Medical Bills - Over $200 bill from routine checkups

Asking out of curiosity. I just got off the phone and got this resolved between the hospital and the insurance company. I'm sure the answer is "no, there's nothing you can do" but the experience has left me feeling really dirty, so I want to write about it.

For context, I have pretty good insurance through my work which is supposed to cover preventative care including check-ups and 1 routine eye exam per year.

I have a routine physical and a routine eye exam scheduled.

I go in for my physical on October 1st and it's nothing out of the ordinary.

"Do you smoke"

"No"

"Turn your head"

*cough*

You get the picture.

At the end of the exam they asked if there was anything else I wanted to ask about.

*sorry for the details*

I then asked about some blood spotting on the toilet paper when I wipe my ass. I drop trou, he spreads my cheeks, takes a 2 second peek, comes back up for air. "You have some hemorrhoids, I'd recommend eating more fiber".

I get the bill, and there is one bill for the routine check-up called "Professional Visit" for $290 which is covered by my insurance. And there is a second line item called "Office Visit" for $215, on which I'm charged $53.45!

I go to my eye exam on October 31st. Standard eye exam. I got LASIK so I have to get an annual exam.

"Cover this eye"

"Cover that eye"

"Ooh you have 20/15, impressive"

*drop* *drop*

*dilate* *dialate*

"Everything looks good"

Then at the end she mentions that I have some minor Blepharitis and I should clean my eye-lids more regularly with a wash cloth. Great.

I get the bill, and there is one line item called "Eye Exam" for $325 which should be fully covered, but I owe $168.50!

I call insurance and ask about the physical. They explain that they coded the billed as two separate visits. One routine exam (which was covered), and the other one for an "office visit" where there was a medical diagnosis.

The dude literally said "is there anything else?". Then we somehow teleported to another dimension where this became an "Office Visit". I said "yeah, my ass is bleeding", he looks and says "eat more fiber". And now I owe $50???? Isn't the whole point of a check-up to, you know, check-up on things? Am I not supposed to ask questions?

Insurance says call the hospital.

On the eye exam, they say it wasn't coded as a "routine eye exam" because there was a "medical diagnosis" that I should wash my fucking eye-lids more which was the "primary cause for the visit". So instead of being free, it costs $168.50. Same fucking thing! Separate visit, completely separate department, different staff, same hospital, same shill.

Insurance says call the hospital.

I call the hospital and was honestly underwhelmed at how easily all the charges were dropped. It took me less than 5 minutes to explain and have the 1st line customer service agent take the bill from over $200 to $0.

I know in the medical realm this isn't even a blip on the radar, but the thing that disturbs me is how pervasive these ridiculous charges are. It seems like they do it on purpose to prey upon the people that aren't willing or able to call their bullshit.

I mean, if I'm at work filing my expense report. And I "accidentally" record a few expenses 2 or 3 times and pocket an extra few hundred dollars, I would be immediately fired, sued, and incapable of getting another job. Insurance companies and hospitals do it as a standard process and there is no penalty.

Is there anything that can be done to punish this type of behavior??

*edit - Location is in WA, USA

Posted Dec 6, 2018, 1:08 AM UTC · edited

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