I have hypertension, and my cardiologist ordered a calcium score. With an ounce of caution I first checked back if it would be covered by my insurance, not because I'd refuse it otherwise, but because in the past mistakes done by insurance, facility, staff, pharmacy caused me to pay more than would have been necessary if administrative staff were not such dullards. Turns out the cardiovascular facilty says they only offer it for a flat fee of $75 and won't run it through insurance. Huh? So I check with my insurance why they would not cover it. Their first reply is that they would need to know the code, they can't say anything without knowing the code. Back to the cardiovascular institute, me asking them for the code. They don't give me the code, she also writes she left a voicemail with business, I should also try their business number and she gives me that number. I tell that to the insurance, they now call the cardiovascular institute's number, but there also seems to be no progress. Now they email me back, their reply is not definitive, it seems they would cover an angiogram which includes a calcium score. Now me back to the cardiovascular institute. They say my cardiologist only ordered a calcium score, not a full angiogram. Now me back to the insurance. They reply "Since there is a medical policy on the code for the procedure you would need to discuss this information with your doctor. Since we are not medical professionals, we are not able to interpret this information. They would be able to go into more detail of why we are not covering this test". This was now back-and-forth causing all three parties more time than would be worth those $75, while all the time another person from the institute, a scheduler, keeps leaving multiple voicemails with me asking me to call her back to schedule the calcium scoring. I always replied to her that I can't commit to scheduling before I know the insurance question, but she relentlessly keeps leaving voicemails asking me to call her back to schedule. Duh! So not only does she not listen to her voicemails, or ignores what the patients say, these peeps also don't talk to each other. Cardiologist, nurse, technician, scheduler, nobody is on the same page.
I am looking for two types of replies:
- What is a medical policy on a code for a procedure that an insurance can not interpret but keeps the insurance from paying? A policy always needs to be issued by someone. Is that issued by the cardiovascular institute, or state, or federal? I asked for a copy of that policy, but yes, you guessed it, of course they didn't send it to me. So I don't know what that policy *is*, who has *issued* it, and why a "policy" on a "code" makes it impossible for an insurance to pay for the procedure. And in addition, why an insurance can say "since we are not medical professionals" and therefore is "not able to interpret" that information. While the costlier procedure, a full angiogram that includes a calcium scoring, is apparently paid for by insurance. An insurance company can not explain a policy that bars them from paying for the procedure. "Talk to them why we can't pay for it". Bizarre!
- How is it possible that in the country that prides itself to be the greatest on earth a heart disease patient even has to do all that communicative pingpong, playing the middleman between multiple dysfunctional units, allocating unnecessary time for everyone involved? How come a 75 bux calcium scoring is not paid for by insurance for a heart disease patient? It's only 75 bux, but I am someone who thinks in terms of principles, and I think we need to provide opposition to a system that causes people to pay for stuff simply because doing so is less work than inquiring about the legitimacy of the charge. "Just pay for it and be done with it". This is the type of script I would write if I were to produce a campy sitcom intended to ridicule the US healthcare system.
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