The never-ending headache that is health insurance

This morning I saw my pain-in-the-ass vascular surgeon about the final surgery on a stubborn varicose vein. I won’t get too much into why he’s a pain because it has nothing to  do with money…well, I guess it does because if he hadn’t pretended that he did the procedure we decided on, it would have saved me at least $100 in co-pays. Anyway, before I had the first two procedures in January 2008, I asked him once and his admin staff twice if everything was good to go with the insurance company and they all said yes. Then the bill came and because it wasn’t pre-certified, the insurance company only paid 40% instead of the 80% they would/should have. BCBS of Illinois has been giving my doctor the runaround for a year, and the admin assistant who deals with that stuff had a stack of files going back two years of billing cases with similar issues. Apparently they always pay up, but they’re counting on frustrating the hell out of accounts receivable staff to the point where they give up trying.

The doctor started off with an apology for discussing billing issues with me, but said that what the insurance company had paid so far (and might only ever pay) didn’t even cover the pre-profit overheads for the surgery. Apparently the surgery that he officially bills @ $8300 per leg gets a Blue Cross Blue Shield approved fee of about $2200, of which $950 is the barebones cost of materials and staff costs for everyone but him. Well, I can do the math for the two days per week that he does this and only this office surgery, and BCBS pays some of the lowest fees out there…so for those procedures alone, he makes a minimum personal profit of $20,000 a week. I soooo don’t feel bad for him. 

On the way out, I told the assistant to bill me for the 20% co-insurance that I owed no matter what the insurance company did about their portion of the fees. So when I go in for an ultrasound of my leg tomorrow morning, I’ll be slapped with a bill for $870 – expected, but I hate the timing. Then it also turned out that there were smaller co-pay/co-insurance bits and pieces that I’ve owed for a year and that they claim to have been sending me bills for monthly (I honestly haven’t received a single one of them), so that’s another $130 I’ll be coughing up. Add another $85 for my portion of today’s and tomorrow’s appointments, and BLECH.

Let’s harken back to my credit score of 805, where I was penalized for not having any installment payment debt (e.g. car loan, student loan). I wonder…if I arrange to pay that bill in monthly chunks, will that do the trick, or is that such an unofficial arrangement that it won’t count? I can pay the whole thing up front, but if I can get some personal benefit out of it somehow, I’ll take it.

6 Responses

  1. Ugh.. what a pain. I can’t believe your doctor whined about his rates. If he doesn’t like it, he should’ve never agreed to the negotiated rates with your healthcare insurer.
    My gynecologist also doesn’t want to be bothered with insurance matters. He keeps using the lab that is not within my insurance’s network. The insurance company usually bills me the out-of-network amount, which I have to call in to complain. My insurance usually relents, but it’s still a pain. Something has to be done to overhaul this bureaucratic mess.

  2. Health insurance is a pain the neck! I don’t think owing a doctor will help your credit unless you pay for it with a credit card or perhaps care credit.

  3. Guess I’m lucky – having no insurance alleviates all this mess. And I especially liked the “Blech” part! I’d go with the CareCredit. You can get zero interest for a very long period.

  4. Did you ask your dr. for a copy of these “monthly bills” they have been sending you? I hate dealing with insurance companies, which is where I find most of the problems come from not the dr.’s office. Although, in your case it sounds like a combination of the two. It’s amazing how after calling to complain a few times suddenly bills are “taken care off” and paperwork they “never received” is found. Gah! Good luck with your adventures into the health care system!

  5. Sigh – what a nightmare! Makes me glad that I’m Canadian.

  6. I’d try offering to pay it off in one chunk if they take off a portion of the bill. Its always worked for me!

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