Tuesday, October 6, 2009

More blood draws and the freakin' health insurance system

I called the pharmacy to refill my Astelin nasal spray yesterday and found out I didn't have any refills. I then called the doctor to get a refill and ended up having to go in for an annual physical...I suppose so they don't think I'm OD'ing on nasal spray.

I was in the room and she mentioned that it was time for a cholesterol test. ICK. More blood draws. Luckily it was only one tube and I actually made it through SITTING UP in the chair and no woozy feeling. That is two successful blood draws in two weeks!

I also got my flu shot yesterday...except I could get the nasal mist instead of the shot! I was pumped about that!

Along with these successes, yesterday was also a glorious occassion because I finally "settled" a insurance saga that began with a routine eye exam in JULY 2008.

My health insurance is VERY good given that I work for an academic medical center. The vision coverage is a little tricky, however, because the exam is covered by my health insurance and you can opt in to take on a supplemental vision insurance plan to cover either one pair of glasses or one pair of contacts per year. It also gets complicated by the fact that you have to go one place for the exam and ELSEWHERE if you need glasses. My first year working here I wanted to go to one place to get it all taken care of and I checked with my HR office AND my insurance before I went and they said it was fine - it would be covered. I got my exam and glasses and voila - had to pay out of pocket the $250 for the exam because in all actuality, the provider was NOT covered. I called both HR and my insurance back and they said, as you might expect, "too bad. so sad". Sigh.

So, I ended up going to an opthamologist here on last year. After my routine eye exam last year (which is suppossed to be covered by my health insurance), I received a $55 bill. Without inquiring WHY I had to pay $55, I gave them my supplemental vision insurance information, which paid it.

Then, because I get either one pair of glasses or contacts "free" from my supplemental vision insurance per year, I ordered glasses on 12/27/08. I didn't really NEED new glasses, but I figured since i had paid for the insurance all year, I might as well get a pair. On 1/10/09 I got a bill for $155 saying the insurance did not cover it. WTF. WELL, the $55 charge back in July 2008 was for a contacts fitting fee so my insurance assumed I had gotten contacts and therefore used up my one freebie per year. HOWEVER, I did NOT get contacts at the visit - it was an erroneous charge. I then had to call my eye doctor to get the charge dropped and have them refund the insurance company before the insurance company would pay for my glasses.

Most people would have just said screw it and paid the $155 bill.

NO NO NO. NOT ME.

I made countless phone calls and emails to the eye doctor billing office to get the the $55 refunded to my insurance company. Although the billing agent agreed that I was charged this fitting fee erroneously, I had to call her weekly for a period of four months until she actually sent the refund through in JULY 2009. ONE YEAR AFTER MY EXAM! Because this billing agent apparently never answers her phone, OR returns voicemails, I wasn't ever sure if the check had been cut so I also called my insurance company weekly to see if they had gotten the refund.

MEANWHILE, I was calling the place where I got my glasses promising that their $155 was on the way...

I thought this was all settled then last week I got another $155 bill for the freakin' glasses?! ARGH!!!!!!!!!!!!!!!!!

Yesterday I made ONE MORE phone call to the insurance woman who confirmed that they received the $55 in July and then sent the $155 to the glasses place on 8/13/09. I called them to confirm this and they received the $155. "The bill must have been sent in error".

And THAT ladies and gentleman, is how you handle having eye insurance these days.

This whole cycle almost started AGAIN when I received a bill after my July 2009 eye appointment for the EXACT SAME CONTACTS CHARGE! WTF? This time, though I knew enough to call and ask what I was getting charged for and they realized (again) that the charge was made in error.

My friend HC and I were recently talking about how we (she also works for the same place) have the most optimal insurance of anyone using this facility and if we have these kind of problems, what does that mean for everyone else?!

3 comments:

Holly said...

That's hilarious! Way to persevere!

Old MD Girl said...

FYI -- The whole annual physical is such a scam. There is nothing written anywhere that says it is necessary for a person our age, and in fact the NHS in the UK does not cover annual physicals.

Guidelines on cholesterol don't really exist either. They say once ever 5 years starting at 25, but there is no / scant evidence for this.

I hate primary care!

chacha said...

I have the same set up - eye exam through health insurance and other stuff through vision insurance. However, I don't wear glasses so I haven't had to deal with it yet - though my husband will next time he goes in with our new insurance.

I surprised they didn't ding your credit for having not paid the $155 for so long...