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.