More Fun with Medical Bills (and the People Who Send Them)

A few more victories from this week's foray into my stack of medical bills and insurance statements:

• A bill for $87.90 for the balance due on my super-attractive lymphedema sleeve: My physical therapist had told me that the cost of the sleeve should be covered 100% under the terms of the Women's Health and Cancer Rights Act of 1998, so I was surprised to get a bill at all. The total cost of the sleeve was $293.00 (and no, it isn't trimmed in precious gems), so the insurance company had only paid 70% of the price. Which is, you know, less than 100%.
  
  So I call the insurance company. And the very nice guy who answered the phone tells me that the claim was paid at the out-of-network rate. I'm surprised to hear this, too, and think that perhaps lymphedema sleeves are so esoteric that there are very few manufacturers and that possibly none of them are in my network. And I float this theory by the very nice guy, who dismisses it—very nicely, of course—out of hand.
  
  So I ask him how I would go about finding an in-network provider, because I'm told that if I start having to wear the sleeve a lot (while I exercise, for example—which I aspire to do again someday), I should really get a second one and alternate between the two. So the nice guy does a quick search of his online directory, and he says, in a still-nice-but-sort-of-"told you so" kind of way, "There are 33 in-network providers in Brooklyn alone."
  
  But just when I'm starting to feel defeated, he makes the kind of noise you might make if you had accidentally inhaled a fly. Or if you had to retract your "told you so" tone of voice. Turns out that he was scanning the list of the 33 in-network providers in Brooklyn and discovered that my provider was on it. Hee hee hee. So now they're going to re-process the claim, which means that I will only be responsible for a $10.00 co-pay.
  
  Next!


• A bill for $500.00 for a surgical consultation: I called my insurance company, and they had just received the claim from the surgeon's office on Tuesday. (That would be the dreaded 6/6/06, but I'm not going to focus on that.) It'll take them 2-3 weeks to process the claim, so I can just sit tight for now.
  
  I love bills that translate to "We haven't been paid by your insurance company yet, so we're going to bill you in the hopes that you might actually send us a check more quickly than they will. But we promise that once we do get paid by your insurance company, we will make sure to reimburse you for any overpayment. And, in the meantime, we will not for one second enjoy earning interest on your money."


• A bill for $650.00 for a radiation oncology consultation: These folks submitted the claim to my old insurance company—the one I haven't been covered by since last August. Good thing Zach and I spent an eternity filling out new forms when we were there in January. Somehow, though, they had the information for my secondary insurance, which didn't kick in until January 1, so they must have looked at the forms long enough to get that right. In any event, they are now going to send the bill to the right place, after which I can submit any remaining balance to my secondary insurance. The way I calculate it, those two things alone mean I won't see a bill again until maybe sometime in August.


• A bill for $274.56 for the anesthesiologist who did such a heroic job during my port surgery: This bill was actually for $1,120.00—$274.56 is just the balance remaining after my primary insurance paid its share (or what it deemed to be its share). I called to find out whether the remainder had been submitted to my secondary insurance, and the friendly guy I spoke to said that the claim had actually been re-submitted to my primary insurance and was currently "in review." (That's code for "OK, we'll take another look at it because, yeah, we do screw things up a good percentage of the time, so you might get lucky this time around.") Once they hear back, they'll submit any remaining balance to my secondary insurance.
  
  OK, fair enough. But my favorite part of the conversation was when the friendly guy told me that I could have ignored the bill in the first place.
  
  "It's just computer-generated," he said. As if HAL had reanimated itself and started sending out rogue medical bills to unsuspecting cancer patients.
  
  Oooh—spooky.

So if you're still keeping track at home, that's $1,512.46 in bills that I received but did not, in fact, have to pay. (Of course, there's another $400.00 that I do have to pay, but still.)