Yes, it’s time for more wonderful stories of medical billing. We had none of them in August, and I’m sure that you missed them just as much as I did. So, gather round, children…

You remember that little issue of the medical appointment at UWMC that got coded “in network” (where Paul hasn’t hit the out-of-pocket limit) when it should’ve been “out of network,” the one about which I spoke with Marcie at Group Health weeks ago? Marcie left a voice mail for me last week, saying that the appointment had been “authorized”, by someone at Group Health I guess, and was therefore being considered in-network.

I called Marcie the next day, only to discover that she had gone on vacation for a week. So, I left her a message saying that: 1) Paul did not have any sort of authorized referral to UWMC from anyone at Group Health. 2) The bill from UWMC that was coded “in network” was the clinic portion of Paul’s first appointment with Dr. Futran. However, the bill from UW Physicians for that same appointment with Dr. Futran was coded “out of network.” All portions of the appointment should be one or the other. 3) Group Health had denied coverage of Paul’s treatment at UWMC at “in network” rates because the care was available at Virginia Mason. We knew that going in, and made that choice. All billing from anyone related to UWMC should be out of network.

Today Marcie called me back. She told me that she had been notified that the appointment had been authorized, and should be in network. Furthermore, she had already filed the preliminary appeal, based on my phone message to her last week, and it had come back denied… even though she mentioned that the physician portion of the appointment had been coded out of network. Marcie agreed with me that this made no sense. However, she was calling to tell me, my only option at this point is to file a written appeal with Group Health, in which I should include all the back-up documentation, etc. etc. etc.

DAMN, but this is annoying! I could just let it be, and pay the $21.25, but there’s that whole principle thing that I have trouble giving up on. I’ll write the letter over the weekend; it will go out next week. Marcie says that I’ll hear something from an appeals person within 10 days.

It’s nice to know that I’ll have something to write about in a couple of weeks.