I deal with ignorance a lot at work. Not bigotry, just lack of awareness about things. And I really don't blame people for it too much. But today I encountered a pretty ridiculous example, and I would like to share it with you.
A patient is having trouble getting her insurance to cover a couple of routine screenings and another test. She called about it today. Apparently the insurance company is saying they have the wrong diagnosis codes for the procedures she had done. So I called her insurance company to see if I could help her figure things out. Here is how the call went.
[Holds for 10 minutes.]
Customer Service Rep: Blue Shield of California, my name is [name]. This call is being recorded. How can I help you?
Me: I'm calling from a doctor's office, and I have a patient who is having trouble getting you to cover some tests we ordered. Can you please tell me what information you have on file for [date of service]?
Rep: Do you know how much the claim is for?
Me: Around $2000? I don't know exactly, I don't have the patient's bill in front of me.
Rep: It must be this claim for $2210. I show that the services were not covered benefits. Oh wait! It looks like we covered $220.
Me: And what was that for?
Rep: Diagnosis code V76.12 and procedure code 00403.
Me: Okay, V76.12 is "need for screening mammography." What is 00403?
Rep: It's the procedure code.
Me: What type? It's not a CPT code [standard procedure code]. It must be unique to your system. What does it mean?
Rep: Uhh... let me check.
[Puts me on hold for 2 minutes.]
Rep: Hemo- hemoglobin.
Me: Hemoglobin is not a procedure. There is no way that's right. The only procedure code that should go with the diagnosis code "need for screening mammography" is a procedure code for a mammogram.
Rep: Uh... hold on.
[Puts me on hold.]
[Disconnected.]
SERIOUSLY. WTF. This guy works in the health insurance industry and he doesn't know what hemoglobin is. It's the protein on red blood cells that transports oxygen. It is NOT a procedure. It's like saying "eyeball" or "toenail" or "skin cell" is a procedure. What a dumbass. I would like to say I can't believe insurance companies hire people who don't know anything about medicine or medical terminology, but I can. This guy was clearly not familiar with the word "hemoglobin" and he definitely didn't even realize the idiocy of what he was saying to me.
2 comments:
The travesty of it all is that this woman will not get her procedure covered and she has little to no recourse. Someone like you caring enough to sit on the phone for her is a rarity--an oddity even.
Good work on your part.
Thanks, Toby. I think we'll get the procedure covered. At work I'm drafting a letter to the insurance company and will send medical records and a request to reconsider the claim. And I have spoken to a few slightly more competent people.
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