February 11th, 2016 by Ed Bruske
I had my annual physical exam yesterday and my doctor ordered a few tests, which can only mean one thing: hours on the phone trying to figure out how much I’m going to be charged.
We were here last year. After my doctor ordered a routine cholesterol screening, my insurance company wanted me to pay an outrageous amount. It took months of digging to learn that the hospital than runs our local health clinic and my insurance company could not agree on the reimbursement code for a simple blood test. I was just the chump caught in the middle.
In addition to the cholesterol test, my doctor this year has suggested the usual “metabolic panel” as well as a test to measure thyroid function and Vitamin D. Also on my to do list: an ultra-sound to check my aorta for any signs of an aneurysm. (Yes, I’m getting old, my cholesterol is high and I used to smoke.)
But I was determined that this year would be different. I wanted to know exactly what I might be billed for these tests before I took them. Surprise! It took five calls to my insurance company–Fidelis Care–to get any traction.
The first time I called, the representative told me she couldn’t tell me what the cost of the tests would be. “You’ll have to ask your doctor,” she said. “He can call us on our provider line.” But when I called the doctor’s office, I was told, “We don’t do that. You need to talk to your insurance company.”
Okay, so I called Fidelis again and this time a different representative told me she would try to answer my questions and put me on hold. We were disconnected and, even though she had my number, she never called back.
On the third attempt, the agent who took my call didn’t hesitate at all before telling me that all testing triggers a co-pay of $25. I looked up my policy online and, sure enough, it said “diagnostic tests and imaging” were $25. But it also said “screenings” were $15.
Were the tests my doctor ordered “screenings” or “diagnostic”? I had no idea, so I called Fidelis a fourth time. And when pressed, the fourth agent, after consulting with his supervisor, told me tests conducted at my primary care physician’s office would be $15, while those done at another office would be $25.
As you might imagine, I was a bit exasperated by this point. The ultra-sound was supposed to be done at a clinic in Greenwich, a few miles away. Would that be $25? I called there, but was told they couldn’t know what I might be charged for the test.
I finally thought to consult the federal website for the Affordable Care Act (Obamacare) and, lo and behold, the very first item listed as free under “preventive care” is a one-time aortic aneurysm screening “for men of specified ages who have ever smoked.”
Calling Fidelis a fifth time, I confirmed that I would not qualify for a free ultra-sound of my aorta because you have to be between the ages of 65 and 75. I cancelled my appointment. I figure I can wait another year and a half till I turn 65.
But wait! There’s more.
A closer look at the federal website revealed that while a cholesterol screening is considered a free service under preventive care, the full “metabolic panel” my doctor requested, as well as the thyroid test, are not. So I’m guessing there will be some kind of copay for those, and I can’t wait to find out how much the clinic tries to charge me.
But lookee here! The shingles vaccine my doctor suggested also is covered under the Affordable Care Act. I can get it free at the local Rite Aid.
You may be thinking I’m being a bit ridiculous. The amounts involved are so small. What really blows my hair back is how difficult it is to figure out exactly how the system works. Even more, how little the players involved seem to know. And they look at me like I’m from Mars when I ask.
I can’t help thinking how hard this must be for people who don’t have the resources or persistence that I do. Or maybe they just pay what they’re told and never give it a second thought.
What a sad commentary on our woeful health care system, which seems designed more to suck money out of ordinary folk and send it off to profit-making insurance companies, device makers and the pharmaceutical industry.
In case you were wondering, we’re the only developed country in the world that works this way.