[DAVES]

Originally Posted by Shadywood

So far, VHS has not impressed me. But neither have the specialists they've sent me to.

During my one yearly check up with my new VHS primary care doctor, I mentioned that it had been more than five years since I'd had a stress test. So instead of just scheduling the test, he sent me to a VHS cardiologist (to collect another fee, I guess). The cardiologist collected my copay and then informed me they don't do stress tests anymore, but instead use a CT scan to look for plaque in my heart. So he sent me to Lake Radiology, where I paid yet another specialist copay for a radiologist to agree that I needed a CT scan to screen for heart disease, based on the fact that I use statins to control my cholesterol.

My insurance, United AARP Medicare Advantage, states in all the plan documents that cardiac screening tests are covered 100% with no copay.

So, naturally, the radiologist used a "diagnostic" code rather than a "screening" code to file the insurance claim, while specifying in English that it was a cardiac screening test.

So naturally, United rejected the claim, since the $103 was less than the $150 copay for radiology diagnostics.

I opened a case with United, who contacted Lake to inform them that they had used the wrong code, who then performed an "investigation", which determined that they had used the correct United code for a cardiac screening. Apparently, Lake Radiology is the authority on United insurance codes, not United Healthcare.

So I personally called Lake, managed to get through to a "supervisor" (after arguing with a brick wall for half an hour), who informed me that they had no intention of refiling, despite the fact that both United and Lake agree that it was a screening test and not a diagnostic, and United had given them the correct code and told them they would happily pay the claim if they would just file it correctly. I pointed out that I would not be paying, United offered to pay, and their own stubbornness had wasted far more than $103 of their time on phone calls and "investigations", which seemed absurd when United had offered from the start to pay the bill.

But brick walls don't have minds to change, so I was forced to give up. I guess Lake will not be getting their $103.

Can't wait for January to get out of this goofy system.

My opinion. Just reading your posts. Perhaps, I am wrong. You seem to be screaming.
You probably have not spoken to the right people. The person you are talking to may not even have the power to correct things.

I recently had four different such issues going at the same time. Truth they sort of compounded on each other even though they were unrelated and with different organizations. In each case the solution was finding the right HUMAN. I just got the last of the four resolved. Each of the four, I got resolved in my favor. The last one took almost a year.

I've done customer service. These people deal with problems all day long. By the conversation, there are people you want to help and others that you put on the bottom of your growing pile.