the joys of raw, blinding anger

vsp · 01-09-2003, 05:26 PM

In early November, I came down with a nasty bout of bronchitis. It never turned into pneumonia, thankfully, but I'm still coping with some of the aftereffects. It led to one 5 AM emergency room visit (when an asthma-like attack brought on by coughing left me unable to breathe for a few seconds), a handful of doctor visits, two trips to an ear-nose-throat specialist, a Thanksgiving Day trip to the hospital to drop off a specimen, and a number of prescriptions.

I was afraid that the emergency room visit would end up costing me a fortune, but when the bill came, insurance covered all but about $20. Likewise for the remainder of my visits -- except one.

The first time I went to the ENT specialist, he put a tube into my nose to see what he could see in my sinuses and throat. Once he got it into position, he looked around for about five seconds, removed it, said "I can't see anything physically wrong" and sent me on my way.

Apparently, according to CIGNA, that tube-in-the-nose qualifies as "Surgery - Outpatient" and is subject to a deductable, and thus I found a bill for around $150 in my mailbox this evening. The HELL?

At no time did the doctor tell me before putting the tube in that this was a "surgical" procedure, or that it wasn't just a routine part of a visit to his office. (I'd had it done once before, long ago in the only other time I visited a (different) ENT's office, and don't remember having to pay anything but my usual copay.) I certainly had no idea that the "I don't see anything" five-second tube would cost more than three visits to my regular physician, two months of prescriptions and an emergency room trip COMBINED.

Objects aren't flying around the room... yet. I am trying to decide how best to contest this -- whether to bend the ears of CIGNA's phone drones, the ENT's office, or both. Any suggestions as to how to proceed?

wolf · 01-09-2003, 05:41 PM

CIGNA is apparently having financial problems. I saw a piece on the news today that indicates they are reducing their workforce by some ridiculous number ... around 30%. Of course, such workforce "reductions" only impact the people who are actually DOING the work, rather than trimming the bloated, overpaid, over-perked upper management levels, which is probably how and why your billing got screwed up.

They pass along the financial burden to the consumers, and reeduce your coverage midstream. You probably got information about "important changes in your coverage" in the fine print of the back pages of one of those cute little "keep healthy tips" magazines they send out.

warch · 01-09-2003, 05:43 PM

Gather all your paperwork.I was under the impression that you needed to sign a consent form for any surgery. I've had to do this for way minor outpatient procedures, always given copies. If you didnt sign anything specific to surgical procedure, that's big for your case.

Call the doc and review the procedures/visit. Id start there.

When you talk to anyone, document the time/date and their name, take notes. Be calm and build your case. If youre squeeky persistent enough it may get reviewed.

I'm thinking the insurance co is simply responding to the docs invoice, maybe he's padding.Or if the insurance co is playing fast and loose with coverage, be very squeeky and annoying, maybe they'll waive it to make you go away.

Dont yell, be clear and shoot for a litigious lilt in your voice. Go get 'em.

elSicomoro · 01-09-2003, 06:26 PM

Letters, vsp. Write letters to everyone involved. Send them certified.

If this doesn't remedy the problem, call NBC10 or Fox Philadelphia.

01-09-2003, 05:26 PM	#1
vsp Syndrome of a Down Join Date: Jun 2001 Location: West Chester Posts: 1,367	the joys of raw, blinding anger In early November, I came down with a nasty bout of bronchitis. It never turned into pneumonia, thankfully, but I'm still coping with some of the aftereffects. It led to one 5 AM emergency room visit (when an asthma-like attack brought on by coughing left me unable to breathe for a few seconds), a handful of doctor visits, two trips to an ear-nose-throat specialist, a Thanksgiving Day trip to the hospital to drop off a specimen, and a number of prescriptions. I was afraid that the emergency room visit would end up costing me a fortune, but when the bill came, insurance covered all but about $20. Likewise for the remainder of my visits -- except one. The first time I went to the ENT specialist, he put a tube into my nose to see what he could see in my sinuses and throat. Once he got it into position, he looked around for about five seconds, removed it, said "I can't see anything physically wrong" and sent me on my way. Apparently, according to CIGNA, that tube-in-the-nose qualifies as "Surgery - Outpatient" and is subject to a deductable, and thus I found a bill for around $150 in my mailbox this evening. The HELL? At no time did the doctor tell me before putting the tube in that this was a "surgical" procedure, or that it wasn't just a routine part of a visit to his office. (I'd had it done once before, long ago in the only other time I visited a (different) ENT's office, and don't remember having to pay anything but my usual copay.) I certainly had no idea that the "I don't see anything" five-second tube would cost more than three visits to my regular physician, two months of prescriptions and an emergency room trip COMBINED. Objects aren't flying around the room... yet. I am trying to decide how best to contest this -- whether to bend the ears of CIGNA's phone drones, the ENT's office, or both. Any suggestions as to how to proceed?

01-09-2003, 05:41 PM	#2
wolf lobber of scimitars Join Date: Jul 2001 Location: Phila Burbs Posts: 20,774	CIGNA is apparently having financial problems. I saw a piece on the news today that indicates they are reducing their workforce by some ridiculous number ... around 30%. Of course, such workforce "reductions" only impact the people who are actually DOING the work, rather than trimming the bloated, overpaid, over-perked upper management levels, which is probably how and why your billing got screwed up. They pass along the financial burden to the consumers, and reeduce your coverage midstream. You probably got information about "important changes in your coverage" in the fine print of the back pages of one of those cute little "keep healthy tips" magazines they send out. __________________ wolf eht htiw og "Conspiracies are the norm, not the exception." --G. Edward Griffin The Creature from Jekyll Island High Priestess of the Church of the Whale Penis

01-09-2003, 05:43 PM	#3
warch lurkin old school Join Date: Oct 2001 Location: Minnesota Posts: 2,796	Gather all your paperwork.I was under the impression that you needed to sign a consent form for any surgery. I've had to do this for way minor outpatient procedures, always given copies. If you didnt sign anything specific to surgical procedure, that's big for your case. Call the doc and review the procedures/visit. Id start there. When you talk to anyone, document the time/date and their name, take notes. Be calm and build your case. If youre squeeky persistent enough it may get reviewed. I'm thinking the insurance co is simply responding to the docs invoice, maybe he's padding.Or if the insurance co is playing fast and loose with coverage, be very squeeky and annoying, maybe they'll waive it to make you go away. Dont yell, be clear and shoot for a litigious lilt in your voice. Go get 'em.

01-09-2003, 06:26 PM	#4
elSicomoro Person who doesn't update the user title Join Date: Jan 2001 Posts: 12,486	Letters, vsp. Write letters to everyone involved. Send them certified. If this doesn't remedy the problem, call NBC10 or Fox Philadelphia.

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