Not Your Deductible, Not Your Co-Insurance. Just Your Co-Pay.
Hi Friendos,
Recently I had a minor ultrasound-guided procedure at a Manhattan location of Lenox Hill Radiology. I knew the procedure was fully covered by my insurance, because I checked on this in advance, but Lenox Hill’s admin errors led them to disagree.
I arrived 15 minutes before my appointment time to check-in. I wrote my name on a clipboard as directed by the busy-looking women at the check-in desk. 20 minutes later, she called me up to “complete my check-in process.” She passed me off to another person at the desk who said I had to make a payment of $200 something. I told her I had called my insurance company and they said everything was fully covered under my policy. “Well, do you have the name and reference number for that? Because without that I can’t do anything and you have to pay.” I said I had that information at home, but I didn’t have it with me. (This was true! I have a file on my computer where I take notes during each call with Cigna and I do write down the rep’s name and the reference number for the call.) She repeated that I had to pay. I said I did not owe anything and if they refused to see me it would be a violation of their contract with Cigna. She said she’d have to discuss it with her manager.
I sat and waited for the manager. The manager called me over to the desk and (angrily) said I had to pay for my appointment. I repeated that I had already called Cigna and they said this service was fully covered under my policy. She asked for a Cigna representative name and reference number. “I don’t have that with me but you’re free to call Cigna and discuss it with them directly.” Her: “Well now it is 16 minutes after your appointment time.” Me: “I arrived here 15 minutes before my appointment time and completed all the paperwork online. It is not my responsibility that your check-in process is running behind.” I could feel my heart beating faster and knew I sounded angry. The manager sounded angry too and I am sure this would cause many patients to pay up, rightly or wrongly. I said that under the terms of their contract with Cigna they were not allowed to refuse me service if I did not make an upfront payment. She continued to repeat that I had to make a payment but also kept repeating, “We are not refusing you service.” Aha! I had her by the balls and felt my heartbeat slow down to normal. She called Cigna, on speakerphone, and we could all hear the hold music.
A few minutes later, while the hold music continued, the radiology tech emerged from the treatment area and told the manager “we’re ready to do her procedure.” The manager said she had to wait to talk to Cigna. The tech asked how long that would take; the manager didn’t know. Everyone stood around and listened to the hold music for a few more minutes. The tech said, “The doctor is ready for the procedure.” The manager hung up the phone and said I should go with the tech for my appointment but they would be billing me.
Cigna processed my claim. I owe $0.
But…I am not here to take a victory lap. My heartbeat increased during that encounter because I experienced it as a fight and there was a response in my body to that stress. Not what I would plan for the moments before a medical procedure. So I won by avoiding a payment I did not owe, but the cost to me was not exactly free.
Reflections and lessons learned:
- It helps my financial self-defense when I know what I should expect to pay at the time of the appointment vs. after my insurance company processes the claim. I was prepared for my radiology appointment, but was not prepared at a recent dental appointment. At that 9am appointment they had me sitting in the waiting room for 35 minutes (who is already running late at 9am?) and I was stressed about getting to my next engagement on time. I had not expected to owe anything for that visit because I was incorrectly recalling my old dental insurance, which worked a little differently from my current policy. On my way out, the person at the front desk said I owed $183. He kept saying I “had to pay the co-pay,” which I knew was a round 2-digit amount, not $183. It was clear he was lying about something and bullying me (later I realized he was intentionally conflating amounts for my co-pay, remaining deductible, and co-insurance). I said I would pay my bill after insurance processed the claim. He said “We don’t send bills, you have to pay now.” Y’all, I should have walked right out that door. I don’t think he would have tackled me in the hallway and you KNOW they would have sent me a bill! But I was stressed about getting to my next appointment on time, so I just paid (I will not return to the dental practice of Kevin Lehman on 14th Street). Preparation matters.
- It is stressful to fight back at first, but this improves with practice. It’s not like someone at a doctor’s office has personally insulted me when they make a billing error and demand payment. It’s too bad that they are trained and professionally rewarded for bullying people into paying, but now I better understand that their contracts with my insurer usually only allow them to demand co-pays upfront, and I can make them wait for any remaining payments until after my insurance company has processed their claim. Providers don’t want to take the financial risk of an unpaid patient bill, but if they refuse service, they make no money at all!
I also recently had a physical. The front desk person said I had to provide a credit card for them to keep on file. “It is our policy. All patients have to have a credit card on file.” I said I did not leave cards on file because I worry about identity theft. She repeated it was their policy, and I repeated myself also. She’d have to talk to her manager. “Ok,” I said, and I did all the other paperwork they handed me. I wasn’t stressed or upset. I waited for a while, and then they called me back to be seen by the doctor. Their very firm policy totally evaporated as soon as I challenged it. That one felt like a victory.
-Stephanie
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