It's true. See what this "friend" wrote me some weeks ago:
Oh, so you're the guy who's driving up everyone's premiums with your insatiable demands for weekly colonoscopies.
Don't worry: the TMI in the full entry is about insurance companies, not what the doctors found.
Thanks to some medical history, my regular doctor and I had decided early this year that a colonoscopy was warranted at my tender age of 44. Not exactly fun, from everything I'd heard, but I'd rather have a day or two of inconvenience than colon cancer. So I [the details of the procedure have been redacted except for this completely accurate depiction by Dave Barry for reasons of national security; trust us on this one, you don't want to know—your neighborhood NSA guys]. No problem—benign! Okay, I'll have to return in a few years.
A few weeks later, I received an explanation-of-benefits sheet from my insurance company saying they had paid $mumbledy to the place where I got my colonoscopy. (By the way, did you know that March is Colonoscopy Awareness Month? I always wondered why that's the first half of the regular Florida legislative session.) Okay, I thought: that's the facility. What about the doctors?
No problem! A few weeks later I received another explanation-of-benefits sheet, with no payment to the GI. None. Zip. "You're too young to know," was the explanation at the bottom. No, it wasn't: they said that they wouldn't cover preventive colon care before I was 50. A few days later, another nonexplanation of nonpayment, this time to the anesthesiologist.
Puzzled, I called my insurer. "The diagnosis code does not fit with an allowable expense." I suspect the real explanation was three times as wordy and I have shortened it as a result of the lasting mental trauma I experienced. I explained: I've got a family history. "The diagnosis code does not fit with an allowable expense, and you've got an ugly nose, too." I explained: not only did I have a family history, but the GI removed a polyp. How could it be unnecessary if they found something? "The diagnosis code does not fit with an allowable expense, you've got an ugly nose, and your sister's one, too." I explained: not only did I have a family history and the GI removed a polyp, but the insurance company had paid for the facilities charge. "Oh, yeah, and see if your doctor can change the diagnosis code."
Well, that went over like a ton of Rush Limbaugh with the accounting department in the medical group. "So they're asking us to commit fraud?" was the response. We talked for a few minutes, commiserated, and then I sent in an appeal to the insurer. Triple-checked the right address.
And in a few weeks, regular as clockwork, the post office delivers a new explanation-of-benefits charge with a payment to the GI. Woohoo! Except not so fast! There's this small matter of the anesthesiologist, who for some strange reason had his own accounting department. (I'm beginning to think that this is the result of midlife crises for doctors. "What'd you get, a Porsche?" "No, an accounting department." "With racing trim?")
So I thought a bit and asked some friends: what is the rationale for an insurance company paying for a surgical procedure but not for the anesthesiology? That's like listening to Sean Hannity without earplugs or watching the Miami Heat sober. I called up the insurer (yet once more) and after a bunch of "get them to change the diagnosis code" calls and a few detours, the customer service rep put me on hold for, oh, 40 hours. Okay, about 40 minutes instead. And said that he'd fixed it. I obtained some critical details and then called up the anesthesiologist. I talked with the accounts receivable staff, commiserated, and then passed along every bit of information I could so she could file the second appeal. And now, finally, it's been repaid.
... but for a few salient facts, such as the time I spent resolving this, the time two doctors' offices spent, and the fact that I was able to appeal successfully because I know how to work a bureaucracy. And in a just world, you should not have to have a graduate degree and several books that touch on bureaucracies to have it all work out in the end.