I had a breast reduction in 2001.
Now, as I understand it, coding the form for a breast reduction is confusing. In reality, each breast is considered its own seperate surgery, so the insurance claim form should state that I had two bilateral reduction mammoplasties.
I guess, tho, there is another little box you can check for a breast reduction, although I don’t really know what it is.
Anyhoo, I went for over a year occassionally getting a bill for over $13,000 from my surgeon’s office. So I’d call my insurance company to find out what was wrong. And they’d tell me it was coded incorrectly. So, I’d get a name and number of the person I spoke to and call the business office at my doctor’s. Tell her the problem, and tell her who to call at BCBS (or vice versa. I dunno. I tried to hook them up so many times, I can’t remember).
Finally, I got exasperated and got my HR department involved. That finally got the situation taken care of, but I got this explanation from my HR rep:
Apparently, the business office at the docs repeatedly submitted the paperwork incorrectly such that it looked like I had *three boobs reduced at one time * (now, they did take off 6 lbs, so one could see it that way… ). BCBS, understandably, denied the claim, saying that paying for the reduction of a three-breasted woman was not in their policy. And the two offices would go back and forth, back and forth, never seeming to take the time to make a damn phone call and clear the situation up.
In the end, I needed to redo my surgery (another 3 lbs off!! Whoo hoo!!!). But when I contacted my doctor, she said, “Considering you haven’t paid your bill for the last one, I’m hesitant to perform the surgery again.”
WTF??? The reason my bill isn’t paid is because your business office won’t pull their heads out of their asses!! (Not to mention the fact that I had to do the whole thing over because she fucked it up in the first place. But that’s a rant I’ve spewed elsewhere and will spare you.)
So, I told her - effectively - to shove it and went to another doctor who knew - and who’s business office knew - what the fuck they were doing.
Oh, and I did get sent to collections twice by the same fuck ups. Even after I made sure that the payments I made (wholly in order to keep from going to collections whilst this cluster fuck worked itself out) were acceptable.
Fucktards.