Oct. 29, 2004

More on "my physical was not fully-covered"

Ellen Fox, in her Oct. 22 letter to the Reader's Forum, wrote "as an iPlan member, you have chosen a benefit plan design that gives you greater choice and control in managing your health care expenses. With a consumer directed health plan, such as iPlan, you have become distinctly aware of what your health care dollars actually purchase -- something that is invisible to those in more traditional plans such as an EPO or PPO."

The medical provider would have given me this service regardless of my plan, and would have billed me directly (rather than my iPlan account) if I had an EPO or PPO.

Fox wrote, "as a partner in the purchasing decision, the iPlan allows you to treat your health care the same as you would any other purchase. Questions you would normally ask when you purchase any consumer service should be asked of your doctor: How much will it cost? Are there any additional charges? What services will I receive for each charge? Then, you can make the decision whether you wish to purchase additional services, such as the 'pre-physical.' "

These are all really great questions to ask a medical provider. I did ask and was told everything was "fully-covered." So the answers from a medical provider are no guarantee that you won't be stuck in limbo as I was holding the bill.

Fox also wrote, "while all of this makes logical sense, it still leaves you in the unfortunate predicament of being charged for a service you thought was included in your preventive physical. The information you received from United Healthcare is accurate: your provider must adjust the bill in order for the claim to be paid as preventive. In addition, you should understand that UHC cannot pay the claim as preventive if the provider refuses to submit it as such."

UHC was very helpful to me. They explained that the medical provider could simply resubmit the charge as "routine" and would receive full payment from UHC, rather than from my iPlan account. When asked, the owner of Medical Associates of Northern New Mexico refused with no explanation. The only thing I can think of is that their accounting processes are extremely expensive and they can't justify the expense in order to satisfy a customer. I realize that doctors are frustrated with the impositions associated with the insurance industry, but I don't appreciate that they seem to be taking it out on the patients.

--Daniel Weeks