BLAST FROM THE PAST: My eye is doing well; I sure hope they ...

From The News & Reporter, Sept. 2, 2009.  

You'd think, with the eyes of the world on not only the politicians involved but also the healthcare industry, because of this big emotional debate going on, an insurance company would be more careful.

Now understand, my insurance company is saying it's just a glitch. It will get fixed, they say. It's getting run through the process again, they say.

But there shouldn't be a glitch. It shouldn't have to be fixed. It was supposedly processed almost six months ago.

    I got a notice from my insurance company last week. It said a $2,800 charge from my eye doctor was denied. Said the policy only covered what was listed and to check the books on what was and wasn't listed. None of the books I've read with my insurance policy go into which specific procedures are or aren't listed. Just what will be paid at what percentage.

    I thought the eye doctor's had handled the pre-approval. They submitted everything, and when it was done, they told me how much I'd have to pay. Before the surgery.

    So it strikes me as a bit odd that I got a denial form, six months later, saying the “patient responsibility” for a $2,800 charge is $2,800.

    Having seen an earlier form indicating a bill for about $2,600 was paid, I thought perhaps a copy of some piece of paper went through the loop after falling off a paper clip. But when I called the eye doctor's business office on Monday, they said the $2,600 was for the surgery itself. There was an anesthesia charge from another office, not as much. There was a facilities charge from the out-patient eye clinic where they did the work.

    Then there was this final charge.

    This charge, basically, relates to the costs of getting me a cornea to transplant.

    Imagine needing a heart transplant, and the insurance will pay for hospital, surgeon and anesthesia, but you were told, “The cost of the heart's all on you.”

    I was a bit incredulous.

    My wife and I went into this knowing we could only do it if it was covered. When we were told what the costs would generally be, after the pre-approval, we thought we could handle it. 

    Of course, we didn't realize how long the recovery would take. I was out of work for a full month, and used up all my sick leave and vacation. My company has a nice thing where you get back a little of what you lost under its family medical leave act policy. But I had to use up all of my leave time first, and be out a little bit longer, before I qualified. It gave me a percentage of my regular, missed pay.

    At the same time, we had a week's furlough to contend with for me, which is lost wages. We have had since May a pay cut she got in her job. We will soon be contending with a week's furlough for my wife, as well.

    We're thankful to still have our jobs, given both the economy and the troubled industry we are both in. But we are also hurting. It's harder to make ends meet.

    So a $2,800 bill for the actual tissue that was placed on my eye had me a trifle concerned.

    Perhaps the guy on the other end of the line could detect a slight, hmm, something in my voice.

    “We can't pay it,” I told the insurance company guy. “Is someone going to repossess my eye?”

    He laughed, but it was a nervous laugh.

    He checked this and looked at that. I told him the billing person at the eye doctor's office said this procedure is covered under Medicare, and an insurance company almost always covers what Medicare covers. So I shouldn't worry, she said. She said they had just gotten the denial, and would put in an appeal.

    The guy accepted the info about Medicare, and did some more “this and that,” and said he would put it through again for payment.

    Just a glitch, he assured me.

    He did not assure me that the insurance would be paying the entire amount, however. Maybe it would. Maybe it would pay 80 percent, and I'd have to pay 20 percent. I can handle that, somehow.

    But since he did not guarantee it would actually be paid, maybe the insurance would still pay nothing.

    So I'm left wondering.

    By the way, I'm going to the eye doctor in a week or so. And the last time I went, I got 20/25 vision wearing my glasses.  So the eye is doing remarkably well.

    I sure hope they let me keep it.