Working the System

In the mail yesterday, we were surprised by a $305.00 bill for the CT scan Jon had in March at the doctor's office.


"No, wait," says I..."we didn't have to pay for the CT scan he had in the ER in January," (when he originally had his kidney stone on a Saturday afternoon). 


Soooo, my to do list today was expanded to include a call to our insurance's customer service department to find out why.  Although I was pretty sure I already knew why.


Well, I just made said call and it went something like this:


After the customary exchange of info... 


Me: "Hi, I'd like to know why we were charged for a  CT scan my son had in March but were not charged for one he had in January?"


Customer Service Lady (CSL for short): "I am sorry, mam, I cannot share that information with you since Jonathan is over 18."


Me: "Um...I'm not requesting medical information, just benefit information."


CSL: "I'm sorry. Unless Jonathan is there to give verbal approval, I cannot discuss this with you.  We are open until 5:00 p.m. Jonathan can call us later."


Me: "Well, that's not going to happen.  I'm not understanding why I cannot get information on our benefits when I am the one paying the bill."  (I'm starting to lose my already-too-thin-patience).


CSL: "That's just the law, mam."


Me: " Okay...could I speak with someone else?"


CSL: "Hold on."  puts me on hold.

5 minutes later......


CSL (the exact same one): "All I can do, mam, is give you an explanation of your benefits.  I cannot share any billing information."


Me: "Okay, thank you." Although to myself I am thinking...'isn't that exactly what I asked for 10 minutes ago?'


CSL goes on to explain benefits and it was EXACTLY as I thought!!!!!


Apparently, if we go to the ER all procedures are 100% covered.  In all other cases we are responsible for 20% of the bill.


So...if we had just taken Jonathan to the ER for that CT scan (even though it wasn't an emergency situation at all) we would have happily paid our $100.00 co-pay and would have $205.00 more in our pockets right now.


No wonder people learn how to work the system...it is totally messed up.


Now I guess we have the bill from Zack's finger x-ray to look forward to since I passed up the $100.00 co-pay at the ER for the $20.00 co-pay at the doctor's office.  Didn't realize his x-rays would have been free!!!!! LIVE AND LEARN!!!