Less than a year. A few regular doctor visits and regular checkup tests. That is what it takes for the healthcare system to unveil its bloody fangs and other dirty secrets.
As the system works, we go to our family physician, pay $10 copay and the rest is taken care of. $20 for a specialist, which is still fine. A few weeks back Priti had to see a specialist for some consulation on a procedure. Desk receptionist checked my insurance card, I paid my copay and we talked to the doctor. After 15 minutes of consultation the doc mentioned some procedures but said she would first verify if my insurance would cover it.
Next day we got a call from her and as we feared, she was not covered under my insurance. So we thought, fine, we would find another specialist who can do the procedure while being covered.
The next bill from the Aetna caught us off guard. $350 charges for that 15 min consultation is NOT APPROVED ! Patients are not told if insurance covers the consultation but fees are anyway charged. Brilliant scheme, I must say. Sounds like the regime of Shylock, huh ?
It will be interesting to see how it unfolds from here. I have sent an email to my Aetna asking an explanation. Maybe I should also ask if they cover injuries caused by severe rectal trauma as well, assuming that is already a “pre-existing” case of most insured people in this country.
Update:
It gets even more interesting. In the words of a friend of mine:
I experienced a slight variation of this. My doctor called up the insurance and asked if the suggested treatment was covered to which they answered in the affirmative. I get a bill from the doctor’s office a year later with the charges. I inquire and they tell me the insurance declined to cover it later. I said that it was absurd to tell the patient that it was covered before the treatment and then shifting the cost to the patient later to which she applied ‘Yes unfortunately that happens all the time and there isn’t anything we can do about it.’
Update:
The doctor’s office called us and said not to worry about the $350 bill, it was taken care of. Cool. This is what I don’t get here. First, there will be bills of obscene amounts. Then the claim history will show that insurance paid a fraction of it or denied it. And the patient will remain confused about the real out-of-pocket cost for anything. So much for a first world health care system.
#1 by Francesco Gallarotti on October 19, 2009 - 4:21 pm
On a completely unrelated note… all the twitter links on the RHS are wrong… you might want to fix that
#2 by therider on October 19, 2009 - 7:28 pm
Francesco, right. I guess that is a bug in that twitter wordpress plugin. Let me see what I can do.
#3 by Pooja on October 20, 2009 - 1:56 pm
Totally with you on this. In our case the insurance negotiated more than 50% of the hospital bill before paying their share. And before every procedure it was us who had to call insurance to check what all is covered.
#4 by subu on February 1, 2010 - 9:21 pm
A global phenomenon. Indian health care system also has learned to do the same trick !! thanks to the loads of insurance schemes and the lucrative business – Hospitals