Right now I feel like God does not love me anymore because I just was nasty to the nurse at Christie clinic. She called to tell me that Dr. B will not change the code on the General Health Panel blood test to diagnostic, because it was not diagnostic.
When I call them, I pray before I call, and try to remember who I am in Christ and be filled with the peace of the Holy Spirit, because I know that these conversations are dangerous battlegrounds for my soul. But when they call me, I don't have time for all that preparation. I just have to pick up the phone and hope.
I had appealed for the change because the last time I spoke with BCBS they said that the GHP is not routinely covered with physicals and is not deemed medically necessary as a preventative test, and can only be covered if it is diagnostic. This is the opposite of what Andrea at BCBS told me in June--she told me it would be covered under my preventative care if it were coded correctly--but whatever. They change their story every time I talk to them.
My rheumatologist (KS, NP) wanted the same panel run, and I was (ironically) trying to save money by only running it once and sharing the results between the two doctors. Dr. B told me that it would be covered as part of my preventative care (in full) so I thought it would be advantageous to have that particular test run through her and shared with KS, rather than the other way around. I filled out a bunch of paperwork to be sure that KS would get the results, but I am not sure whether she ever did, and she had not received them by the time of my appointment with her, and she was annoyed about that, and although she maintained her composure and was polite, it was an uncomfortable experience for me.
Yes. Apparently this was not the advantageous way to go. At all.
...Even though I was assessed an extra charge for the actual physical as well, because during the appointment we talked about lupus and reflux, according to the insurance company, who was looking at the diagnosis line on the paperwork.
So I asked Dr. B (submitted an appeal) to change the code on the GHP to diagnostic and connect it to the lupus so I could at least get it covered at 80%. Heck. I'm already paying $127 for uttering the word lupus in her stinking office. Dr. B says that changing the code would be unethical, reports her nurse. Dr. B says we only discussed reflux and not lupus.
I finally lost it and, practically in tears, told the nurse, "Look, I don't know what is covered and what is not covered, or how anything is coded, or what the codes are. Somebody told me it was coded as diagnostic and needed to be changed to preventative, and somebody else told me it was coded as preventative and needs to be changed to diagnostic, and meanwhile I never see anything. I'm helpless to do anything for myself. I'm flying blind. All I see is a bill for $305.00 that I was told would be covered, but now am being told is not, except it would have been covered at 80% if I had just had my rheumatologist run the lab instead of you. You know what? I have lupus. And you know what else? Lupus is triggered by stress. You know what gives me stress? Going to the doctor gives me stress. And getting bills gives me stress. Having the coverage of those bills denied by insurance, that gives me tons of stress. So I guess I will just stop going to the doctor, and maybe I'll just die. And then I won't have any stress any more."
She was silent for a moment and then she said, "I can see why you would be upset. I wish I could do something to help you." But she didn't say it compassionately. She said it in that flat way that says, "It would be nice if I could do something to help you but I can't." Perhaps she was reading off a card topped with the heading, "What to say if the patient brings up death."
So I replied to her, very brightly, "Yes, well apparently you can't help me. So. You have a good day now, but I probably won't. Good-bye." And then I hung up, because I was sick of her legalistic unhelpfulness.
And now I feel guilty.
I just hate this. Hate this. I cannot tell you how much I hate this.
Friday, August 5, 2016
Tuesday, April 5, 2016
Medical bills
With lupus, they want to test your blood and urine every 3-4 months.
I've had microscopic blood in my urine for the last four tests or so now, maybe five or six, well over a year. They call it microscopic hematuria. They said I had to get it checked out. I put it off for months, but finally moved to have the tests done because of significant pain in my lower back. I had to have a cystoscopy and a kidney CT scan with an IV dye.
There is still blood in my urine. The tests turned up no results. With my deductible and after insurance "negotiated down" the rate for the cystoscopy, I owed something like $800 for that.
