A Letter in the Mail
Diabetes and health insurance means jumping through more hoops.
By Scott Johnson
December 2007 — It all started with a letter in the mail. Actually, calling it a "letter" is probably not quite right - more like a computerized form that an anonymous printer spit out in reaction to some switch that was flipped in the vast darkness of a computer system somewhere. How's that for a personal touch?
It was an EOB or "Explanation of Benefits," a confusing summary of what my health insurance has paid or not paid after receiving a request for payment from a provider.
As I scanned the columns and dollar amounts, there were two charges that jumped out at me, each for almost two hundred dollars which the insurance company refused to pay. Each charge is coded with a letter which I see, after turning to the "legend," explains that these two charges are for uncovered services and are not being paid. That's a red flag in my head!
I think I know who these visits were to, but since the EOB is written in codes and symbols, it's hard to know for sure.
So what do I do now?
I don't know. I come home to this "letter" at the end of a busy and tiring work day, the kids are ready for some attention from dad, and my wife is ready for me to take over with them so she can have some quiet time.
The idea of spending any energy on investigating this sounds miserable. Besides – what can I really do this late in the day? It's pretty obvious that someone didn't get the money they were expecting, so I figure I'll hear from them soon.
Maybe the billing department for the provider will just resubmit the bill, correcting whatever was wrong in the first place. That would be nice – the problem fixing itself all on its own, with me not having to do anything. But what are my chances of that happening?
A while later, I get the bill from the provider. In this case, it was two visits to an awesome dietitian. Probably the most helpful thing I've done for my diabetes management in a very long time. Heck, probably the most helpful thing I've done for my general health in a very long time!
With a bill in my hands, I knew I had to do something. I placed a call to my health insurance company and ask them to take a look at the two charges that were denied. I explained that it was a visit to a dietitian for nutrition counseling, and they say that service is covered, but the bill was coded wrong. I'll need to contact the provider and have them code it correctly then resubmit the request.
Next I call the billing office for the provider. The provider is affiliated with a large hospital, so I'm already afraid I'm going to get lost in "the machine." I wonder if the person I speak to will care at all about my problem, or if they will be more concerned with when their next break is.
I spoke to a woman there who sounded downright aggravated that her phone dared to ring. I explained what I had learned so far and asked her if she could help. She said that it was all computerized, and that she could not just "change a code." She said that she would request a "code review," but it could take two or three weeks before it would be looked at.
Wow. The level of service was astounding, and not in a good way. It frustrated me, but I mentally set the issue aside and waited.
Another month went by and I got another bill, this time along with a threat because my payment (or lack of) was late. It was pretty clear that my call to the billing department didn't do whatever magic was necessary to make this problem go away.
It doesn't take too long before an unpaid bill from a large hospital gets sent to a collection agency. It's not long before stuff sitting at a collection agency hurts your credit score. Try explaining to Vito at the collection agency about your insurance woes and see how far you get.
The idea that some appointment for diabetes management could have a ripple effect that negatively impacts my credit score made me both angry and scared.
My wife suggested that I let the provider know that I was having problems with the billing. At first I dismissed the idea because I didn't think my dietitian could do much in regards to the bill – that's a whole separate department right?
Well, with some more internal deliberation, I went ahead and contacted her. I felt that through two appointments I had built a decent relationship with her, and she had e-mail! E-mail makes everything easier right? So I sent her an e-mail.
She replied and said she felt awful that I was fighting with this type of thing and quickly got her supervisor involved. Her supervisor contacted me very promptly and explained that she thought it was because I had an out-of-state Blue Cross/Blue Shield plan. She would get a specialist in the billing department take a look at it and get it straightened out.
A couple weeks went by and I got a new EOB – this time with the charges being paid! Yes! Battle won!
This is just one example of the "hoop theory."
The hoop theory is this: it's hard enough for me to make it through a day of living with diabetes. Having to deal with extra "stuff", or hoops to jump through, especially as related to diabetes, is like hitting a switch that immediately makes me a crabby and unpleasant person.
But I won right? I got everything straightened out? I should be happy! Instead, I felt conflict. I felt that the trouble I dealt with in order to get this mess figured out made the benefits of the appointment less … beneficial.
It made the idea of scheduling another appointment with the very helpful dietitian unfortunately unpalatable. I had a sour taste in my mouth from the experience, and, as a result, I'm not sure I'll visit her again.
Talk about it in the forum today.
Visit Scott's blog.
dLife's Viewpoints columnists are not all medical experts, but everyday people living with diabetes and sharing their personal experiences, most often at a set point in time. While their method of diabetes management may work for them, everyone is different. Please consult with your diabetes care team before acting on anything you read here to find out what will work best for you.
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Years before I was diagnosed with type 2 diabetes, The Other Half came out of a doctor's appointment with a diagnosis of "borderline diabetes" and an ADA exchange diet sheet. His health insurance agency followed up on the diagnosis with a glucometer and test strips. After a year or so of trying to follow the diet plan and test his glucose levels, things appeared to be back in "normal" range, and stood there until a couple of years after my own diagnosis. Shortly...