One of the great benefits to hosting a blog on insurance matters is that, from time to time, we’re offered the opportunity to help folks out. I really do mean that: all four of us really do enjoy helping people solve their insurance problems [ed: well, it sure ain’t for the money!]. We aren’t always successful, as you’ll see in this instance; what we’d really like is for our readers to offer any suggestions (and/or relevant experiences they’ve had). This can be done via the comments section, or by email. And now, our letter from Bruce*:
[*All names have been changed to ensure privacy. Content was edited for brevity.]
“I'm going to have a stroke or massive heart attack while talking to a medical or insurance institution.
I recently had a physical exam. My chief complaint was constant fatigue. The doctor said my lab tests were fine; it was most probably sleep apnea and I should go get a test to confirm.
I begin to wonder what this will cost. The web has informed me that the "test" is to spend the night in the hospital while being filmed and wired to recording devices. Sounds expensive [and] I wonder what the insurance will pay. I plan to ask the insurance company (BCBS), but know from experience that they do not like this question. I resolve to get the CPT ( Diagnosis code) and ICD9 (treatment code) from the hospital; the charges are $139 for ½ hour visit with doctor before the test and $3000 for the test.
I now call BCBS. I explain that I am trying to find out what my cost would be for a medical procedure before I commit to having it. [I am told] that the information I am asking for does not exist. Oh sure it does; I have the ICD9 code for her. She then asks me what hospital I am going to [and] her the hospital’s financial payer code. I do not have the answer, [so] this ends the conversation.
I really want to know, so I call again. This time I get Marvi [who] listens to my explanation and question. She asks me to wait a moment, and then comes back on line to say the ICD9 code I have given is invalid. I repeat the number in case we got it wrong. She is sympathetic but we can go no further. I now have the information that the insurance will pay for 90% of the usual cost after I pay the deductible. But of course without the ICD9 code I cannot know the "usual cost". One would think that the sacred ICD9 codes would be freely available on the web. I use Google and to my surprise I find the code. It is 89.17.
Now for the diagnosis code (CPT). I learned in another life that the AMA copyrights them and all users must pay a fee to have them. All I want is to be a responsible citizen and keep my medical expenses to those that I consider worth the money. This is a completely discretionary expense. I have no desire to have medical expenses that I don't need."
And there matters stand. The four of us have noodled this, and have thus far determined the following (which we’ve shared with Bruce):
1) He should consult with his HR folks to see what (if any) help they can be in this. (As it turns out, he had not already done so)
2) Determine if he has access to a Flexible Spending Account (to help mitigate his actual out of pocket costs)
3) Go to the carriers website to see if there are any transparency tools available.
So there you have it, dear readers. Any other suggestions?