Feeling a rant commin on........................

I have been away from blog land while I played at being a Leading Lady racer (South Dakota half-marathon) and a panel expert on senior care. While I'm not sure that either title is really correct I did have a blast at both events and feel blessed to have participated in them. So why the rant? Well, let me share...

Remember my surgery last December? Well I got word a couple of months ago that the insurance company was not going to pay for the operating room/hospital services in conjunction with the surgery. They paid the surgeon's fee and all the tests and other things that went along with the procedure, but said the operating room was not a covered benefit. And here I was thinking back alley operations were neither sanitary or legal! Anyway, this nice lady from the hospital told me I might want to contact the insurance company and request they reconsider so I was not stuck with a bill for $17,897.24.

I won't trouble you with all of the details, but I did contact the insurance company, got copies of all the medical records, wrote a detailed letter of why the surgery was reconstructive and NOT cosmetic in nature, and sent them before and after pictures to substantiate rashes and pain associated with the need for surgery. Oh! And I put in my letter how puzzling it was to me that they would consider the surgeon's services a covered benefit, but not the operating room in which he was required to provide those services in a covered benefit. A nice way of saying, "GET WITH THE PROGRAM PEOPLE!

On Saturday I got a letter from the insurance company telling me they had reviewed the claim and "the services are payable." The letter went on to state, "A payment of $8,555.84 will be sent to the provider within two weeks. With this payment, we have paid 100 percent of the approved amounts for these services." And this folks is the subject of my rant...

Upon contacting the billing supervisor at the hospital ( to make sure I was not understanding things wrong) I learned that BCBS has a contract with the hospital that allows them to pay this reduced amount. Had they determined the services were not payable or (God forbid) I didn't have insurance I would have been responsible for close to an $18,000.00 bill. And the insurance companies wonder why ordinary people such as myself feel they have some kind of a racket going. If the hospital is willing to provide care for $8,555.84 with a certain insurance policy in place why in the world can they not be willing to provide the same care for the same amount to anyone in need of it?

Don't get me wrong, I am extremely grateful that I do not have to pay that bill, but I am having a hard time understanding why the above picture is the best thing for us common folks. Had I called the hospital and ask for a reduced rate before surgery my guess is they would have either refused, or at the very least waited to see if I would come up with the full amount before settling for a lesser amount. And what if this surgery had been one of life or death? What choice would there have been but to either sign my life away, or else sign away my life savings (if I had them) and/or a good chunk of my future income for years into the future. Because I am not a huge corporation with lots of lobbyist and employees to help me bend the system to my benefit? How can that be right?

My plan B, had the insurance company not paid this claim was to make small payments and quickly save up eight or nine thousand dollars and offer the hospital a settlement, sure they would take it. Had things gone this way they still would have gotten more money from me than they agreed to take from the insurance company. And what if I was not in a position in which I could save up thousands in a reasonable amount of time? Not that long ago I couldn't scrape up an extra twenty bucks a month, and I know there are many people for which that is true today. Then what does one do?

If you are sitting out there with a huge medical bill, wondering how you are ever going to pay it off, use the above formula (that my insurance company paid) as a starting point in your negotiations towards getting your bill reduced. If it is good enough for BCBS, it is certainly good enough for you.