Mountain View Mommy: Sand, Trucks and Testosterone

June 2, 2007


Filed under: Stuff — by mvmommy @ 2:08 am

The other day I got a letter from my medical insurance provider. It was one of those Explanation of Benefits forms that tells you what the doctor charged them for your visit, and what they will pay for your visit.

I always find these letters slightly amusing because it details out the fact that the Doctor charges $1000 for evaluating your stubbed toe… and that Insurance will only pay $200 for a stubbed toe. Thus $780 is written off as ‘over the negotiated rate’. And you end up paying $20 for your copay.

I know this is the Doctor’s way of getting a fair fee in the end, and the insurance companies way of not getting ridiculous claims. However, couldn’t they just agree that looking at a stubbed toe is only really worth $200. And just bill that, and just pay that. Done deal.

Oh well, that’s not how it works and I leave them too their silly games. UNTIL….. I got screwed by my deductible.

My recent Explanation of Benefits showed that I went in for “surgery” last month. Since the doctor didn’t classify it as a routine check-up, I wasn’t going to be charged my $20 copay. Instead it was to be billed to my insurance at full cost… which would fall to me since I hadn’t hit my deductible yet.

This wouldn’t bother me at all, if I really had surgery. I have no problem working within the system and paying my deductible when it’s due. However, I did NOT have surgery… and I find it ridiculous that they would classify what did happen as surgical, or even worthy of more than $5.

I went in to see the doctor because I had an infection on my finger. It was tiny – like an infected hangnail. However, since it was starting to swell my whole finger, I knew that it needed to be seen. When I went in, I told the doctor that I had this happen once before and I know what to do – but I wanted him to just look at it to make sure I wasn’t wrong. Sure enough, he agreed, took a pin… pricked my blister… drained the fluid… and gave me a band-aid. I even did the draining MYSELF at HIS SINK. And for the next 4 days I continued to prick and drain the infection myself at home. Myself. At my home.

I figured this nice chat of ours would be a routine check-up. Whoa was I wrong. Apparently that pin that he used was a surgical scalpel, and the 1 second it took to puncture me was hard earned surgery. And so he billed me $454 for surgery and an additional $287 for analysis.

And because I haven’t paid my deductible yet… I actually have to pay for this ‘surgery’. If he called it a check-up, like I feel that it was… it would have been a $20 copay. But NOOOO… it was surgery. Clearly. And now I am paying him $300 for pricking my damned finger so I can reach my deductible.

So. Going forward, for the rest of the calendar year, I am going to be certain that I make the most of my $300. To make it worth it, I am going to be sure to do all those expensive tests I have been wanting to do. A few x-rays here. A few CAT Scans there. Maybe a MRI. I plan on giving birth to quintuplets. I plan on staying in the hospital for an indefinite amount of time, with a lot of special food requests. And maybe I will have a few extraneous organs removed just for fun. ALL FOR FREE. You know, I need to get in my ‘surgery’.

Then those doctors can charge whatever they want, insurance will screw them over and negotiate down to 10% of their rate, and I will pay nothing. Thanks for pricking my finger.


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