The whole system is rife with widespread, unreportable fraud. I’m on hour 8 of trying to get a 46 dollar charge for my annual preventative bloodwork reversed since its literally the only benefit of my plan that should be covered, but because the mysterious incantation of CPT and diagnostic codes are wrong, my previous provider is still sending me a bill once a month.
This is what worked for me. (In my case the insurance company and provider were the same - Kaiser - so YMMV.)
Write a letter to your insurance company to dispute the explanation of benefits. Follow the instructions for the dispute process. Cite and attach relevant information, like what annual preventative labwork is mandated to be covered by insurance for people your age due to the affordable care act (I believe this is on healthcare.gov). Note that the labwork was preventative and NOT diagnostic. Then wait for them to process it.
Providers submit my explanation of benefits wrong (in their favor) almost every time I go into a clinic or hospital or lab. And it boils my blood to know they get away with it because 90% of the people just pay it.
Edit: if it's the provider's mistake, then you got to start with the provider.
Yeah there needs to be a better solution to this. Either some sort of expedient arbitration by a 3rd party, or ability to get reimbursed for your time.
What always amazes me is that they can get away with constant mistakes, overcharging and unjustified denials without any real consequences. The worst that can happen is that they have to correct the mistake and do what they should have done anyways. And this only after the patient has spent enormous amounts of time, energy and money. I don’t think any other business would get away with this.
$46/8 hours = $5.75/hour. Would you take a job that paid that wage? Perhaps it's better to concede that they've ripped you off, write a check and move on. Not a hill worth dying on.
But it does not change the fact that you have already wasted a day of your life on this quixotic effort. Along with the months of agitation and aggravation and irritation and anger as this issue percolates 24/7 in the background.
That’s the infuriating thing about it. I suspect the fear of these unexpected parasitic charges in US healthcare is a contributing reason to men’s life expectancy only being 73.5 years.
"Document and report": There's another half hour of your life done and dusted with your time and effort disappearing into a never to be responded to black hole.
