Friday, March 26, 2010

A pain, not in my back, but in the you-know-what...

Most health plans, including mine, recommend a first colonoscopy at age 50. I managed to put off the procedure for eight years, but two years ago, at age 58, I finally got around to having it done. It's a good thing I did, because the doctor found several polyps of a type that, left untreated, are likely to become cancerous. Those polyps were removed, but because they are aggressive and tend to grow back, he scheduled another colonoscopy in two years. Last month I had the second colonoscopy, and the results were good, so I now have a three year period before I have to have another.

This morning I got a letter from a subrogation services company contacted by my insurance company "to get more information about the injury or care you received". The first question on the Questionnaire included with the letter read: Was your treatment due to (please check one below) auto accident? home injury? work accident or injury? medical malpractice? liability, like a slip or fall? other/not an accident (explain below). The letter had a case number that I'd never seen before, but no other information about what they were asking about: not the doctor involved, or the facility; not the treatment or procedure; not even a date of service.

I sighed and called the 1-800 number. After spending some time going through a number of annoying steps in the electronic processing procedure, I was put on hold. Eventually, a claims representative came on the line. I told her that I thought the letter must have been sent to me by mistake, because I haven't been in an accident.

"That doesn't mean anything," she exclaimed cheerfully.

"Why not?" I asked.

"Because," she said distinctly, and I could practically hear the unuttered DUH! "You could havebeen injured in an accident without being in an accident!"

Huh?

After I provided my date of birth, she began to unravel the Gordian knot. The inquiry was related to my recent colonoscopy. Apparently, my insurance company would like to get out ofpaying for this procedure. Never mind that it wasn't an emergency procedure, and I had to be pre-approved before it was scheduled, and they'd been apprised two years ago of the results that would require this to be done again in two years time.

"It says here you had this procedure due to back pain," the claims rep said.

I told her I did not have the procedure because of back pain; I had the procedure because I previously had a certain type of polyps that requires regular screening in case they come back. She blithely disregarded me, exclaiming, "Back pain is what the nurse put down!"

"Well then the nurse got it wrong!"

"Was the back pain due to an accident?"

"I DIDN'T HAVE BACK PAIN!" I exclaimed, although I was beginning to have another sort of pain trying to get her to understand this.

"I can't change the record, but I'm making a note that the back pain wasn't due to an accident, so you can tear up that paperwork," she said.

I hope the new health care plan is able to eliminate some of this idiocy, but I'm not counting on it.

4 comments:

Lisa :-] said...

And people are screaming that they don't want the government messing with "their" health insurance...

JACKIE said...

Problem is, as it stands, we'll be buying insurance from the same people who are causing the problem already. As Bill the Cat would say Thbppppppth!!!!!!!!!!!!

marigolds2 said...

So, yeah Lisa, who are these people anyway? I am going to have cataract surgery this spring, both eyes, and Gail and I spent most of yesterday afternoon on the phone with my Medicare Advantage plan, then with the doctor's office, back to the Plan, back to Eye Associates, etc etc etc. trying to get all the ducks in their row in order to be sure all prior approvals are in place and so forth. Each person on the "customer care" line had a different answer for my queries, and I am still not sure it's all where it's supposed to be.This is relatively minor, and I can't imagine that a majority of people in this country haven't been through something similar, and many things far far worse - I dread what is coming as I grow older and most likely need more medical care for one thing or another. How is it that we can't hear a dull roar rising from a united chorus of victims of health insurance and health care begging for change, for a system that eliminates, as Judi says, "some of this idiocy?"

Lori said...

Good grief!