front of me) but couldn't tell me what it was for. (I'm guessing this was some sort of patient confidentiality thing, although it seemed a little odd as I am the patient.)

I tried again a different way. "OK, let me put it like this: I have no idea what this was for. I don't recall any surgery"

She asked the purpose of my appointment. I said, "I was sick. I went in. He prescribed me some antibiotics. I left. No surgery at all. Nothing remotely intrusive. The entire interaction took place across the room."

The light dawns on my Anthem rep. She scans the code sheet, and while she doesn't actually tell me what the surgery code was for, I hear her mutter something about "lesions." (Lesions??) She asks if I have my doctor's phone number. I assume this means she's going to tell me to call the doctor and I said, "No, but I can look it up."

She finds the number. Then she calls it. I am amazed. She doesn't tell me to call them; doesn't even say she'll call them and get back to me. She calls them while I'm on the line.

Less than five minutes later, she reports the happy news that the doctor's office agrees that there was no "procedure," and that they'll be sending a corrected statement.

Next up: why did MCI send me a phone bill covering the period after I'd closed my account?

1 comment:

Wil said...

"Next up: why did MCI send me a phone bill covering the period after I'd closed my account?"

Good luck. I fought with the billing department at MCI for over a year regarding a bill submitted for charges incurred after termination of service. Not only did they ding my credit report monthly for 14 months, costing me the ability to obtain a mortgage or a car loan, they also filed in small claims court against me until I uttered the magic words: Public Utilities Commission. That turned out to be all that was necessary to end the turmoil over the disputed bill and get them to issue a retraction to the credit reporting companies. Maybe the fact you are an attorney will convince them to correct their errant billing practices faster than they did for me...