13 February 2011

Gatekeepers, part III

Fast-forward to my daughter's one-year well-baby exam, and they're at it again.

After the two-month exam with the whole "go to the health department" debacle, the doctor's office didn't utter a peep about any potential problem with the insurance. She got all her shots on schedule with no issue.

Which explains my surprise when a nurse entered the room brandishing a paper instead of a loaded syringe, telling us that we were going to have to go to the county health department because our insurance wouldn't pay.

My first thought was, "Oh, not this again." After that it was steadily rising anger as I argued with the nurse, the same nurse who had given my daughter's injections all this time with no apparent problem. She left and returned several times, finally backing down enough to tell me that fine, they'd give the shots, but they'd be losing a large chunk of money in the process.

My little girl got the shots, put in the requisite screams and received her special kid-friendly band-aids. We went home. I started making phone calls. Then there was one hell of a big ice-storm that pretty much shut down this part of the country for a few days. When we dug out from under it, I began making calls again, and this is what I established:

My daughter has a very good primary insurance plan through a private insurer. The plan covers 7 well-baby visits within the first year, all with the corresponding approved vaccines. My daughter had used 5 visits and they had covered everything 100%. The one I'd just been to was the 6th visit, meaning that even if I'd gone to an EXTRA visit and somehow fit in some extra vaccinations, that would have been covered too.

I had to wait through several days of a closed business office before I was put through to an office manager of some sort, and by that point I was so angry I left one of those disgruntled-customer messages on her voicemail. That gave her a chance to get huffy in return, so I should have expected her to be difficult when she finally called.

HER: You need to understand, it is our office policy that when we see (daughter's supplemental insurance, which she doesn't use except for copays), we do not administer vaccinations because that insurance doesn't pay for them. Now, I looked up our policy and was sure of that before I called you.

ME: I'm telling you that's a non-issue because that's my daughter's secondary insurance and the billing should never even get to them, because her primary insurance pays 100% of her well-baby visit and vaccinations.

HER: (louder) It is our office policy to send patients to the county health department because we do not get paid and vaccinations are expensive. Now, I have taken my grandchildren to the county health department and it is just fine.

ME: I am not going to the county health department! My daughter has a very good primary insurance plan through a private insurer and they told me that they have paid 100% of office charges, INCLUDING vaccinations, INCLUDING (list of all the recent vaccinations). They cover it all. The secondary insurance should not be getting billed! You don't have to bill them! The primary insurance is paying for everything!

HER: Are you asking me to pretend that you don't have (secondary insurance) when you do? Because I won't be a party to that. And if our medical staff is going along with you in this, I need to educate them.

ME: What?

HER: Are you asking me to defraud (secondary insurance) by removing them from the billing?

ME: What the hell are you even talking about?!?

...it went on, in this vein, for about ten minutes, with me angrily brandishing contact information to this person and that person at the primary insurance's provider-info line and trying to pound it through her thick skull that, unless she was double-billing or something, this was a stupid knee-jerk reaction to seeing the name of a completely irrelevant insurance policy.

HER: Oh. Wait. I should have looked at your chart.

ME: Probably.

HER: Well, I see here that (primary insurer) has paid 100% of all our billing.

ME: That's what I've been trying to tell you.

HER: Well, I just looked up our office policy to make sure I had that right, I didn't look at your chart to verify the insurance coverage. I'll put a note in here for them not to bother you, we haven't had a problem with your insurance at all.

ME: (probably having some sort of mini-stroke on my end from the top-out in blood pressure) If you'd just checked it to begin with, we wouldn't have had to go through all this.

HER: Well, I can see there's no problem so I'm going to write a note to the medical staff not to bother you. We'll pretend we never had this conversation, ok?

...and you can see how well I can pretend we never had that conversation.

Seriously, what the hell is wrong with people? Somewhere in her authoritative drone she also assured me that I didn't understand insurance terms and that 100% coverage didn't mean 100% coverage, that I would get an increase in insurance premium. I gritted my teeth and told her to let ME worry about that, it wasn't her problem.

A little bit of knowledge is a dangerous thing. I wonder how long we'll go before the next run-in.

1 comment:

Jeanne said...

Hi Amorette--just stopped by your blog to see what was up and saw this gatekeepers post, which has me grinding my teeth on your behalf.

You haven't been posting much--I hope that's because you are busy with your daughter. Would you write and update me when you have a chance?

Also, my blog address has changed, for reasons I won't go into here. This is the new one:

http://assertivecancerpatient.com/

Jeanne