My Personal Idiocy and/or the Idiocy of Insurance

Today I must admit that my personal fault in not understanding fully my medical insurance has come back to bite me. The upside, I'll be much better informed, and cynical, in the future.

To give a little history, I found out that I was pregnant at the end of November 2011. I had this confirmed by a doctor a few days later (visit #1). I was told to come back when I was expected to be at 8 weeks for an ultrasound to date the pregnancy which I did (visit #2). That visit occurred on a Thursday. The following Monday I started having some spotting and strange pains. I called my doctor and he said to come in right away (visit #3). After examining me he thought I might have appendicitis so he sent me across town for a special ultrasound (visit # 3.5). I was sent back to my doctor afterwards (still part of visit #3 I believe) and was told that I had miscarried. They had drawn blood earlier that day and had me come back on Wednesday for another blood draw (labs aren't supposed to count so visit #4?) Then I came in on Thursday (visit #5) to get the results. My husband and I decided to wait to see if I finished miscarrying naturally and when nothing happened over the Christmas holiday I went in the following week (visit #6) and was told that my body wasn't taking care of things naturally so we would have to do something about it. After much advice I opted for a D&C instead of medication. The following week, and by this point we're into the new year, I go in for a consult (visit #7) and have the D&C that evening at the hospital (visit #8 just to stay consistent). My 2 week follow-up was today (visit #9) and I'm hoping this will be the last I see of the doctor for a while. Ok, so it was more than a little history, but it's important.

So of the above visits I was billed my copay for visits 1, 5,  6, 7, & 9. Visits 2 and 3 I was told there would be no copay because they are prenatal visits, visit 4 was labs only, and visit 8 was the hospital stay.

It is now at the end of January and I have received two statements for all of the above. One was not a bill but a breakdown of charges for the hospital stay. Now, I arrived at 5pm, was out of there before 9pm the same day and was in the operating room for less than 1/2 an hour and the total charges were over $5300. The second statement I received was for $78.80 for visit #5. On that visit I did no more than get weighed, have my blood pressure taken, and talk to the doctor for about 15 minutes. The breakdown of the bill says it was an office visit and that my insurance adjusted the total balance but didn't pay a penny towards the actual claim.

I, confused, call up my insurance and am told that that particular visit is being billed as a prenatal visit which is not covered. I do a double take. That visit, which I was billed a copay signifying that it would not be prenatal in my mind, is suddenly a prenatal visit, but the three visits before that I have still seen no paperwork for and at this point it has been more than a month so some billing must have occurred. After the phone call I pull up my insurance paperwork and, either to my woe or joy, there is no mention of prenatal office visits, just "physician office visits". In my mind, these are regular old office visits and shouldn't be treated as special (you can see my idiocy taking over, the full extent of which has yet to be seen). This occurred just hours ago and now I have to wait until morning for the continuing saga as I call both my doctor's office and the insurance again.

As for the hospital charges (of which I'm still waiting to see a bill for my portion), I now dread that it won't be the $1000 dollars I was anticipating and instead be closer to $3500 after a closer inspection of my health care coverage. The reason I say this is that when I originally looked at my coverage it showed 20% as my cost for hospital stays and I figured that the 20% I paid would go towards my deductible. I unfortunately missed, not a superscript, but a lack thereof that signified that this was not exempt from the deductible (my idiocy grows at my failure to read carefully). This means I will probably have to pay my full $3000 deductible plus 20% of whatever is left on the bill, hence the $3500 number. This is also in part because of my confusion over the annual deductible of $3000 and the maximum annual out-of-pocket expense of $3000. I missed a superscript there as well, this one signifying that the out of pocket expense is after the $3000 deductible is met making the real total out of pocket for the year $6000! And they call that insurance? That's over 20% of my yearly gross income and that's not counting the $150 a month premium I pay (if we do add that in it winds up being more than 25% of my yearly gross).

Good to see that highway robbery is alive and well.