But the CT scan. Oh the CT scan. The insurance denied the CT scan. So I have a bill for $7550.15 staring me in the face. That would be $7550.15 that insurance refuses even to apply to my deductible. Just a pure, straight $7550.15 out of my pocket.
They said, "This is not covered under the preventative care covered by your plan." They said, "It was coded in with a code that indicates that it is preventative care."
Seriously. Who would ever, ever go to a urologist and have a kidney CT scan with dye for purely preventative reasons? How? When? Ever? Why does such a code even exist in the world?
So I called the insurance company. They said, "They put it in under the code Z0000. That is a preventative code. They have to change it, but when they do, it should be covered."
So I called the doctor's office. I told them what the insurance company said. The receptionist told me, "We got pre auth for you as a courtesy. This is not our responsibility. If their code doesn't work, it is not our problem. We put in a good code. You are still responsible for the bill." I tried to explain that she needed to find a different code. She ratcheted up her voice a notch and said, "You are responsible for your bill!"
I tried emailing the doctor. A nurse called me back. She said, "No. We submitted the claim with the diagnosis of microscopic hematuria. They denied the claim because the test returned a negative result."
My heart is pounding in my chest. I hope you can see some of my dilemmas here, because I don't want to dwell on this frustrating situation to the point of pointing out every ridiculous thing that is happening.
The nurse told me she would try to change a code and resubmit the claim.
I waited.
Today I got another bill. Still looking at $7550.15.
I called the insurance company again. The man told me that the code Z0000 is wrong. I replied, "Yes. I have been told that. Can you please tell me what the correct code would be?" He said, "No. I cannot tell you how to process a claim. It is against our policy to tell you how to process a claim." Of course it is. Of course. He was not unkind. He was not rude. But he was supremely unhelpful. I told him that the nurse had told me that the claim was refused because the test came back negative. He said, "I'm afraid she is giving you bad information. That is not correct."
I called the medical billing customer service. The lady there was nice and told me, "Oh yes. We've been having a lot of trouble with those Z codes. The insurance companies don't like them. I'll put a note on your bill."
I have faith. There is a God in heaven and He loves me. This will eventually be worked out. Somebody, some day, will find and enter the correct code. The insurance company will negotiate down the charge, and we will pay most of the negotiated bill, but we may reach the end of our deductible, so the last $432 or so might be covered at 80%, which is what our plan covers after deductible. I believe that this will happen and that it will eventually be mostly okay.
But.
I am not going to have any more tests. I am just going to wait until my body is rotting and decomposing and then I will ask for palliative care, pain killers.
I will not have any more tests, because I sincerely believe that the stress of the tests and the exceedingly great stress of trying to deal with insurance and billing after the tests, is certain to shorten my life on its own. One of the keys to dealing with lupus is to reduce stress. I can reduce my stress a lot if I have less medical tests, and especially less medical bills.
If only I didn't have to go to the doctor to get my hydroxychloroquine prescription. Because every time I go, they order more tests. I could lie and say I feel fine. I did that once, in the past, before the lupus was diagnosed. I just went in and lied, and it worked great--a wonderful respite from testing!--until I got too sick to function. You see, if you lie and say you feel fine, they won't give you your medicine.
I'll go back to the hospital when it's time for morphine.
I've had microscopic blood in my urine for the last four tests or so now, maybe five or six, well over a year. They call it microscopic hematuria. They said I had to get it checked out. I put it off for months, but finally moved to have the tests done because of significant pain in my lower back. I had to have a cystoscopy and a kidney CT scan with an IV dye.
There is still blood in my urine. The tests turned up no results. With my deductible and after insurance "negotiated down" the rate for the cystoscopy, I owed something like $800 for that.
But the CT scan. Oh the CT scan. The insurance denied the CT scan. So I have a bill for $7550.15 staring me in the face. That would be $7550.15 that insurance refuses even to apply to my deductible. Just a pure, straight $7550.15 out of my pocket.
They said, "This is not covered under the preventative care covered by your plan." They said, "It was coded in with a code that indicates that it is preventative care."
