Flabbergasted? Doctors And Prescriptions Can Fall Off Your Plan

It is readily acknowledged that medical services billing and insurance coverage is a complex path to walk. It should be clear what is covered by insurance and what is not, but not only is this difficult for the insured, it is also often unexplainable to the physicians billing services. The doctor is covered but many tests are only partially payable. The coverage for prescriptions is random. The insurance companies can even decide that a doctor is no longer covered under their program, though they’ve been included in the program for the last decade. Though they are required to tell all the persons involved, this information can be lost in the endless insurance paper chain, leaving the bewildered physicians and their clients to try to figure out the amounts owed.

Clay had been seeing his doctor for five years. The doctor and his patient had worked together to get his asthma under control. Albuterol, an inhaler for short-term symptoms was used. When his breathing difficulties increased, [another steroid breather, Advair was added. When Clay had an unexpected attack, he had to go to the emergency room for treatment. As a standard, all of these services were, completely covered by Clay’s insurance. Two months later when Clay returned to his doctor for a check-up and to get his prescription refilled, Clay was taken aback when the pharmacist told him that the Advair he needed in order to breathe was now going to cost him one hundred dollars every two months.

When Clay informed his provider, he was told that Advair was not included any longer with his coverage. He said that he had tried other steroid inhalers, but they were ineffective. The insurance company provided no solutions. He and his doctor would have to find another drug. Three months later, Clay also received a bill for the full amount of his treatment and lab tests at the previous doctor’s visit. He called the doctor’s office and was informed that his primary care practitioner was also no longer covered under his insurance. When he called the insurance company to complain, their response was that doctors were changed occasionally and it was up to the medical provider to let you know your required payment at the time of the visit. When Clay called the billing office he was told, that because he was a long time patient they didn’t ask for the money up front, but as a courtesy, sent him a bill in the mail.

Clay fought the insurance company for years to no avail.. In the interim, he acquired a bad credit rating because his bill went to collections since he refused to pay it.. There was no compensation for the doctor either, as well as the loss of a good patient. Extra phone time and paperwork was required by the billing company, not to mention the stress of working with a dissatisfied and angry client. The ones who didn’t suffer were the ones who understood exactly what was going on and that was the insurance company.