It’s a Losing Game.

You might think that we MDs could teach a class on dealing with health insurers. We are always trying to justify why our patients should get a certain test or medicine through prior authorizations, pre certifications, appeals, elevated appeals, peer to peer calls (that are rarely with an actual peer). But, no, it makes no more sense to us than it does to you. Sometimes it feels good to share the pain, so welcome to my current minor insurance battle. And even if I win, I’ve still lost because of the time and frustration expense.

When your deductible is met, the insurance is supposed to pay 100% after copays.  So, what do the insurers do?  Well, United HealthCare is now changing what they call a copay so that individuals have to pay more.  I’d need to be a medical investigative journalist to truly find out what is going on behind that big curtain where Mr. Oz, I mean Mr. Witty’s, CEO chair sits.  But, I can tell you that for this MD, the process seems designed to only confuse and confound. 

I met my deductible early this year, so I was surprised to see two anesthesia bills slip through for me to pay. One was for $372 and one for $371.  Now, anesthesia billing is another area of medicine that is a bit convoluted, but we’ll save that topic for another day.  When I reached out to the friendly chat bot on myuhc.com, I was first told I had not yet met my deductible.  But, I outmathed the bot and was transferred to a person, I think.  At that point I was informed it was a copay.  A copay?  Those are very odd amounts for a copay.  I tell them that I have never had a copay for an uneven amount and I have never had a copay for anesthesia.  I am told that if that is true, it is certain to be paid for with an appeal.  Great, I say, where do I appeal?  I find my anesthesia charges for a surgery I had last year as documented evidence it was paid by the same UHC policy without a copay and I go to the appeal link to complete the process.

You know it was not that easy, right?  I am on the appeal web page, I enter all of the required information and up pops an error message not allowing me to submit my appeal.  After several tries and several more bot attempts to help I am back on with another human, I think.  Is there a way to file a form to appeal? No.  Is there a fax number for appeal?  No.  Is there a phone call for appeal? No.  So, why not spend a few hours on the phone getting nowhere as I have nothing better to do than to try to play David to their Goliath. 

And, of course, no one is able to tell me why the allowed amount of a billed anesthesia charge is now called a copay.  I ask if the coverage terms have changed. No. Where I might find this information in my benefits manual or on the website? I am told that it is not written.  Great, now I am fighting an unwritten new rule that cannot be explained.   Thank you I tell the representative for making this already impossible task more impossible.  

 Finally, after a very long time, I get to someone that says “You are right, your deductible was met, this should have been paid.  We’ll get it taken care of for you.”  I pray it is a recorded line.  I copy all of my chats and create a file and I end the call. 

You know how this part of the story ends don’t you?  One month later, I get two bills from anesthesia for $372 and for $371.