Thursday, April 23, 2015

The Greatest Healthcare System on Earth, Part 5,346,789,340

a scene from Brazil, the 1985 Terry Gilliam flick whose brilliant scenes prefigured my life by 3 decades

I opened an Explanation of Benefits online this afternoon and noticed that the cost of the bloodwork (ordered by Sophie's doctor to check whether or not she had an anemia  or something worse problem) was not covered by Assurant, our new insurer. I had specifically looked up and found an In Network Lab, which, according to my insurance company acumen, means there would be no charge.  On the Explanation of Benefits page, under the Remarks column, were the numbers

1001, *0204

I followed the little asterisks down the screen to the explanation for these groupings and read:

0204: This service/equipment/drug is not covered under the patient's current benefit plan.
1001: This type of service is not covered under the plan. Please refer to the certificate.

Oy vey, ya'll. You know what that means, right?

I called Assurance, was put on hold and then finally spoke at length to one of their people. She was patient -- I'd say robotically so -- and kept putting me on hold to research your problem. She came back to say that there were several problems involving erroneous coding from The Provider that neccessitate my calling The Provider, asking her to change the coding on the original prescription, then calling the lab to authorize said changes, then have the lab issue a corrected claim to the insurance company, and then for me to mainline some heroin. 

The Assurant agent also told me this:

We do not cover venipuncture.

I said, But you do cover bloodwork?

The Assurant Agent said, Yes, but we do not cover the venipuncture service.

In other words, I pay private insurance so that Sophie's blood may be analyzed in a lab for possible horrible diseases, but that private insurance will not pay for the means to remove the blood.

Help me Rhonda.


  1. What do they suggest? Ice pick? The absurdity never ends, does it?

  2. Ditto Lily and Mary's comment was hysterical, but not really. Fuck Insurance companies!

  3. Do they think you should suck it out before sucking it up and continuing to pay them? Stupid...

  4. That's the most ridiculous thing I've ever heard. And if I start asking questions I'm afraid I may never stop.

  5. Brazil indeed. I am so very sorry that you must navigate this Amazonian wilderness.

  6. To use one of my new favorite phrases, "What the actual fuck?" Since when is the venipuncture not part of the actual blood drawing procedure? Do they propose that the phlebotomists not get paid now? Only the lab techs who put the samples in the machine? Oy. I called to check benefits for a lab test I needed done on Tuesday and was told by the insurance rep that "if they choose to pay for it, it will be an out-of-network payment, so the split will be 80/20, but that's only if they pay; they might not pay for it." No shit. That's why I called to check benefits. The entire reason for this phone call (and wait time of nearly one hour) was to ask whether or not they would pay for it. I wonder if sometimes these phone reps go home and question their own sanity after a day of doublespeak. Or perhaps they just prepare for their next career as politicians who don't answer questions, either.

  7. Do they expect you to use mosquitoes? Vampires? Seriously. WTF?



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