Filing Grievances with Insurance

I went into my Anthem Blue Cross account online today to check on the claims related to my emergency appendectomy that I had on June 9 in New York. They have already screwed up once since they posted all the claims to my OLD insurance account that I had at my former employer. I also had Anthem and my new member # is almost the same except for the prefix sequence. When I was in NYC I told the hospital to use my new insurance. I even limped my way went down to the billing dept after I was discharged to MAKE SURE they had all the correct info. Still, it was charged to my old insurance. Great job! I called today and Anthem is going to post the charges to my new insurance acct that went into effect on June 1. So at least that issue will be taken care of.

Unfortunately there was another serious billing issue I discovered. I was reviewing the claims online because there is a separate claim for each doctor. For example, the anesthesiologist charges a separate fee. The radiologist charges a separate fee, etc, etc. There were 3 separate charges for the surgeon who performed my appendectomy. Anthem will not pay the entire claim because he was an "out of network" doctor. Although it has not been billed yet and it says "pending" on the online claim, my possible portion of the bill will be $1666!

How would I have known the doctor was out of network? Oh, I guess I forgot to ask while drugged up laying naked on the operating table, "Before you slice open my abdomen, is the surgeon in my network?" The hospital did what they needed to go to get my surgery completed and they had to call in a specialist. I understand that completely. This was not a planned operation and I HAD NO CHOICE IN THE MATTER. That's what an ER is all about - the unexpected. I didn't PLAN to have my appendix almost burst while in NYC. Now, this argument hopefully, will save me $1666 in charges.

The Anthem rep, who was amazingly helpful, told me that he hears these cases all the time. HE told me he would file a grievance for me. I will know in 30 days what the judgment will be. He says they have an entire dept at Anthem dedicated to researching grievances and negotiating with the various doctors who charge the exorbitant fees.

What I don't understand is why I may be responsible for charges that could have been prevented. It's not fair and I actually have insurance! What is wrong with this picture? Should I have refused the operation and risked my life? What about all the people who don't even have insurance? Here I am, possibly having to pay $1666 for an operation that, according to my insurance, should have only cost $250. That's right, according to my benefit coverage, if admitted to a hospital I only have to pay a $250 co-pay and all physician and surgical services are covered at 100%. That is for in-network though. Could the hospital used one of their own doctors to do this surgery? I have no idea. Again, I had no control over the situation and I wasn't making the decisions. The decisions were being made FOR ME. I was out of the loop and shouldn't pay the price. I was traveling on business and had no idea this was going to happen.

It seems like I should have a great case to escape the charges. I hope I do. Although I have no idea what the Grievance Dept at Anthem does exactly, the rep told me the rep told me they deal with these situations all the time with out of network doctors charging INSANELY high fees. Oh I almost forgot, one of his fees for "ER services" cost $1125. I only remember seeing him one time just before I went up to the operating room. All he said was "Hi. I'll be performing your appendectomy tonight." That was it. What exactly cost $1125? He never touched me in the ER. He was in street clothes and looked like he just got there. Also, the day after the surgery he came to see me for about 3 min and looked at the bandages. That cost was $595 and my portion is $350! Whatever. I really hope Obama can get universal health care passed so everything is regulated. This is out of control.

Loving every minute in NYC

I am havinc such a great time in New York. I was able to fly in on Saturday since I had to be here for a trade show on Tuesday morning. It was the same price if I left Monday morning, so I thought, "Why waste time when I could stay with Nathan in the West Village?" I'm glad my boss allowed this. And I am not even staying in the hotel room when the show starts on Tuesday ($319 a night at the Westin in Times Square). So I am saving the company money and everyone is happy.

Heck, I didn't even need a cab to the John Wayne Airport in Santa Ana since I parked at my work garage, which is 1 mile from the airport. I researched and took the shuttle that runs every 30 min from the front of the Marriott, right next to my office garage in Irvine. Door to door from my apt in Newport Beach to the airport it was 30 min. Then from Laguardia I took this express bus that was only $12 to get to Grand Central. From there I took the subway to the West Village.

It got me thinking, it's amazing how wasteful people can be in Corporate America. People opt to stay at big, fancy hotels when there are so many cheaper alternatives that would save corporations a lot of money and keep a higher profit margin. Granted, not everyone has friends who have empty guest rooms that are convenient to the subway, but you can totally stay at a million hotels in much hipper and interesting neighborhoods.

It reminds me of a time when I traveled to NYC for a tradeshow in 2001 when I was a marketing assistant at now defunct NewsEdge in Burlington, MA. I opted to stay in a hotel through some online hotel site right in Washington Square. It was only $152 a night compared to the $279 per night hotel near the site of the trade show in Times Square. I took the subway everywhere (cheaper than taxis). Bottom line: I wasn't wasting company resources. I have been at group dinners with sales executives and they would order $50 and $100 bottles of wine. They would order like 10 appetizers and the $35 steak. They would order like 4-5 alcoholic beverages each! They felt entitled to do this. I'm sitting there thinking, "Wow, we are about to have layoffs, the economy is shit and you're ordering a $35 steak and 5 drinks on company dime???"

Times are tough, but I know how to "make it work" while traveling on business. Imagine if most people took this approach. Imagine if most people weren't trying to take advantage. Companies would save millions of dollars. I could be a personal consultant and help companies strategize in their corporate travel. If a conscious effort was made a real impact could be made at organizations.

I really love NYC and totally would live here if it wasn't so cold in the winter. They should uproot NYC and place it where Los Angeles is and everyone would be happy. Today I went up to 125th Street in Harlem with my friend Jason to see at the Studio Museum. It was several videos by performance artist Kalup Linzy, who dresses in drag and performs several songs and skits. It was pretty funny. He has a lot of stuff on myspace and Youtube. Oh, and this was totally FREE. We then walked down through Central Park and saw some cool waterfalls before getting too tired (we walked 3 miles) and caught a subway back to the West Village around 77th Street.

I went with my friend Anh to Rice to Riches in SoHo and got their Rocky Road flavor. This is one of my favorite dessert places. What a unique concept. You have about 12 different flavors of rice pudding and they put it in a plastic container that is reuseable. I now have two. A small creation is $6 and worth every penny. There's a sign on the wall that says "No Skinny Bitches" so my friend Anh took a photo of me in front of it. I will post once I get that photo after she posts to Facebook.