Wednesday, July 20, 2011

Getting Gouged

Toward the end of last April, I paid another follow visit to my ENT specialist. At this point, I had run out my 90-day follow up period included with the surgical package from last December. My insurance changed January 1, from an 100% coverage HMO to a PPO 80/20 type thing.

This was my first visit under the new insurance coverage.

The doctor did what was expected: as an ENT specializing in laryngocolgy, he used a scope to quickly glance down my throat into my larynx.

All was well, and I went home.
I received the bill two weeks ago:
  • Physician $136.00
  • Surgery $243.00
What surgery? I called billing and informed them that I did not have surgery that day. They looked into the matter and informed me that that was just the code entered for billing, and I was actually being charged for a laryngoscopy (the scope down the throat thing).

Oh, I see... And what is the 'Physician' charge for? To see the physician, she says.
O.K... so, you charge me to see the physician but I get charged again if the physician actually sees me back? I don't think so, ma'am. Try again.

She explains that the laryngoscopy is billed as a separate procedure that I need to pay for. By this time I was getting pissed.
"He's an E.N. fucking T! A laryngocologist. He supposed to look down my throat. That's his physician job."

Then she goes on about how I could make payment arrangements.
I told her that I am refusing to pay for the laryngoscopy. Remove it from my bill, or forward to collections, it matters not. The result would be the same.


Bike Bubba said...

I'm not quite sure why, but any endoscope procedure is treated as a surgery. If you don't pay for it as a surgery, what's worse is that your insurer won't pay their 80%.

For my colonoscopy last year, it was a real surgery because they found polyps, thankfully benign. But it still came as a surprise to me.

Brian said...

Strictly speaking, "surgery" is any diagnostic or treatment procedure that involves physical manipulation of the patient (as opposed to "medicine" which generally involves treatment with medication.) So a laryngoscopy counts.

In modern practice, surgery and medicine are integrated, though they are still largely considered separate disciplines (most med schools have a "Department of Medicine" and a "Department of Surgery", for example.)

None of which makes your bills suck any less, I realize.

Gino said...

i was advised by somebody who's been using the same coverage for years to call the insurer, explain the situation, and they will carry the ball from there. the insurer wont pay any bullshit charges either, and providers have a tendency to throw everything up there and see what sticks.

he said the insurer has pull that i dont have, if they keep having issues with a provider, they have the opportunity to hurt them.

Vanesa Littlecrow W. said...

Good for you! It really does sound like you are being double billed.

Mrs. D said...

I know exactly what you are talking about. We had the same issue with Fearless Maria who had a similar procedure. Not sure which is worse, the procedure or dealing with the bill.