Last June, I went to the worst rheumatologist appointment ever (Read: The Storm After Years Of Calm). And I thought, now that I have a new rheumatologist that I like, that I had put it behind me. But to my surprise and chagrin, a few weeks ago, I received an explanation of benefits from my insurance company stating that I owe over $300 for labs that my insurance plan isn’t paying for.
First of all, why am I getting billed for this now? It is April of 2018 and this appointment occurred in June of 2017. Second of all, no, just no.
I will not be taken advantage of this way, especially since after the tests were run, I found out what they were and they were totally unnecessary. Tests were run for multiple myeloma (makes no sense), and for a doctor that didn’t seem to believe I have lupus and RA, she ran no confirmatory tests for the illnesses that I ACTUALLY HAVE (Read: I Do Have Lupus And RA After All...).
So I contacted the person who is our designated contact at the insurance company. She proceeded to attempt to school me on what a deductible is and that mine hadn’t been met yet, hence the charges. I calmly explained that I know what a deductible is and all of that, but that’s not what I was questioning. I asked if I could appeal, and was told that I had 60 days from the date of service to appeal. I asked how it was fair that I could be billed for services 10 months later but only had 60 days to appeal? We continued to go back and forth, with her being incredibly dismissive and disrespectful to me. I finally asked to be contacted by a supervisor. I’m still waiting.
(Also note that since this appointment took place last year, it would have counted toward that deductible, which I met.).
I also contacted the person that administers our insurance, and was told that my best bet was to contact the provider. I explained that in order to spare myself further mental anguish, that was definitely not an option. In fact, I have attempted, on at least six occasions, to contact the medical group administration, without success.
I have no intention of engaging with this provider ever again. And I have no intention of paying any bill I receive now for lab work or anything else associated with that appointment. It’s nearly a year later at this point. And I was trying to move on from that appointment, which set me back a lot, both physically and emotionally.
It is unbelievable to me that doctors can provide subpar care and nothing can be done about it, unless it gets to the level where you have a lawsuit. It seems that, that is the only way that patients can get any sort of vindication. I can’t reason with a terrible provider. I can’t get a direct line to anyone at the office above the provider. I can’t get any assistance from my insurance company. So what am I supposed to do?
I would love to work for an insurance company and advocate for patients in my position. I would love to be able to contact a provider and say “you have to write off this bill because the patient was not treated well, and neither them nor we are going to pay for it.”
Clearly, there is a reason why I have not and will never see this provider again. It is not like I have gone back multiple times to see her. And I pay all my bills. As long as the services are rendered properly, I have no problem paying. But when services are rendered far below where they should be, I am going to fight that, especially when I had assumed that everything was done and paid for. It’s a bit strange that 10 months later they are coming after me for money, but this provider has never contacted me to see if I was coming back to see her again or not. I guess the loathing was mutual.
It’s also interesting because my insurance is claiming that they’re not paying due to the diagnostic codes. Which brings me back to the beginning. Of course, because the tests don’t make sense for the diagnoses I have and am being (successfully) treated for. So you see, I am being sent in circles. Once I knew what tests were run - after they were done and I saw the results - I knew they were totally unnecessary. But this doctor was so convinced that she was right and I was wrong that she went on a very pointless (and expensive) fishing expedition.
And this is where the medical profession and the insurance industry get it wrong. That this doctor’s experience in medical school trumps my near decade as a patient living with lupus and RA is absolutely ridiculous. And that I should be the one to have to pay for the fragility of her ego is even more ridiculous. She made an error. It was a grievous one, but thankfully I’ve had a (correct) diagnosis for long enough to know that she was wrong and that I wouldn’t put up with that kind of treatment from any physician. So I cut my losses, now she needs to cut hers.