‘Revenue-enhancing’ has become a dirty word

DO YOU KNOW WHAT YOU SIGNED AND WHAT IT OBLIGATES YOU TO?

Even if you have insurance!

It didn’t used to be like this, and I’m sure they have plenty of good reasons, probably having to do with nitpicking by insurance companies, but I’m getting really tired of getting lied to, and having to be on my guard all the time for every little thing when I go to the office of some medical professionals.

I don’t want to name names, as I suspect it’s widespread, but I’m finding that I can’t get out of a medical/dental office without little enhancements  to the experience being offered as if they were included, or as ‘covered by insurance, so don’t worry about the cost,’ and when I check turn out to be covered – yes, but at 50%. Or with a ‘credit toward’ some expense which is entirely optional.

Or in the case of one practitioner, when he informed us that our insurance allowed us the reduced cost which had been negotiated by the insurance company – they didn’t actually pay him anything! I felt cheapened by the experience (which was expensive), and wondered whether I was supposed to be offering him his full price!

The lists of what isn’t covered can depend on whether someone entirely separate from you has called this (whatever it is) by one name or a different name, such as people being warned lately that a hospital admission (going in and staying over night) is not necessarily a ‘hospital admission,’ covered by insurance!

It wouldn’t be my problem, except that these little untruths are destined to cost ME big money, if not just time and effort. And hours on the phone to attempt to straighten out with person after person on the phone in ‘billing.’

Is it necessary – and if so, why isn’t it covered?

I depend on my insurance company to, in some sense, control the costs of medical procedures, which, having written this, may be the problem.

But I can’t change the contract negotiated between whoever is paying for the medical insurance and whoever is paying the providers of medical services by one iota.

I don’t expect to hear, from an insurance company, “doctors recommend this as completely necessary, but we won’t pay for it.”

Also, I don’t actually hear from a provider, “this is absolutely recommended, but insurance won’t pay for it.”

Instead, I will turn up at an appointment for a covered service, and find I have to see the billing person first, because I have a HUGE ‘copay.’ At which point my choices are to leave, or to pay for a bill I wasn’t expecting. For a service the doctor says is entirely optional – but necessary.

The result? Constant vigilance is required.

And I can’t go to one of these visits and deal with something that pops up on the spot (there is a small additional charge for X because insurance doesn’t cover it) – done in such a way that you are a cheapskate if you don’t get the extra candy-flavored teeth protection for your growing offspring.

Or you have to respond to the eye doctor’s in-house glasses representative that yes, you know the frames available at Retailer-X are cheap – and that you don’t care.

You can’t get home, as I did today, and find out that the service you received as ‘it’s time for your X-rays’ is only covered by your insurer every 60 months. And you didn’t ask, because you assumed that was their job.

Am I exaggerating?

I think not. This has happened in at least five different places and kinds of medical services in the past six months.

And even the blood tests are done by a place which hands you a form that says ‘Medicare may not pay for these services’ and requires that you sign that YOU will pay for them if Medicare rejects something – the doctor ordered!

Every time you decide you’re not going to take the risk, you end up spending gobs MORE time there, and may have to fast all night again if your doctor’s office doesn’t happen to be open that early on the day you went in.

Because, ultimately, the buck stops with you, and this stuff is unbelievably expensive (when billed at full rates), and they will send bill collectors after you.

So it’s important, you have little control, you can prepare for one thing and be bowled over by something else completely without realizing it, and every single thing will cause you stress, time, and energy.

I wonder how the older folk cope?

Has this bitten you?

 

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5 thoughts on “‘Revenue-enhancing’ has become a dirty word

    1. Alicia Butcher Ehrhardt Post author

      Spent over an hour on the phone yesterday (or was it the day before?), and a while today. Fortunately, my health insurance is through Princeton U., and their HR department puts up with no nonsense from the drug and insurance companies (big client). Woman there understood immediately what the problem was, and is taking care of it completely for me.

      Also, and this was new, she asked MY permission to listen the the phone calls which gave me the runaround – so she can fix the problem for the future!

      Liked by 2 people

      Reply
  1. joey

    I see this mostly in my job, and yes, mostly to older folks, but I’ve been bitten a few times myself. Like lab fees? Why is it okay for the dr to biopsy, that’s covered, but I have to pay out of pocket to have the results determined? How cray-cray is that?
    My favorite is dentists. They send a special finance person in to explain costs and percentages and deductibles, and I can’t make sense of a single thing they say, really, so I ask for the bottom line and tax, thank you very much. And of course, they get me with the free cleaning and x-rays for the whole family, but insurance will pay for sealants on kids ONLY under 14, and somehow that seems wrong. What the hell happens at 14?!?
    I buy from the eye doctor, but then order the second pair online, cheap, cheap, cheap. And sometimes they don’t want to give you the pupillary distance, cause they don’t want you buying elsewhere, and I have, twice, been downright mean about it. Five of six of us wear glasses, so unless eye doctor’s buyin, I’ll be online with the cheap, cheap, cheap! Ugh.
    I’ve had a lot of different insurance policies in my life, and they’re all the devil, except maybe TriCare, which pays for just about everything, but you may have to do it in a military hospital. LOL Ugh.
    Socialized healthcare or GTFO, but that’s what all the Socialists like me say…

    Like

    Reply
    1. Alicia Butcher Ehrhardt Post author

      The problems I see with socialized medicine (they need to be addressed, not that they are something that should stop us): the waits – no need to buy the newest MRI machine, and you can wait a year for an optional one; and the fact that once healthcare is a single line-item in the budget, it is EASY to slash it.

      And it sometimes doesn’t want to cover the rare cases.

      Other than that, we need SOMETHING – because we’re paying for it anyway, or our families are going without.

      As for dental sealants, I remember taking our kids to a clinic at a university where the dental hygiene students did them – under the watchful eye of an instructor – for very reasonable prices.

      I think at 14 kids are considered capable of cleaning their own teeth properly (have they ever had teenagers???).

      Liked by 1 person

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