Question
QUESTION: Last month I had a medical procedure done (colonoscopy).
My deductible with Blue Shield was fully paid up for the year.
Just before the procedure, I asked at the front desk whether
I would have any further expense beyond the $100 co-pay.
They told me it would be fully covered by my insurance. All I would have to do is forward the Blue Shield payment back to the medical center when I receive it. I said OK. I received a billing statement from the medical center for $4150 and on it was a yellow sticker requesting that when I receive payment from Blue Shield I should endorse it and forward it onto the medical center. But when I got the check from Blue Shield, it was in the amount of $2900. It seems that I have to pay the difference, yes? I am not sure what to do. I was led to believe the procedure was covered fully. Is it wiser for me to pay the difference ($1250) and then take it up in small claims court, or not pay the balance and let the medical center go after me for the it?
ANSWER: My suspicion is that this happened because of the way that it was coded. Were you there for a screening colonoscopy without any history of problems or did you have symptoms or previous issues.
---------- FOLLOW-UP ----------
QUESTION: The mediacl problem has been going on for about 3 months. No prior issues.
Answer
I'll bet that they coded it as a screening colonoscopy. Call them and ask them to send you a copy of the claim that they submitted. You are entitled to it. Then write me back once you get it. Also when you write, please mark it private so we don't bother others with this.
