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.

Ugh…

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?

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