| rev:text
| - DISAPPOINTING!!
--Chronic low-back--
1. I asked before I scheduled an appointment if they were in network at BCBS - Yes
2. Initial appointment was OK although after a couple decades living with a worsening problem, nothing new.
3. Course of action was to go through *TWO* painful spine injection procedures because insurance required it before longer lasting RF procedure.
4. I found out AFTER both procedures were performed that the procedure center is NOT in network and they just moved on forward without informing me. (My last appointment I ran into a patient who was annoyed with the same thing)
None the less, the two test procedures went well and the 2nd one I got up off the table and had NO PAIN for the first time in over 20 years. Light at the end of the tunnel, right? Noooooooooo!!
I was all ready to get the "big" procedure, studied up on it, knew it was going to hurt like the dickens, was aware it was going to be more painful for at least 24 hours and was told most patients hurt more for 24 hours but it can be up to 2 weeks.
Then comes the bad news. Dr. Wu told me they do the right side one day and then I come back in 2 weeks and they do the left side. I asked why. He said he didn't know. I asked does it make any difference medically and he said "no". I said "does it take any longer?" and he said it is actually faster... but that I would have to talk to the office manager.
I sat with Valerie (This was before I even know this was all out of network) and she said they always do 2 procedures because they don't get paid for the other side otherwise. I said that sounds like a coding problem. She said she would investigate. I did the same.
What I found out from BCBS is a vertibra is considered an area so if the first part of an area they treat is full reimbursement and the 2nd part of an area they treat is partial. AHA! Two treatments because they get paid less!
I received a call back from someone Valerie had investigate (Heather?? Cant' remember her name) and she said they did it because it was "medicare standard". I told her I wasn't on medicare and don't know why they would do that. I also explained to her what I learned from BCBS about reimbursements and that it seemed to me that I have an MD saying there's no medical reason to have 2 treatments and for me it means trying to get transportation 2 days. 2 days off work plus two recovery times, etc. She wouldn't budge. When I asked her who made this decision it was "Chief Medical Officer". I asked who that was "Dr. Burkhead" I asked to speak with him or make and appointment to discuss this issue with him and "he won't talk to you" was the response.
I then asked to schedule an appointment to see Dr. Wu again to discuss alternatives since there was no way I could do two painful procedures and I objected to the time, money and extra pain for their pocketbooks.
I met with Dr. Wu a couple of days ago. I actually like the guy and he did a great job with the two procedures and even after this mess, I would trust him to do the right thing medically. Unfortunately, he had been coached. I got the "medicare" excuse and "this is how we do it" speech. He could not come up with one medical reason why I had to have two procedures and was definitely annoyed when I pointed out that he took an oath. he left the room fairly abruptly and I showed myself next door to try and take care of the medical bill.
I ended up talking to the nicest guy in the place. I was actually there to talk to him about the how "out of network" and to hand over a check I had received from BCBS that they wanted and I started grumbling about the procedure being split in two. He was confused. I explained they wanted to do right side then left side and he said "we never do it that way. We always do both sides at the same time" He seemed genuinely perplexed and asked me a few questions. One was "how many?" and I said 5 vertebra and he said "Ow, that's a lot and you could be in a lot of pain" and I said I understood, but I would rather be in lot of pain once than a little less twice... I know me... if it hurt I wouldn't be back so want to get it out of the way.
Seriously nicest guy ever and you could tell his true, genuine concern. Turns out he was head of nursing. I don't know if he is going to be able to huddle with the docs and talk some sense into them but what I do know is they have no business sense! Two procedures when they should be done in one is over-billing. I'll be kind and not use a stronger word. Medically, two procedures is 2 sedations, double the chance of infection, etc so not a good idea.
Bottom line... I've spent a bundle. My company is self insured and I'm part owner so it is *ALL* out of pocket in the end. I'm still in pain and was hoping they would see the light but am losing hope each day I have to live in this never ending pain.
REALLY? IT DOESN'T TAKE MUCH TO DO THE RIGHT THING DOC!
Want a better review? EARN IT.
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