Honest mistake or Medical con artists?

In eleven plus years as a cancer patient I've had a few run-ins with billing and insurance matters related to my healthcare. I've definitely got some tales to tell.

There is one that still irks me from three years ago and I almost had a repeat of it a few weeks ago. I'm going to share it below.

In 2002 my wife got pregnant. Dear wife was in the early weeks but her OB/GYN ordered a Ultrasound. An appointment was made with a diagnostic facility Concept Diagnostic in nearby Lake Worth.

At the that time and now we have an insurance where we pay a $15 co-pay on doctor's visits. Any time either DW or I have to see a new doctor, hospital or testing place we have to show the card.

When DW and I went to the appointment and after registering and waiting, we were taken to an office area. A woman for Concept told us that our share of the bill for the U/S was $110 plus change. This was the result of a phone call this diagnostic facility did with our insurance company or so they said and The $110 we were being asked to pay was amount the insurance company said we would owe. We hadn't come prepared to pay a bill, but the test was needed. I charged the amount on my VISA card.

Approximately a month later the insurance company sent us the explanation of benefits. There was the Amount charged, the amount allowed, Deductible, Co-Insurance and Payment amounts. At the very end was patient responsibility. The Patient responsibility was $15. What it says on our insurance cards.

Well it could be a mixup, or not. At least I thought so then. The same day I got the explanation of benefits I called the Testing Facility. My purpose was to ask for a credit to my charge card and that I would be coming in.

The same person from a month earlier told me they don't do that, namely credit my credit card.. I'd have to wait so long etc. That's when I started fighting, this was wrong and I told them so. I can see a delay if it was a check but not a credit card. Also I wondered how did they get what we owed mixed up? We have Florida Blue Cross Blue Shield PPO for insurance. Surely my wife was not their first patient with this insurance. Now you're telling me you won't credit my card for a mistake.

The billing person didn't back off at first. Not till I told them what I'd do, dispute the whole credit charge, complain to the Better Business Bureau, make a consumer fraud complaint to the appropriate agency etc.. After hearing all this the billing person said my card would be credited the $95 overcharge. I had it done that very afternoon.

If you recall a few weeks ago I went for an MRI. The MRI or Open Imaging place is in Boynton Beach to our south. I'd been there before for an ultrasound and a couple of chest x-rays in the past. Every time I had to pay a $15 co-pay.

By the way Boynton Beach Open Imaging LLC(aka Florida Open Imaging) is part of the same company as Concept the testing facility in Lake Worth that DW went to in 2002.

After registering that for my MRI and being told to take a seat I was called to the counter again. I was told by a person at the desk that my share of the bill was $169 plus dollars. That BB Open Imaging had called the insurance company and was told this was my share of the bill. All eerily similiar to my 2002 experience.

I firmly said I'd pay $15 and no more to the person who just told me I owed $169. Also I told them why and recounted what happened in 2002.

What happened? BB Open Imaging backed down immediately. I was told I'd get my explanation in the mail and then a bill. No $15 co-pay was even asked of me at the time. It was never asked of me in the past. I'd get a bill in the mail.

I was very irked by this experience. The 2002 experience I hadn't forgotten, and I have grown to distrust this firm tremendously. This was the firm used by my insurance, I have little choice in the matter. When I got home from the MRI I called my insurance company. I was thinking of blogging about my experience back then but deferred till I had more information. BCBS was helpful but vague as to what my payment would be for the MRI. It was explained to it would depend on how BB Open Imaging billed the test.

Yesterday I got my explanation of benefits online. No surprise to me, my amount owed for the MRI is $15.

Description of Service: MRI ABDOMEN W/O&W DYE
Physician: Boynton Beach Open Imaging Llc
Date(s) of Service: 08/22/2005 - 08/22/2005

Amount Charged- 3116.00
Amount Allowed- 846.44
Amount Paid- 831.44
Coinsurance- 0.00
Copay- 15.00
Deductible- 0.00

Were these honest mistakes or a Corporation trying to screw people with medical problems? There are certainly companies who will attempt to take advantage of people. Ones who don't know better or won't speak up. Given my history with these people and their reactions in both 2002 and last month, I incline to the later in my post's headline. I'll be heading back for an MRI in November again and I wonder what will happen then. One thing is I will come prepared. Stay tuned.

Breakfast- Basil's blog