Freakin’ Blue Shield, $*#%! health insurance!

Switched to Blue Shield after the hell known as Anthem/Blue Cross. It’s more affordable, better benefits, but do my problems end…????

HELL NO!

I’ve had a moderately crappy year as far as health goes, multiple colds, death in the family, assorted other life drainers. But all things considered I’ll concede the glass is half full right now. Anyway, went to my plan doctor a few times, routine office visits that cost me $30 copay. I get the claims from Blue Shield in the mail.

First visit billed $117, routine office, amount allowed = $65.18, Keith pays $30.

Second visit billed $117, routine office, amount allowed = $65.18, Keith pays $65.18.

Two virtually identical visits…so why am I paying $35.18 more for the second one?

I call Blue Shield, they tell me to talk to my doc about what medical codes were used in processing the visit. I call my doc, the phone lady tells me to call billing. I call billing, phone tag, then she tells me to call my insurance because both were billed as office visits.

I call Blue Shield again, the woman tells me to call the doctor about the medical codes. Through gritted teeth I tell her I called the doctor and they told me to call BLUE SHIELD. She says it’s illegal for her to tell me what medical codes were for these visits, so no discussion until I get those codes.

I call the doc back the next day…codes were mostly the same for both visits, though the higher priced visit has the code 780.50, sleep apnea. I wasn’t there for sleep apnea! But the phone lady tells me I don’t have to be there for sleep apnea to get the code, maybe something similar. Sigh.

Scream at the wall after hanging up.

Call back Blue Shield, get a much more helpful woman. One of the PRIMARY CODES (there’s more than one????) on that expensive visit triggered a mental health thing, which isn’t included as part of the routine office visit…it goes on the deductible.

And if you’re confused by any of this GOOD–welcome to my world!

So a routine office visit suddenly stops being routine when the doc labels me a mental health visitor. But he still charges me a normal office visit…BS sees what he coded me and decides my visit should go toward my deductible.

A simple code doubled the cost of my visit. No extra work, no extra labs or medicines. A simple difference in doctor/patient discussion doubles the cost.

The BS woman said I could call my doctor and ask to resubmit the claim with the codes reversed, so the mental health one would be secondary and the visit would be adjusted to $30. Tempting, though I’m probably making less than minimum wage, going through all this work to save thirty five bucks.

Health insurance = lawyers = used car salesman. Wait…I’d rather have the car salesman by my side in a Braveheart-styled battle.