I hate insurance of all kinds

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BethM

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So I've been having a bit of bad luck lately and I just need to rant about it somewhere. Really, I want to scream. This is going to be long, but I just need to get it out.

On Saturday, I got a bill from my Ear/Nose/Throat doctor. I had an appointment in September, just an office visit. Dr. looked in my nose, discussed my most recent sinus infection, caught up on my progress, normal office visit. Prescribed me Cipro, said to come back in a year. My insurance reports that the office visit was fully covered, but they will not pay for "outpatient surgery." I checked the doctor's receipt, and he'd circled "nasal endoscopy" on it. Then I checked the half-dozen other receipts I've had from him over the past few years, all for IDENTICAL office visits, he did the SAME procedures, but none of them had the "nasal endoscopy" part circled. So now they want me to pay $207 for I don't even know what. They've already gotten my lousy insurance to pay almost $300 for the office visit, and I wasn't even in the doctor's chair for more than 15 minutes.

I've always liked my ENT, he's nice and very helpful. His nurse will call in antibiotics prescriptions any time I have a sinus infection (sometimes 8 per year!) without me having to go in for an office visit. He did a fabulous job on my sinus surgeries. But I am now thinking of dropping him over this.
After I opened the bill Saturday, I got a terrible pain in my neck and face, and it didn't go away until Sunday.


Then tonight. Husband and I popped out to the grocery store after dinner. Already dark out. We were about a half mile from home, and I got pulled over. The officer said my passenger's headlight was out, and issued me a "fix it" citation. Which is perfectly fine. Except that our car insurance never sent current insurance cards. Our policy is up to date, but the cards we have expired last month. Which I didn't realize until the cop is wanting my insurance cards. So now
I have to appear in court on Dec. 9th to show proof of insurance.

Now.....my work is extremely busy during Christmas, and does not approve time off, for ANY reason, between Thanksgiving and Christmas. If you're out, it counts against you, and they've fired people over it. There's no way to avoid being penalized, because any time you're off is "unapproved." So I'm going to be penalized for having to take time for that.

When we got home, husband called the insurance company, and they emailed him copies of our insurance cards, he printed them out, so we're fine on that now.

Here's the best part.......Jason went out to check how difficult my headlight would be to replace (never done it on my Prius before). THEY BOTH WORK FINE. Even the one that is marked on my fix-it ticket as being out. Tail lights, turn signals, license plate light, all fine.


I was already starting to feel Scrooge-ish about Christmas. Was going to give donations to ASPCA, etc, instead of giving gifts, because I can't stand Christmas shopping, and I think it's pointless anyway.
Now this. I am going to be grumpy for MANY days.
 

Amy27

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I am sorry you are having a rough time.

If you want any help fighting your doctor bill, let me know. That is what I do everyday. I am a coding auditor for an insurance company and audit physician charges. Feel free to PM me here or send me a message on facebook. It is a pet peeve of mine when physicians bill for things they didn't do. I can't tell you how many times I have caught physician offices and hospitals doing that. It is really sad. You could also call your insurance company and let them know that you don't think this procedure was performed and want them to audit the charges based on the medical documentation. The physician would have had to document that procedure.

I know in Ohio they let you fax in proof of insurance instead of going to court. I would call and see if that is an option. If not see if they will let someone else go in your place to show proof of insurance. That stinks that your job is so strict on taking time off.

I hate when I feel like everything is going wrong. Even if you can do things to fix it, it is stressful having to take time to fix it all. Especially when you got a ticket for a light that wasn't even out. I would be ticked and your work situation would make me even more ticked.
 

BethM

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Thanks for the suggestions, Amy.
I do plan on calling the billing department for the doctor's office first, I just haven't been able to do it yet. They'll probably be closed tomorrow, so I'm aiming for Thursday. I looked up "nasal endoscopy" online, and the description sounds much more involved than what was done. I was sprayed with decongesant, and he did look in my nose with his handheld scope. But there was absolutely no tube/camera/etc inserted.

I guess my main confusion is that he did everything exactly the same as before, but I've never been billed for this in the past. The only thing different is that one thing circled on my receipt. (I save most of my doctor's receipts.)
Hopefully they will reverse the charges. If not, I will be calling my insurance company and seeing what they can do. I will try to remember to ask for them to audit the documentation. They didn't pay out anything on it, but applied it towards my deductible.

I checked my traffic ticket, and "mandatory court" is checked/circled in two different places. The neighboring "town" allows people to fax in the proof of insurance, but I guess mine does not. I don't quite understand, I would think that would save them money overall.

I put in my vacation request (half a day) for December, and my boss took about 5 minutes of looking it over before reluctantly saying it would be ok. I felt like I needed to tell him all the details, so he wouldn't be too annoyed about it. My job will be especially busy that week, as there is an earlier deadline for guaranteed Christmas delivery for international orders. Oh well.

My work hires a lot of younger people who like to take a lot of time off, so they've made ironclad rules that hurt everyone. (It's mostly during the Christmas shipping season.) They do other stupid things, too. They hung up signs all over saying "If you are sick, stay home!" But they haven't waived any of the penalties for missing work, so people are coming in sick. There are signs printed out from the CDC advising to wash your hands every time you blow your nose, etc., but then a week later they advised that we're not supposed to use the restroom outside of break time unless it's an emergency, and if people keep "abusing" restroom breaks, they'll start enforcing that.