Seriously. Who would ever, ever go to a urologist and have a kidney CT scan with dye for purely preventative reasons? How? When? Ever? Why does such a code even exist in the world?
So I called the insurance company. They said, "They put it in under the code Z0000. That is a preventative code. They have to change it, but when they do, it should be covered."
So I called the doctor's office. I told them what the insurance company said. The receptionist told me, "We got pre auth for you as a courtesy. This is not our responsibility. If their code doesn't work, it is not our problem. We put in a good code. You are still responsible for the bill." I tried to explain that she needed to find a different code. She ratcheted up her voice a notch and said, "You are responsible for your bill!"
I tried emailing the doctor. A nurse called me back. She said, "No. We submitted the claim with the diagnosis of microscopic hematuria. They denied the claim because the test returned a negative result."
My heart is pounding in my chest. I hope you can see some of my dilemmas here, because I don't want to dwell on this frustrating situation to the point of pointing out every ridiculous thing that is happening.
The nurse told me she would try to change a code and resubmit the claim.
I waited.
Today I got another bill. Still looking at $7550.15.
I called the insurance company again. The man told me that the code Z0000 is wrong. I replied, "Yes. I have been told that. Can you please tell me what the correct code would be?" He said, "No. I cannot tell you how to process a claim. It is against our policy to tell you how to process a claim." Of course it is. Of course. He was not unkind. He was not rude. But he was supremely unhelpful. I told him that the nurse had told me that the claim was refused because the test came back negative. He said, "I'm afraid she is giving you bad information. That is not correct."
I called the medical billing customer service. The lady there was nice and told me, "Oh yes. We've been having a lot of trouble with those Z codes. The insurance companies don't like them. I'll put a note on your bill."
I have faith. There is a God in heaven and He loves me. This will eventually be worked out. Somebody, some day, will find and enter the correct code. The insurance company will negotiate down the charge, and we will pay most of the negotiated bill, but we may reach the end of our deductible, so the last $432 or so might be covered at 80%, which is what our plan covers after deductible. I believe that this will happen and that it will eventually be mostly okay.
But.
I am not going to have any more tests. I am just going to wait until my body is rotting and decomposing and then I will ask for palliative care, pain killers.
I will not have any more tests, because I sincerely believe that the stress of the tests and the exceedingly great stress of trying to deal with insurance and billing after the tests, is certain to shorten my life on its own. One of the keys to dealing with lupus is to reduce stress. I can reduce my stress a lot if I have less medical tests, and especially less medical bills.
If only I didn't have to go to the doctor to get my hydroxychloroquine prescription. Because every time I go, they order more tests. I could lie and say I feel fine. I did that once, in the past, before the lupus was diagnosed. I just went in and lied, and it worked great--a wonderful respite from testing!--until I got too sick to function. You see, if you lie and say you feel fine, they won't give you your medicine.
I'll go back to the hospital when it's time for morphine.
Wednesday, February 10, 2016
Trucking on with lupus
Finally I had the cystoscopy and the kidney CT scan done. It's a relief to have them over with.
I don't like the IV injection of dye that goes with the CT scan. It's a gross sensation, and my kidneys hurt for a couple of days afterwards. I'd not had that pain before, and wasn't expecting it. I was afraid it might mean that there was something wrong, but it didn't. Everything was fine. I guess having some pain like that helps you be extra grateful for a report of good results, and assuages the irritation of having to pay for a test that probably could have been skipped.
I hate cystoscopies. But this one was fast, over so quickly, I almost wondered if the doctor could have seen what he needed to see. I am not complaining, as long as I don't have to go back. He said it looked good. He said that the kidneys are a filter, and as we age, filters have some backwash, and microscopic blood in my urine is no big deal. This is not quite as comforting to me as it probably ought to be, but it is what it is.
So the next thing to work on will be my eyes, which are troubling me. I put this off because I needed to get through the urology stuff, and also because I think I might have a routine ophthalmology appointment coming up, which would enable me not to have to worry about whether it is authorized by insurance.
