27 March 2010

Gatekeepers, Part II

So on Friday, I took my daughter to her two-month well-baby exam. And all went wonderfully with that. She's big, she's strong, she's healthy, she hates getting shots. All normal.

I'd gotten a bill for $40, for two past copays we'd owed from before we knew the exactitudes of her insurance plan. That was $20 a visit, so I was prepared to pay $60...the two old copays and one current one. Except when I sat down to pay, they wouldn't take my money. They kept insisting that the supplemental insurance could be re-billed and that I shouldn't have to pay a copay. I kept trying to pay. They kept telling me no.

Fine. I took the $60 and spent it on baby supplies.

A few hours later, I got a call from the doctor's office. This had happened the last time she was in for a well-baby exam and vaccinations, so I was half-expecting it: a call to make sure she was doing okay after the shots, that she hadn't had a reaction. Except it wasn't that at all.

“Do you know if your insurance is going to cover this visit and these shots? Because frankly your supplement isn't even going to pay us enough to reimburse for the meds, and if your insurance isn't going to pay you need to be getting your vaccinations at the county health department.”

....uh, what?

I was so taken aback by this, I didn't build up any steam for a full-on hissy fit. The baby is covered under a good, commercial insurance plan...Aetna... and I was just about positive that a two-month checkup and vaccinations would have been covered. There hadn't been any problem before. I didn't have the booklet there in front of me, but I was sure...wasn't I? Why was she calling me and not the insurance? Was there some reason this wouldn't be covered? Why was she being so snitty about this? Why the threat to send me to the health department instead of...oh, I don't know...billing me? What was this all about after they refused to take my money that morning, when I sat down with cash and tried to give it to them? I mean, what the hell?

I fretted about it for a while, then spoke to a very nice woman at Aetna. I gave her a brief rundown and she asked if I was serious. She asked if this kind of behavior was normal for where we lived. She offered to call the office for me and I told her yes, please, thank you so much. She left a message for the business office woman to call her back on Monday and told her that yes, of course well-baby visits and vaccinations were covered and she could have called her to ask her this herself, instead of bothering the patient, if she had concerns. I was very happy I talked to the woman at Aetna.

But why did they call me? Why the insults? Why would they completely skip over the possibility of billing me? Why does someone who works in a billing office not know whether one of the major commercial insurances covers something that just about every insurance plan covers? The world may never know. It's a shame the doctor's so nice, because I'm pretty disgusted with his staff.

And nope, we never did get a call checking on the baby after her vaccination like we did the first time. Maybe they were in battle mode over assuming they wouldn't get paid and they didn't care. Weird.


Jeanne said...

This sounds awful, and pretty crazy, but not unusual, I'm sorry to say.

I have a couple of these I need to sort out myself.


Jake Baxter said...

Keep on making money - money is grave