Wednesday, September 28, 2005

Evil Part 2, Spittin' Venom

Another current issue with money causing problems is more personal, and it's actually got me so angry that I'm spittin' venom. As I referred to in a previous post I'm having a dispute with a doctor's office over a bill in which they are refusing to give me the negoiated discounted fee that they have under their contract with the PPO in association with my insurance company. Because we are self-employed we have to carry a high deductible policy to be able to afford health insurance at all. What's the point in paying for insurance and going to an 'in network' office if they aren't honoring their contracted discounts? I've been on the phone all morning with a nice lady from the PPO who is trying to 'close the case' and make me agree that the problem lies with the insurance company. She's just trying to get through her day with a minimum of upset, and I can understand that. But the problem is not with the insurance company except that perhaps their statements are misleading and erroneous in saying that I'm only responsible for the discounted price.

Part of the problem is that under our policy 'routine' care like physicals and yearly female exams and immunizations are 'not covered'. However, I have yet to find it written in any of my materials that 'not covered' means 'no discount'. So what if my yearly exam doesn't get applied to my deductible and out-of-pocket limits? That's all that 'not covered' means. Generations Ob-Gyn is the only doctor's office I deal with that is taking that to mean that they don't have to honor the discount in their contract with the PPO. My kids' pediatrician's office doesn't charge us the non-discounted price for their immunizations and physicals. They give us the discounted fee because they are in the PPO network. Our 'regular' doctor doesn't charge us the non-discounted fee for 'non covered' tests and visits. They apply the negotiated discount to all of our fees. I've only had this problem with this particular office. I think they are very greedy and opportunistic.

It seems that the root of this problem could be that these huge medical practices hire 'medical management companies' to run their offices. These management companies promise the doctors that they will take care of all their billing, etc., relieve stress about the financial end of things, and increase profits. Hmmm, how do you squeeze more money out of people? One way is to bend and stretch the rules and maybe even break them. Hey, look how big this practice is. What are the chances of someone making a fuss over $49.50? Even if one person does, if five others don't then we've made an extra $247.50. And if anyone does make a fuss then we'll just treat them like shit and they'll go away and we won't have to worry about them anymore. And that's one more space for another sucker!

I really hate that this has come down to a dispute over a piddly $49.50. I could write that check and send it. It won't break my bank, not today anyway. And I could continue to give my business to an office I have absolutely no respect for. I love my obgyn doc. He's very kind. I've been going to him for over 10 years, and he's very familiar with my unusually complicated obgyn history. Honestly, there have been times when we could have pursued malpractice settlements over my child-birthing and hysterectomy experiences. People have sued over lesser things than what I went through. But we didn't because we aren't greedy and opportunistic and don't believe in suing over every possible thing. Maybe that makes me a sucker. I just accepted what happened as the hand I was dealt and moved on. Were the doctors incompetent? Maybe they were. I don't know. We're all human and make mistakes and have bad days. But I definitely won't be going back to that office even if they resolve this issue in my favor. If they'd just drop all the crap then they wouldn't have to deal with me ever again.

I've also been in contact with the State of Tennessee Department of Commerce and Insurance, and one of the Insurance Investigators has recommended that I file a formal complaint with Consumer Affairs.

4 comments:

DHammett said...

You may want to speak direcctly with your doc about this issue. If you really love having him take care of you, you're probably not alone. You'd be doing him a favor, as well as his other patients, not to mention you may get your issue resolved.

In any event, I think making him aware of the problem is a positive. There's a pretty good possibility that he doesn't know about it. He's certainly not going to want to lose patients, especially those with whom he's familiar and has some history. And for him to think that your pretty, er, face will be walking out, never to return...

Rae Ann said...

*blushing* Uh, and speechless too. lol

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