In the middle of this, I'm still trying to get this house sort of decorated, or at least undoing some of the decorating that was here and is not according to my style.
I need to call a contractor to discuss tiling some bathroom floors.
Our master bathroom has a very cheap vinyl plank flooring right now, that Shawn and I put in when we tore out the carpet, as a stop-gap until we could figure out what to do. Confession: it isn't very pretty, but I like it. It's comfortable. I know how frigid tile is going to be, once it is installed. I am totally conflicted about this. Here we are in this pretty-nice house, with a totally campy bathroom floor, and because comfort always trumps aesthetics for me, I am at a total loss to make a decision.
I also have paint swatches all over the kitchen table. The peachy beige in the main front hall is just not right. Yet, I don't think I really care enough to change it. I don't like it, but I don't really care. It is so not important to me. And yet, I think, if we have to sell this house, we will have to fix that color. And then I think, if we are going to eventually need to invest in fixing it, it would be nice to fix it in time to enjoy it. But then again, I don't care enough to make a decision and move forward.
And, of course, there is balancing medical bills with home improvement bills. Medical bills always win, unless I can get out of the tests in the first place.
Sometimes I think I am going blind, and I wonder how I will feel about home decorating when I can't see anything at all.
It looks like we might get to go to the Redwood Forests this summer, sometime. Shawn used to say he didn't want to take me because he feared that once I'd satisfied that heart's desire, I'd just up and die on him. I'll try not to.
I don't like the IV injection of dye that goes with the CT scan. It's a gross sensation, and my kidneys hurt for a couple of days afterwards. I'd not had that pain before, and wasn't expecting it. I was afraid it might mean that there was something wrong, but it didn't. Everything was fine. I guess having some pain like that helps you be extra grateful for a report of good results, and assuages the irritation of having to pay for a test that probably could have been skipped.
I hate cystoscopies. But this one was fast, over so quickly, I almost wondered if the doctor could have seen what he needed to see. I am not complaining, as long as I don't have to go back. He said it looked good. He said that the kidneys are a filter, and as we age, filters have some backwash, and microscopic blood in my urine is no big deal. This is not quite as comforting to me as it probably ought to be, but it is what it is.
So the next thing to work on will be my eyes, which are troubling me. I put this off because I needed to get through the urology stuff, and also because I think I might have a routine ophthalmology appointment coming up, which would enable me not to have to worry about whether it is authorized by insurance.
In the middle of this, I'm still trying to get this house sort of decorated, or at least undoing some of the decorating that was here and is not according to my style.
I need to call a contractor to discuss tiling some bathroom floors.
Our master bathroom has a very cheap vinyl plank flooring right now, that Shawn and I put in when we tore out the carpet, as a stop-gap until we could figure out what to do. Confession: it isn't very pretty, but I like it. It's comfortable. I know how frigid tile is going to be, once it is installed. I am totally conflicted about this. Here we are in this pretty-nice house, with a totally campy bathroom floor, and because comfort always trumps aesthetics for me, I am at a total loss to make a decision.
I also have paint swatches all over the kitchen table. The peachy beige in the main front hall is just not right. Yet, I don't think I really care enough to change it. I don't like it, but I don't really care. It is so not important to me. And yet, I think, if we have to sell this house, we will have to fix that color. And then I think, if we are going to eventually need to invest in fixing it, it would be nice to fix it in time to enjoy it. But then again, I don't care enough to make a decision and move forward.
And, of course, there is balancing medical bills with home improvement bills. Medical bills always win, unless I can get out of the tests in the first place.
Sometimes I think I am going blind, and I wonder how I will feel about home decorating when I can't see anything at all.
It looks like we might get to go to the Redwood Forests this summer, sometime. Shawn used to say he didn't want to take me because he feared that once I'd satisfied that heart's desire, I'd just up and die on him. I'll try not to.
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