Can We Talk 2

Hospitals and Insurance

         I hate that pre-authorization process. I don't know what needs to be pre-authorized. The hospital usually takes care of it, but they mess up. And they don't hold themselves responsible for their own mistakes.

         Apparently, the hospital has been calling women back for suspicious mammograms (the original is covered) without any need to authorize a follow-up. That has changed, and I got caught in the change. I have to pay the full price of the follow-up, which is not cheap.

         Example 2. Almost a year ago, I had an MRI done for a frozen shoulder. Originally, it was going to be "with ink" and they got the pre-auth code for that. Then I discovered I had to go off my blood thinner for that, so I told them my doctor would never allow that. I called her to be sure, and she insisted I would have to be admitted overnight and go on an IV to get off the blood thinner for that kind of reading. So I told the shoulder doctor, and he changed his mind. He could get what he needed without taking me out of work for 4 or 5 days for the blood thinner process. So that meant canceling the procedure and getting a new pre-authorization for an MRI without ink.

         A few days later someone called me and scheduled it for the following Saturday. I didn't know they even did them on Saturday. I specifically asked if she had a new authorization. She said yes. Needless to say, the bill was denied by the insurance company for failure to pre-authorize. (Anyone remember when they would pay, but charge a penalty? That's history.) I called the hospital and recorded the date. They were going to take care of it. I didn't get a bill for six months. I thought they were working on it. Then I got a bill. I wrote a letter, explaining that I didn't have the codes, they would have to appeal to the insurance company.

         They have not responded to me, but have sent a new bill for the full amount. I have 48 hours to get it straight, or the insurance company will not reconsider it. I want to go public with the incompetence of the hospital and the expense they are putting on me due to their error. This is almost $2000 for a 15 minute out-patient procedure. I don't mind paying my 20& after the adjusted amount as agreed by Blue Cross and this hospital. I don't want to pay 100% of the full price. I'm not going down quietly, but don't know where to turn.