Insurance companies…

I just got off of the phone with Care First.  A few days ago John had received a bill from Dr. DeMuth’s office that was for a dollar amount of forty some dollars.  We had paid the co-pay and we had been told that our insurance would be accepted there, so I wondered what the issue was.  Part of me said don’t bother with it… you’re not responsible.  Part of me wanted to know and I’ve been a patient of Dr. DeMuth before and wanted to make sure everything was kosher, so to speak.

Then today, I got a bill from the CFCRS ambulance ride.  It had claim denied printed on it.

So, I picked up the phone and made a call to Care First.

It turns out that Dr. DeMuth’s office was billed out of network instead of in network.  Care First’s error.  They’ll re-process it.

For the Ambulance ride they paid at 100%.  I made a comment to her that perhaps they Care First underpays for ambulance services.  She acted like I didn’t understand what I was saying.

So, I told her… John & I used to always comment that it would be lovely to be an insurance company. You go to the grocery store and they say the total is $200 and you say, you’re only getting $150 and they bag your groceries.

She laughed and said, I wish that worked for me.

While I’m on the topic of insurance companies…John had had PT/CAT scans done at a PET/CT Imaging place in White Marsh and at Christiana Hospital.  John showed me the statements from Care First.  They paid Christiana Hospital more money than they paid the imaging place.  It seemed discriminatory to me.  Why would two places doing the same scans get different payments… wouldn’t it be one price for the same scan irregardless of where you got it done.  The hospital charged more for the scan than the imaging place did.

It could be that they pay a percentage and so you get paid more if you ask for more.  It could be that hospitals get paid at a higher rate than imaging companies.  It could be that Delaware  gets paid more for the scan than Maryland.  Maybe the hospital has a more advanced machine and gets more.

I don’t know… but we looked at it as if… why aren’t both places getting paid the same amount for the same service.

I guess I’m just a little frustrated… it will almost be six months and they don’t have bills straightened out yet… seems a little ridiculous if you ask me… collection calls are a different ball of wax compared to the initial bills for services in JULY.  It also means if they don’t get things straightened out then I may be taking collection calls into next July…

The lady at care first also never even stated her condolences.  I told her that it would be nice if when somebody called and said they were calling about their husband’s account… he passed away in July, it would be nice if condolences were expressed.  She said, “I’m sorry, my condolences.”  And then continued with her emotionless call.  At work we try to add a personal touch to calls and express empathy when a customer has a loss… I guess I forget that all people who take customer service calls don’t work the way we do.