This morning I was looking at a bill from the podiatrist who I saw recently for a little problem with my toes. I was surprised by how high it was, so I went to my health insurance website to look at the benefit statement that would explain it from their side.
They broke the visit down, as they like to do, into three parts: the office visit, the X-rays, and the actual treatment. For the first part, they covered it minus my copay, fine; for the second, they "covered" it but said that it had to count toward my deductible, so I had to pay the adjusted amount for that, which pffft but fine; and the third part it said they didn't cover at all.
I went down to the footnote to find the code that explained why, and it said, and lord knows I quote, "Your plan does not cover routine foot care or associated expenses."
I mean. What? "Your plan does not cover routine foot care" at the podiatrist? The one I picked from their website, which said he was in-network? In-network for what if it doesn't cover treatment? "You can go see him, but he can't do anything" hardly seems to have a point.
I called them, and the very nice woman I spoke with agreed that that sounded wrong; she looked here and clicked there and finally said that, yeah, no, that ain't right (not a direct quote, obviously). She said it should have been covered, and either she could send it back to the claims department to fix, or if I had 5 or 10 minutes then, she could adjust it while I waited. I chose that, of course, and after listening to the jaunty hold music for a while, she said it was fixed and should show up in about 24 hours.
Whew! So that's $65 back in my pocket. As well as relief from the utter ridiculousness of thinking that they agreed I could see a podiatrist, but he can't treat me. Because that made my head want to explode.
Health insurance in this country is such a scam, I tell you what.
Honest to god, anytime I hear about any story about US health care it stresses me out. HOW IS THIS THE ACTUAL PROCEDURE??? I mean, honestly, it is terrible.
ReplyDeleteIt truly is. None of this should be for profit.
DeleteI'm with you on the craziness of our health care system; it's frightening!
ReplyDeleteHonestly, yes!
DeleteIt is. The Cleveland Clinic a few years ago figured out the costs of an average labor and delivery, calculated that it cost $15 each time they had to call the insurance companies to try to get them to pay while costing the insurance companies likewise and that it took an average of I forget how many rounds where they fake that they don't have to pay it, for months, for everything--and Cleveland went, look: let's start here. Why don't we just set a single price that averages in whatever costs from all deliveries. Have a baby, pay this much, C-section or not. It will save you way more money than you're paying now for no good reasons.
ReplyDeleteNot a single company took them up on it.
Infuriating.
DeleteOh, it's terrible. I now have to drive my 93-year old mother 30 minutes each way (after I've driven 20 minutes to go get her) to a private practice podiatrist for foot care because The Cleveland Clinic will NOT provide routine foot care unless the patient is a diabetic because Medicare no longer covers it. My mother is on blood thinners, and I'm scared to cut her nails and take care of her calluses and corns. But without insurance coverage, the cost is enormous. Luckily, the private physician will accept a nominal fee for this service. The US has a horribly broken healthcare system.
ReplyDeleteBroken is the word.
DeleteIt is SUCH a scam. I had an experience decades ago that STILL makes me seethe, it was so mind-numbingly stupid. Good for you for calling and hooray that you spoke to someone who could (and WOULD) help!
ReplyDeleteI will never get over the $500 pregnancy test I had to take at the ER. NEVER.
ReplyDelete$500?!!
DeleteThat's insane!
DeleteUghhh... health insurance is such a scam. I FEEL YOU. And so many people are just like "ugh, whatever, it's not worth a phone call" and just pay it. Or just figure they'll get the runaround from the insurance company, which is what I always assume. BLAH. I am glad you got this figured out!
ReplyDeleteMy mother said, "I hope you're going to call," and I thought, well, worth a try. I didn't actually expect it to work!
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