Thursday, November 5, 2009

Seeing Red

Unusual subject for my daily shopping trip, you're probably saying... and I agree, but unfortunately that is exactly what I'm doing right now... seeing red. Yes, this is partially a rant. To make a long story relatively short, I had to go for some medical tests today that are technically surgical procedures but they are done by a technician rather than a dr, at the dr's office. Now, according to my benefit plan booklet, such services are not subject to a copay and since my out of pocket for the year has been met, the procedure should be covered by my insurance at 100%.

Once I arrived at the office, the front office girl checking me in asked for a copay so I asked if I was seeing the dr or a nurse practitioner, because I hadn't been informed that I was. She politely said no, so I asked why a copay was expected... to which she politely said "We have to charge you a copay for the visit"... to which I politely replied (based on my former life background as a medical coder and medical insurance business analyst) - "There is no visit - a technician is doing the test and I'll be seeing the dr on Monday for the results. That will be a visit and I'll be happy to pay a copay then." (I had already had one visit earlier this week - also with a copay.) I was then told that I had to pay the copay or they wouldn't do the test.

Two hours later, a lot grumpier from the pain, and $30 poorer, I was on the phone with our health insurance carrier, clarifying my benefits. I was told that if the provider billed for an office visit and if creative coding was done so that the visit wouldn't be bundled into the procedure (as it would rightfully be if it had actually occurred), I would be charged a copay... my only recourse would be to dispute that no office visit occurred -after the claim was paid. What frustrates me is that 1) no services were performed today that required a copay; 2) the medical community purposefully forces us to make multiple appointments to simply collect additional (and in this case, bogus) copays that the average person would never think of questioning, and 3) because it appears if some really squirrelly billing may be being done, I'm going to have to jump through hoops to prove my case to get that copay back. What irritates me even more is that this will be about the 5th time in the past couple of years that I've had to fight with our insurance plan over miscoded and mispaid claims. In one case, the plan paid out thousands of dollars that they shouldn't have because a dr checked the wrong box on a form. And we wonder why healthcare in the US is such a mess. I just e-mailed a couple of old friends who are still in the industry to verify my stand on this whole thing (although I couldn't find any industry coding changes in my research), but for now, yes, I am seeing red!

I hope you'll agree that some of these items I tracked down on Etsy (which coincidentally, are all titled "Seeing Red") are really gorgeous and definitely went a great way in changing my "seeing red" mood to a more positive mood - cuz they did!

If you guessed that I probably went through all of these eye expressions at some point today - I think you'd probably be right! Scared the crap out my hubby - The Great WOO was like "Whoaaaa" - he'd never seen ALL of the eye expressions in a single 24 hour period, much less at the same time! He's recovering well tho :) This fun and funky Seeing Red mini pillow from pearldragon is just too cute!

Cardinals are a long time favorite of mine - but if you've been following my blog for awhile, you probably already know that! So when I ran across this beautiful painting Seeing Red by deck on Etsy, I knew I just had to include it in today's post. Isn't it gorgeous!?!

I used to love to play bunco when I was younger - I think I may try to find a new group to play it with in the near future. It's a simple but fun dice game, and kicking back for some bunco fun and sharing some wine with friends would be even more fun with these Seeing Red...2-sided BUNCO wine charms from stewartathome. Before you start wondering why only 5 die sides are showing, the reverse sides spell out B-U-N-C-O !

Admittedly a little more relaxed now that I've shared my great finds with you, I need to get to work on a couple of photo shoots for some new listings I need to get up tomorrow! Hope your Thursday was a great one and that this leaves you seeing red in a great way!


Splendid Little Stars said...

Well said!!! ripping my hair out, too! Today, I was dealing with some of my mother's medical bills--both with the providers and the insurance company. AARRRGGHHH! Whenever I feel like torturing myself, I simply work on this for a while. After I get a roaring headache I'm allowed to stop for a while.
On a happier note, your reds are great! I play Bunco every month with my neighbors. We have a fabulous time!

Howling Caterpillars said...

How very true, Mystic...
I feel your pain...
All of my forms say that I'm there for a MVA...of course that was a YEAR ago and they don't change it...pfft.

On a much lighter note, the eye pillow made me LOL and I LOVE Cardinals. Have them on the feeders alot.

Priscila said...

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If you would like come check out my blog and enter my current giveaway at
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Shrimp Salad Circus said...

Ugh - my sympathies. I spent over an hour on the phone yesterday 'clarifying' an insurance claim as well. I feel your pain!

Very Verdant said...

I am glad you were able to see red in a lighter way. Thanks for sharing these great finds and here's hoping your medical (billing) issues are taken care of quickly! What a pain!

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