|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
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.