Billing Errors and Support Groups

It’s a couple of weeks past the first mammogram, and the bills are starting to roll in.

The bill for the mammogram was $503.

This is with insurance.

When I was checking in at the imaging center, one of the questions was if I wanted a 3D mammogram. If so, it might or might not be anywhere from $75-$125 extra.

I don’t know what possessed me to check “yes”. I suppose it seemed like a good idea since I hadn’t had a mammogram since 2012. I wasn’t delaying the mammogram on purpose; I went back in 2013, but without insurance the pelvic was estimated at $800 plus then the mammogram.

So now I have insurance for the last several years. I couldn’t decide who I wanted to go to. I take a long time to make a decision. Work conditions and work load were such that any time away just made it worse when you returned. Processes were not in place to encourage women, the bulk of the work force, to take care of their health. It was like I had health insurance for emergencies. Have an appendectomy? You’re covered. Get hit by a car? No problem. Now if you are out with an emergency, someone will have to cover your work or it won’t get done. Wouldn’t it be a practical approach to assist your work force by planning in such a way as to provide time for maintenance care, not just emergencies? Either way, the workplace needs a backup plan.

I noticed a disclaimer printed on the bill that said my claim was rejected by my Blue Choice Medicaid.

Y’all? I don’t have Blue Choice Medicaid.

I work in an optical office. The doctor I work for gives eye exams. This is my first experience working in a medical office which accepts insurance. Our office accepts most insurances of major medical, plus Medicare, and Medicaid. The monkey wrench that gets thrown into the works is a thing called Vision Plans.

Ah, Vision Plans. Learning about that was an eye-opener to me because I’d never had a vision plan. Do you have a vision plan? Do you know who it is with? Most people don’t. They just know they have a vision plan. The most popular plans we see in this area are Eyemed, Spectera, and Vision Service Plan, but there are many, MANY more.

When many people make their appointments as a new patient, they don’t want to chat on the phone even though I need to gather critical information to complete their patient file. It’s not enough for them to give their name and contact information and to say that they will bring their insurance when they come to their appointment. I have to break it down for them: you tell me that you have a vision plan and I need to confirm that you are eligible. So simple, but people can’t be bothered, plus they think that we on the other side of the check-in desk have a magic button that we push to get the information about their vision plan. News flash – we don’t. It is your responsibility as the policy holder to know that information. In the time of COVID, I don’t want people hanging around the lobby filling out paperwork and answering questions. I want everything pre-addressed and all possible problems located before they even enter the building. This can be accomplished by telephone, email, and texting. Help me do my job efficiently. If I don’t gather this information until you come into the office and you are not eligible, suddenly you are mad at me for not trouble-shooting the situation. Your time is wasted. My time is not wasted because I now have the information that I needed and I can take care of you better. Some people are old school and want to do all their dealings in person, but times have changed.

Some of the vision plans have been sold to other companies causing further complications in locating them. You used to have Davis with was sold so now you have to go to the new parent company to access that information. Or let’s say they used to have Guardian or Superior but it might now be with Versant, but don’t forget to check VSP. It’s so ridiculously complicated that I made my own spreadsheet with user names, passwords, and links to websites.

Then there’s Medicaid. When you have Medicaid, it could be any number of plans, and we don’t accept all of them, so we need to know what form you have. If we don’t accept it, you are going to get a bill. You don’t want to get a bill.

So even though I have presented my information on the phone and in person at the imaging office, they still got it wrong. I’m not mad because I get it. Blue Cross Blue Shield is a popular insurance, but a lot of other plans piggy-back their names so they sound similar, like “Blue something or other”, plus some of the Medicaid plans have the word “Blue” in them. So if you are working the accounts and you enter the word “Blue”, you will get a long list of choices. You could possibly think that you are clicking on one and accidentally click on another.

It’s complicated and stressful for everyone.

So I called the number on the bill and talked to a nice lady name Krista to tell her that I have gotten a rejected bill and don’t have Blue Choice Medicaid. She noted right away that they needed to correct the insurance, which she did, and said that they would rebill.

However, this doesn’t feel good that the first bill was handled incorrectly, because I’m sure there will be many more of those to hit my mailbox.

*****

I joined a FB support group for women with DCIS. So many of those people are having single and double mastectomies, radiation, and hormone-suppressing medications. It was a sudden reality check with a steep learning curve.

I started practicing sleeping on my back because if you have a mastectomy, you can’t sleep on your sides. I bought special post-surgical bras for compression to help eliminate fluid build-up. I learned that DCIS is considered stage zero because it is self-contained in the ducts, but if it escapes the ducts, it is considered invasive. Some health professionals consider it pre-cancer, but the word “Carcinoma” is still in the description, and that is a sore point for the people that actually have DCIS. I learned that some of the women are having reconstruction after mastectomy, and if they don’t have enough skin left after mastectomy that skin from other parts of their bodies are harvested to use for reconstruction, and they might be getting implants or expanders.

I don’t even know what else I don’t know, but let’s roll forward.

Tags: DCIS