Open Mic – Claims Dispute

At the Colorado Health Insurance Insider, we’ve decided to start an “open mic” so our readers can express their views in an open forum. They’ll be able to get feedback from other readers and engage in discussions about Colorado health insurance topics.

The opinions expressed in the “Open Mic” category do not reflect those of Insurance Shoppers, Inc. or the Colorado Health Insurance Insider. If you have an “open mic” topic you would like to submit, use the “contact us” tab at the top of the page to email your letter to me.

Without further ado, here is our first open mic submission…

The End of Healthcare As We Know It: An Open Letter
by
Tim McGettigan

Dear Anthem Complaints Department:
On August 17, 2007, I was admitted to St. Mary-Corwin Medical Center in Pueblo, CO. for an outpatient MRI. Last week, I received a bill including not one, but two co-payments for the MRI. After looking into the matter, I discovered that my insurance company, Anthem Blue Cross-Blue Shield, is demanding two separate co-payments for this particular treatment because, Anthem claims, the MRI included two distinct procedures.
Frankly, I find this puzzling. Anthem’s request for two co-payments appears to be nothing more than a transparent attempt to squeeze additional sums of money from customers who are already paying way too much for medical insurance. From my perspective, on August 17, 2007, I was admitted to the St. Mary-Corwin Medical Center once (and only once!) for one (and only one!) MRI. Thus, I believe that I should be responsible for one (and only one!) co-payment. However, as anyone who has ever tried to communicate with an enormous, faceless medical insurance bureaucracy has learned, the thoughts and interests of individual patients are of little concern. What matters is money: the bottom line. And Anthem’s new “a la carte” co-pay policy ( i.e., without prior notification, Anthem can be charge its patients more than one co-payment for any particular hospital admission or procedure) is nothing more than a devilishly clever way to fatten Anthem’s bottom line.
Just imagine, if you will, the can of worms that Anthem’s new “a la carte” co-pay policy opens. When medical insurance companies claim the right to demand two co-payments for one MRI, then what’s to stop them from requiring multiple co-payments for every other procedure that takes place in a medical office? So, what’s next? Separate co-payments for blood pressure tests, ear exams, knee reflexes? The sky’s the limit!
Eureka! Insurance companies have struck gold…again!
Of course, the only downside to this lucrative new policy is the fact that the few remaining Americans who can still afford health insurance will no longer be able to use it. What middle class American will be able to risk seeing a doctor when their insurance company is at liberty to charge multiple co-payments on a whim. I can see it all now: In the not too distant future, Doctors will say to their patients, “Stick out your tongue and say, Aaaahh!” and patients will be forced to respond, “Geez, Doc, I wish I could, but I just can’t afford another co-payment.”
Oh, the humanity!
In conclusion, I humbly call upon the powers that be at Anthem Blue Cross-Blue Shield to rescind their “ala carte” co-pay policy. I hate to cut into Anthem’s expanding profit margins, but, at the rate we’re going, pretty soon not even Donald Trump will be able to afford an office visit.
Please do what you can to rectify this sorry state of affairs.

Sincerely,
Timothy McGettigan
Tim McGettigan, PhD, is a Professor of Sociology at CSU-Pueblo

About Jay Norris

Jay operates a health insurance brokerage in Colorado, where he helps individuals and small groups obtain and maintain health insurance coverage.
Complimenting his work as a health insurance broker, Jay also provides data analysis and creates visualizations that are easily understood by consumers and other stakeholders in Colorado’s health insurance market.

Comments

  1. This sounds like a glitch in the insurance company’s billing system. You should be able to contact the hospital and have them give you documentation that only one MRI was done. If the insurance company doesn’t remove the extra copay for the extra MRI that never happened, I think you would have a case for the insurance commissioner. I would think your agent should be able to help you with that. Is Insurance Shoppers the agent?

  2. Oops. I should have made that clear. Tim is not our client and I’d never talked to Tim until we received his letter to submit on the blog. If our clients ever do submit a post to the “open mic” category, I’ll make that point clear.

    I’m guessing his policy is through his employer (CSU-Pueblo?), so he probably doesn’t have an agent.

  3. Michael Samuels says

    The problem with most disputes with your carrier is that just cutting through the red tape can be problematic. Also, most people don’t know that they can fight when your carrier refuses to pay certain claims. But when you have a hospital that has created a whole new fee system, then of course that spells trouble. I found a very interesting video on YouTube called ‘The Raymond Report’. The host is a veteran of the industry and is now starting a web-based show geared towards helping consumers with problems and you can write them to help solve disputes. You can search it on YouTube and they also have a website: theraymondreport.com

    I’d love to hear that it works out for you. It sounds like the hospital has found a way to make more money and others will pick up on it quickly if it can’t be stopped.

  4. Brian Clark says

    This is just how the system works. The hospital has made these two different procedures, so you have two different copays. A $100 copay per MRI isn’t too bad in my opinion. The policy you have is pretty rich compared to most. If you had an HSA type policy or one of the other high deductibe options that most self employed people are being herded to these days, you would be paying for the first $2000, $5000, or even $10,000 worth of expenses.

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