Health Care on a Personal Level

Back in June I had a medical procedure performed. I was having some gastrointestinal issues and my doctor recommended having an EGD (esophagogastroduodenoscopy) - essentially they put a scope down my stomach to determine what the underlying issues were. To make a long story short they found some lesions in my stomach (pre-cursors to ulcers). They put me on some medication and my symptoms have subsided for the most part. I was generally happy with this part of my experience

My experience with my health insurance is a completely different story. First and foremost, I was told by my doctor they could only perform the procedure at a facility located an hour from where I live (about 40 miles). The facility where my doctor visits take place and where they perform these procedures was out of network. The doctor, of course, was in network but the facility was not. Thus, to have the procedure covered by my insurance we had to go to the other facility.

About a month after the procedure I started to receive statements from my insurance company indicating which bills they paid, and what they did and did not cover. Everything was covered (except for co-pays and such): the doctor, the pathologist, the facility, but not the anesthesiologist. According to the insurance company he was out of network. What? How could that be? I thought that I had traveled out of my way an hour to go to a facility that was in network? That's where my thinking was wrong; the facility was in network but the anesthesiologist was out of network. How could I have made such a poor assumption? When I inquired my doctor's office about what seemed to be their error, their nonchalant response was: "that's unfortunate your insurance isn't covering the anesthesiologist, but it's your responsibility to cover any cost that your insurance doesn't." Evidently, just prior to sedation, I'm supposed to ask the anesthesiologist whether he's in network or not.

Once I received the bill ($490) from the anesthesiologist I submitted a claim to the insurance hoping that their denial was a mistake. It was not. Again I received a letter stating that they could not cover the bill per the out of network status. Next I took my complaint to my human resource representative hoping that they may have some pull. They said that they would see what they could do. At the same time I sent a letter to the anesthesiologist asking for a discount on the services provided. To their credit they gave me a discount of $245. Unfortunately the HR rep could not get the claim pushed through and after a third attempt the claim was again denied.

So here I am stuck with a $245 bill that I've fought 5 months and don't want to pay. We live in the country with the "best health care in the world", so I must have done something wrong. But no I didn't. I paid my health insurance premiums, and went to a provider who was in network. But in a health care system that is so convoluted and confusing that doctors can't even figure out I am screwed because one facet of the procedure was out of network. I must pay the bill or risk having it go against my credit. Eventually I'll pay the bill but not without complaint.