Amazingly, it's one of the better places to work around here. :/

I guess it's not all that bad. I think the two things happening at the same time is just really stressful for me.
 

BethM

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Some research has turned up that the Prius models with HID lights have a history of problems with the headlights. Including the lights mysteriously flicker out, then will appear to be working fine later. Some people have lost both lights while driving at night.

So now I have to try to get Toyota to replace the lights for me.
From what I've been reading, they don't really want to replace the lights, but if you argue enough, they will pay the entire cost.

Bah!
 

wabbitmom12

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BethM wrote:
From what I've been reading, they don't really want to replace the lights, but if you argue enough, they will pay the entire cost.

Bah!
Isn't that the problem? Why should you have to argue or get mad to get them to take responsibility? It's so frustrating! I can't tell you how much time I have had to invest arguing with companies and/or people, just to get them to do what they should have done to start with. It's one of my pet peeves!
 

BethM

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wabbitmom12 wrote:
BethM wrote:
From what I've been reading, they don't really want to replace the lights, but if you argue enough, they will pay the entire cost.

Bah!
Isn't that the problem? Why should you have to argue or get mad to get them to take responsibility? It's so frustrating! I can't tell you how much time I have had to invest arguing with companies and/or people, just to get them to do what they should have done to start with. It's one of my pet peeves!
I agree. You would think that Toyota would not only want to make it's customers happy so they will buy another car from them in the future, but also keep people from causing a media fuss, especially after this stupid floor mat thing now.

I now have an open case with Toyota Customer Experience, but can't get my car in to the shop until Saturday next week. Both headlights working, for now.

I did luck out a little bit. My dad was a mechanic with Toyota for 25 years. Even though he and I have barely spoken for....my whole life....., he called some of his Toyota friends, and found out there is a NEW (2 weeks old) service bulletin regarding flickering/intermittant HID lights. He also suggested that there *might* be a recall coming down the line. I am hoping this will help.

I will still have to wrangle with the dealership when I go in. Some people have to pay up front, then wait 6-8 weeks for Toyota to send them a refund. Not cool on a $600 repair. Other dealerships take payment directly from Toyota, so there is no charge to the customer. Yet other dealerships charge the customer for labor only, then bill Toyota for parts *and* labor. Hopefully I will get the second option.
 

BethM

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I also spoke with my doctor's billing office today. The woman says that, according to their internal records, I WAS billed (and paid for) the same procedure, last year, and the year before that. My receipt for last year does NOT have "nasal endoscopy" circled on it.

It seems that my insurance company considers my doctor looking in my nose for 2 minutes to be "outpatient surgery," and it is "not covered."

Also, the price I have been billed on this procedure has increased a lot. This year: $230. Last year: $137. The year before: about $100.
I am glad that core inflation staying low has not prevented the cost doctors care nearly doubling in a year.

I did make the woman tell me how long I have until my account goes into "past due" status. They will not be getting paid until then.
 

Amy27

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Wow that is crazy about your car. What a big hassle.

I would still call your insurance company about the doctors bill. I could understand if the procedure was applied to your deductible or co-insurance but it is weird it would just plain not be covered.

The reason I say that is because I have worked at several physician's office doing billing before I moved to work at a insurance payer and saw how unfair things were. For example, if we submitted a bill and received a denial stating something was not covered we would bill the patient. A lot of times the patient would call the insurance company, call us back and state if you bill this way, my insurance does cover it. It was usually a really small easy change and then the procedure would be covered. A correct claim sent to an insurance company has a lot of different information on it. If one thing is wrong, could even be a keying error, it could be denied. Insurance companies are a lot stricter when paying for procedures because they are usually more money then office visits. So I would call and ask them why this is a noncovered procedure. Where in your benefit plan does it say that.

I have seen a lot of people pay bills that they really didn't owe. Which is one of the reason I left my last job. They had crappy morals and because patients just paid stuff they never changed their internal policies. A lot of those patients were elderly and never wanted to owe anyone anything. It was really sad.
 

BethM

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Amy27 wrote:
I would still call your insurance company about the doctors bill. I could understand if the procedure was applied to your deductible or co-insurance but it is weird it would just plain not be covered.
Thanks, Amy, I will go ahead and call my insurance next week. They did apply part of the amount to my deductible (not all of it). The billing woman was the one who said it wasn't covered.

I mostly try to not talk to my insurance, ever since my sinus surgeries. It was just too frustrating. The things they wouldn't cover was crazy.
I will go ahead and try to talk to them, to see what's going on with this.

I guess I'm suspicious lately, too. Last month, a friend of mine in California was billed over $300 for the lab work on her yearly exam. She called them, and they said they'd "forgotten" to bill insurance.

I almost feel like I should just pay it, because I think I'm going to be short on my medical reimbursement account this year. But I really don't want to pay for something that I shouldn't have to pay for. I'd rather just go buy $50 worth of Tylenol or whatever at the end of the year to make up the difference.
 

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