Kate in the Middle

What Surprise Ailment We Feel after the Doctor Visit

Writer / Kate Rhoten

Healthcare is necessary, and while it may be a touchy subject among our peers, I’d like to share a little story about a recent experience that sheds light on the challenges faced by many. This isn’t about specific drugs or waiting lists; rather, it is about billing and doing right by the patient.

A few months ago, I needed to get a physical completed in order to receive Health Savings Account (HSA) funds. I reviewed the health insurance website and found what I thought would be a good doctor for our family. A call later, I made appointments for myself and my husband. The office required two appointments – one for an initial meeting to gather information followed by a second for the full physical appointment.

We arrived for the first appointment with everything ready to go. We were able to do a review of our medical history as well as a blood draw. It was routine, or so I thought. The necessary medical billing codes were provided to the physician assistant to make sure we would receive the HSA benefit.

We returned a couple of weeks later for the results of the blood work as well as the physical. This, too, was routine. We were pleased with our experience through this appointment. It wasn’t until later that we were introduced to what would be, at the time of writing, a three-month ordeal.

Despite our attempt to make this easy, it became anything but. Although we provided the billing codes, they were not used. We found out via our health insurance Explanation of Benefits documentation and statements from the office. It was annoying at first, but we thought it could be easily corrected.

We were wrong. Not only did we receive the EOBs with information not quite right for preventative care, but we were the lucky ones to find out that our blood work was sent to an out-of-network lab. Now, this really irked me. Why is it that the medical office cannot determine the correct lab to send our blood to in order to maintain the in-network cost?

Now we have a balance with the primary care physician and a lab. Adding insult to injury, we have asked for assistance to have the billing either adjusted and resubmitted or to offset the balance owed internally within the practice. This has been a never-ending saga that seems to be of no concern to the medical office.

The funny thing is they even ordered a test for the blood that is not considered part of the routine blood panel. Seriously, this is not okay. In essence, we may be at a point of having to pay $500 or more due to their ineptitude. We have continued to document and email, but we are not holding our breath.

This just happens to coincide with a news story I saw about an individual who was taken to the emergency room and ended up having surgery shortly after being examined. The unfortunate issue here was the fact that the anesthesiologist was not in-network. Even with our best intentions or in an emergency, you never know what will happen.

This experience has given me new insight into the difficulty of navigating the healthcare world. While I appreciate the fact that I am healthy and have good insurance, I have had a little taste of the frustration and lack of transparency that many experience on a regular basis.

We will not be going back to this particular practice. W, will be asking many questions before we begin with another, and we will conduct more research. After the fact, we found out others have had the same issues with the same practice.

With that being said, if you have healthcare, be thankful. But do your due diligence to be sure your records and billing are correct. Verify, verify, verify.