Friday, October 25, 2019

A Bumpy, Lumpy Year & the Blessing of Excellent Healthcare

A month after my reaction to blood pressure medication, we received a bill for over $1,080 (US) from the emergency services billing company. I called to question and was told that the ER doctor was out of our provider network, we were responsible for payment, and I needed to file any appeal with my insurance company. If that organization refused further compensation I should call her again, she said, promising her employer would work with us (presumably an installment plan).

I spent a few hours calling back and forth between these corporate entities. Our insurance provider insisted we only owed $75.44 and the billing company had no right to demand payment of that declined balance. An opposing customer service rep insisted that was untrue, that the insurer had no right to limit the amount due as no contract existed between these two firms.

At last, a woman with our insurer told me she put in a dispute on our behalf with the billing company. What?!? Confused as I am, I don’t intend to drop the matter.

Fast forwarding to the afternoon, I told my primary care physician when he asked about my stress level. Steam practically pouring out his ears, he admitted a lack of expertise but expounded upon his opinion. He thinks our insurer knows full well their company is responsible for the $1,080.

My doctor believes both enterprises hope the patient pays without question, satisfying the greed of each. Lots of folks cave into pressure from this extortion, he explained. My husband would have been one of them, sad to say. In fact, Dr. S maintains utter disbelief in the ‘out of network’ explanation.

I guess my next step is a friendly call to the ER facility, or perhaps a personal visit. Then, in about a week, I intend to call the biller’s representative for information on the insurer’s alleged petition and proceed from there.


Meanwhile, a lingering lump on my scalp grew three times larger over the summer. My hairdresser classified it a harmless cyst (called a wen) and advised having a dermatologist remove the cumbersome bump. I mentioned this to a medical student during her initial consultation, she passed it on to Dr. S, and he (fulfilling his residency at this clinic) consulted a senior physician before she followed up on their examinations.

This attending physician assured me their procedural department could remove the cyst, which insurance would be much more likely to cover versus a dermatological procedure. In addition, she kindly spent valuable time accompanying me to the checkout desk so as to assure both ideal scheduling and proper insurance coding. For one $20 copay, I will undergo this little outpatient surgery and receive a surreptitious follow-up on my blood pressure. Nice, huh?

Whew! I’ve rambled enough. But how nice to find caring, competent professionals. Wish me luck on the other mess.

Have you heard of a wen before?



  1. Medical places can be a nightmare. I try to always go places that are in my plan, but stuff happens. I just had a cyst removed too and it cost me the same amount. Nothing to it.

    I hope you get this big bill removed and you can move on.

    Have a fabulous day and weekend, Darla. Big hug. ♥

  2. Know nothing about wens, but I see a dermatologist in a few weeks; several of my siblings have had melanomas removed, so I figure it's time to get a once-over. I chose a female doc, thinking that I'll be less embarrassed...LOL! When I feel and broke two bones in my left hand, I kept a spreadsheet of charges, insurance payments, and tried to keep everything updated. When something weird came was about an out-of-network doc who had a hand in my insurance company called them for me and we got things straightened out. But, it seems, that they try to frighten you into paying first, then when that doesn't work, they actually do their jobs and follow procedure. It's sad! Feel better!

    1. Thank you. I appreciate the kind and reassuring words.

  3. I have had loads of wens!!!!!

    And had them removed. And all has been fine!

    Not to worry!

    This bill 'em and figure they'll cave and pay it...! Horrible! So glad you have people, to go to bat for you. People who understand and can .... Do what's needed to be done.

    We had the same sort of experience, with our new washing machine Saga. Just we little customers, had no clout. When the contractor, who did our previous work, got into it...... He pointed out how much money, the contractor he works for, spends at this store. Of course, they are huge customers.

    Then, lo and behold, the store did anything we wanted!!!!!!!!

    It stinks, but it shows, how "the Little Guy" is not listened to. And needs a "Big Guy" to go-to-bat for them.

    Mmmmm, seems the last election, was won, on this premise.....


    1. I'm glad you got the contractor to back you up. :)

  4. Insurance companies are such a pain- all about money. I am glad you can get that removed for just a co-pay. I have not heard of a wen. Have a nice weekend! XO

  5. I have not seen a doctor in years. Decades? This is why.

    1. Oh, no! I don't like hearing that. My in-laws are the same, though,and both older than me. It's worth the cost and hassle, in our opinions, to keep a check on our wellness. Stay healthy!

  6. Oh gosh I"m sorry you are going through this. I think WA state just put a cap on "out of network" charges. Who can tell, when a doctor or even nurse on duty is in your network or not. Magic? The whole health insurance scammology thing, like calls from Nigeria or something trying to get money from seniors by saying they're a grandkid in jail and need money, please go to a 7-11 for a moneygram, or pay in Amazon gift cards. My mother had constant "wens" on her scalp. She'd have them removed and back they'd come.

    1. Thank you. I am lucky to face this for the first time. And scammers who take advantage of the elderly, especially those grieving, are scum. Fingers crossed this doesn't come back, or grows as slow if it does. Be well!


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