Anyone want to help me flush about $200/mo down the toilet???

That's what I feel like I'm doing anyhow.

Ben has it set up for our medical insurance to be directly taken out of his check every two weeks (we're paid bi-weekly).

I feel like hospitals, clinics, doctors just don't care about their patients anymore. Hospitals and clinics are being ran like a business and at the end of the day, the doctors seem to only care about "the bottom line". {Read: money}

Case in point:
At the end of August, I went for a ROUTINE Pap. My annual exam is fully covered under the terms of my insurance. All that I am responsible to pay is $20 at the actual visit. (This is my co-pay.)

All is well and good (or so I think) until last Monday (the 16th) I receive a bill from Quest Diagnostics. They're the lab that ran the testing. Now, my insurance has a contract with Quest so all lab work.... all ROUTINE lab work that they perform is covered.

Well, apparently I find out that the HPV test that the doctor physician's assistant ran that day is NOT a routine part of an annual exam and thus is NOT covered by my insurance.

The provider (hospital/clinic/doctor) tried to be sneaky... see, the charge for the pap was $68 and the HPV was $105. The provider "wrote off" the $105 and then that meant that the insurance would only pay a portion of the original pap, leaving me the balance.

This was explained to me by a representative from my insurance company. She said that had the provider NOT ran that test, then what would happen is that the insurance would pay for part, the provider "writes off" the remainder and leaves a ZERO balance for the patient. However, because they ran the test and wrote IT off, then I'm left with paying part of the pap.

I asked the insurance rep what I should do. She said that there should be no patient responsibility and that the provider should resubmit the claim. She explained how they could resubmit the paperwork so that they could do the "write off" in such a way that leaves me, the patient, with a zero balance.

The next day, (Oct. 17th) I called the gynecology department and spoke with the receptionist. I explained to her that I needed to talk to the physician's assistant who ordered the test and have her resubmit the claim. "Sheila" took my name and number and said that someone would be calling me back.

Tuesday came and went.

Wednesday came and went.

Finally, I call back first thing on Thursday morning. (Oct. 19th) I explained to "Sheila" that no one had contacted me as of yet regarding this matter. I reminded her that the bill from Quest was due on Oct. 26th and I'd like to take care of this in a timely manner. She indicates to me that she's sending an email to this woman "Valerie" who is in the insurance department and "Valerie" should be calling me back soon.

This was at 8:55am, Thursday morning.

Friday morning, Oct. 20th, I call "Sheila" back. I explain to her that "Valerie" has not returned my call. She then gives me the phone number to the billing department for the hospital portion of the building. (The name of the place is Cleveland Clinc Hospital and apparently half of the building is a "hospital" and the other half is a "clinic" or something like that.)

I call and speak with a rep and go through the whole story all over again. She then tells me that I've called the hospital and I need to talk to the clinic.

WTF?!?!?

Ok, so she gives me the phone number for the billing department at the "clinic". I speak with a rep and tell her AGAIN my story. Next thing I know, her supervisor gets on the line and asks me what the problem is.

I'm irate at this point and had had it up to H E R E.

And yet, once AGAIN I tell her the whole thing. I explain how the HPV test was ordered unbeknownst to me (i found this out afterwards) and not only that but the insurance only covers routine paps---- my insurance does not consider the HPV test to be routine. She's the first person who seems sympathetic. She takes down my name and number and says she'll call me back---that she had to do some investigating because I wasn't showing up in their system.

This was Friday at 9:55am.

The weekend comes and goes. Now, it's Monday morning. (the 23rd) Finally, since it seems that I'm getting the run-around, I decided to call Quest Diagnostics directly.

I spoke to a very nice gentlemen, "Danny", who noted the account. He said that unfortunately he can't do anything, but to keep trying to get the provider to either resubmit the claim or pay the remaining balance. I thanked him for his time and decided to call "Rose" the supervisor who was supposed to call me back on Friday afternoon.

I talked to "Jos�" at 10:35am. He indicates to me that "Rose" is working on the situation and she is involved with another manager to get something approved. I'm not sure what exactly he meant by that, but I assumed that she was in the process of researching this and trying to find a way to take care of it.

The rest of the day came and went. Here it is, EIGHT freakin' days later and I've accomplished nothing really except waste my time and cell phone minutes.

So, I have to call BACK again and find out what the hell is going on. I feel like these providers just decide to order tests or procedures on a whim and they really don't care if the patient's insurance will cover them. I say this because it's not as if she (the P.A. who ran the test) asked me if it would be covered by my insurance. I didn't know she was even running this test.

I am angry because, as a responsible person, I feel that I am doing my part to live up to the terms of my insurance and my insurance is doing their part to live up to the terms of the policy as well. It seems that the doctors/physician assistants/nurses are the ones who don't take the time to talk in depth with the patient to let him/her know what is being done and give him/her the opportunity to check with their insurance.

Had "Judy" (the physician's assistant who did the pap and ordered the tests) said to me, "I'm also going to order an HPV test along with your pap. Is this something that is covered by your insurance?" I would have said, "Let me check," and called my insurance company right there on the spot!!

Instead, these providers ASSUME that the patient is covered and at the end of the day we're not and WE are the one stuck with paying the bill.

It's just not right. And, I think it's downright unethical!

Until next time...peace, love, & HEALTH!!!