Thursday, March 27, 2008

Okay, I'm up now, and I'm mad

I was just going through our mail and received an Explanation of (medical) Benefits statement from the insurance company. Or as I like to call it: an attempted explanation of how we decided to screw you this time. As usual, the "usual, customary and reasonable" rates for service is where they get you; that, and the deductible.

So here's the breakdown of what the doctor's office charged the insurance company:
$125 for the physician fee
$156 for ONE immunization
$32 for a second immunization
$20 for a third immunization

The insurance company wrote to tell me that they think my doctor's office overcharged me and they would pick up only about 40 percent of the bill. Oh, but since I've not met my deductible, they applied all of what they would have covered to that.

And I blame the doctors' offices, too. They know they're dealing with a third-party payer with deeper pockets than their patients. The insurance company low balls the doctor, the doctor high balls the insurance company and the consumer gets screwed. I hate going to see my doctors for this reason - weeks of surprises in my mailbox. It's probably all part of the insurers plan to lower costs.

I would be happier just paying the entire bill up front, filing a claim and taking whatever the insurer reimburses. At least, then I wouldn't have to do mental gymnastics every few months to figure out how much of a shaft I'm getting. Think of the time I'd be saving! (I could probably do my own pedicure and give myself a facial and get in a workout or two. HAHAHA ... workout, that's just crazy talk.)

But an idea did occur to me: If I knew the insurance company's "usual, customary and reasonable" rate schedule, then I could shop around for a doctor with rates that closely match that schedule. So tomorrow or maybe early next week, I'm going to call my doctors' offices and try to procure their fee schedule. Then I'll call my insurers to ask them for a list of their UCRs. Am I too optimistic thinking that my insurers and my doctors would just hand me a nice, neat list?

I'll keep (all five) of you posted.

2 comments:

maryellenlewis said...

Haha! I am still getting bills for doctors visits from June. I haven't even received the bill from Anna's birth yet.

Josee said...

I was getting bills from Dan's birth up until his first birthday. I finally just told them I wasn't paying them anymore money and they said, "Okay." Crazy.